Mar 21, 2023
Acne Vulgaris is the most common type of acne. It is an inflammatory disorder and it is usually self limiting. In this blog you will learn about the different variants of this disorder and how it is managed.
Learning about this topic is going to be extremely helpful for your Dermatology preparation.
Due to all these factors, there is hyperproliferation of keratinocytes in the duct of sebaceous glands. Sebocytes, which are on the inner side of sebaceous gland, secretes sebum, while keratinocytes only line the duct. Due to hyperproliferation, more and more keratinocytes are proliferating, causing blockage in the duct of sebaceous gland. Sebocyte is secreting sebum, but due to blockage more and more sebum is accumulating that causes an increase in sebum collection also known as seborrhea. Sebum is a very good culture media for bacteria. So when there is excess sebum, there is increased proliferation of bacteria called Propionibacterium acne. Once there is proliferation of bacteria, it releases lipase enzyme. The lipase converts triglycerides in the sebum into free fatty acid. Free fatty acid will cause inflammation. Many times the inflammation becomes red, inflamed.
Clinically various types of acne are seen called polymorphic. Poly means multiple and morphic means morphologic. So multiple types of morphological lesions can be seen. These lesions can be comedones (most characteristic) or there can be other lesions in the form of papules, pustules, nodules/cyst.
Comedones are the most characteristic lesions of the acne and they are of 2 types : Open/ black comedones and Closed/ white comedones. If there is disruption of the epithelial lining, the keratin gets exposed and due to exposed keratin, it gets oxidized and appears black. Sometimes there is intact epithelial lining on keratin, due to which they appear white
Grade 1- if the lesions are mainly comedones
Grade II- if the lesions are mainly papules
Grade III- if the lesions are mainly pustules
Grade IV- if the lesions are mainly nodules, cyst called nodulocystic acne. It is the severe type of acne
Grade I Acne Vulgaris.Since the majority of the lesions are comedones
Grade II- Papules,pustules with solid raised lesions
Grade IV- Severe acne, large lesion with cystic swelling, nodules and abscess, along with other various lesions
Varies, depending on the different grades.
Grade I- topical treatment like Retinoids (adapalene, Tretinoin
Grade II- along with topical retinoids add topical antibiotics (clindamycin) with or without benzoyl peroxide
Grade III- along with topical retinoid topical antibiotic +with or without benzoyl peroxide, add oral antibiotic like doxycycline, minocycline or azithromycin
Grade IV- drug of choice is oral retinoids (Isotretnoin)
Systemic retinoids are teratogenic. Should not be used in pregnancy. There are 2 types :
Systemic retinoids once they are consumed, they start accumulating in the fat and after stopping, they keep on releasing slowly .The drug can still be teratogenic for a period of time even after stopping. For Isotretinoin- patients should not conceive during the therapy as well as I month after stopping the therapy. The wash out period for isotretinoin is 1 month. For Acitretin- it requires 3 years to completely wash out.
Patient is taking isotretinoin, for how much duration patient should not conceive after taking the therapy?
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