Acne

Acne vulgaris is a common skin condition that typically starts during puberty and is experienced by most teenagers, for some it lasts into the third decade of life (Lavers, 2014). Acne may be mild to severe, and can have a severe impact on a person’s mental, physical and social functioning at a critical time in life. It demands a holistic, biopsychosocial approach to care.

Acne is a disorder of the pilosebaceous units, caused mainly by increased sebum secretion and plugging of follicles (Figure 1). The bacterium Propionibacterium acnes exacerbates the problem but is not the principal cause. The initial trigger for acne is the androgen hormone. There is a genetic predisposition, and often a family history of the problem.

Drugs such as corticosteroids, hormones, anticonvulsants and epidermal growth factor receptor inhibitors can trigger flares (Oakley, 2014). Occlusive cosmetics and polycystic ovary syndrome are also associated with acne.

Acne appears mainly in areas of the body where there are more sebaceous glands, such as the face, back and chest.

NICE (2021) classifies acne by severity:

• Mild: predominantly non-inflamed lesions (open and closed comedones) with few inflammatory lesions (Figure 2)
• Moderate: more widespread with an increased number of inflammatory papules and pustules (Figure 3)
• Severe: widespread inflammatory papules, pustules and nodules or cysts (Figure 4). Scarring may be present.

Patients can have a mixture of inflammatory and non-inflammatory lesions at different stages of formation. Lesions last for days, weeks or months (Table 1). Once the acne has cleared, scarring may have as much of an impact on the patient as the acne.

Comedones must be present for a diagnosis of acne (NICE, 2021). Patient assessment should include a medical history and a consideration of past acne. Examine the face, chest and back, and record the number and type of acne lesions, skin changes and any scarring (Van Onselen, 2017).