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Dermatology
Acne Vulgaris
Built from Dermatology, 5th Edition
What’s inside
9 sections · 153 slides
Overview
What acne is, how common it is, and who is at risk
- What this deck covers
- Key features
- Clinical spectrum of acne
- A short history of the name
- 40-50M
- Acne beyond the teenage years
- Who is at higher risk
- Genetic factors
- Dietary factors
Pathogenesis
Four processes combine to build every acne lesion
- Four processes that build an acne lesion
- Four contributing factors in acne pathogenesis
- Follicular hyperkeratinization
- Stages of comedo and inflammatory lesion formation
- Hormones and sebum production
- Androgen metabolism pathway in the sebaceous gland
- Androgens in infancy
- Adrenarche and the rise of acne
- Estrogen and progesterone effects
- Inflammation can start early
- Type of inflammation shapes the lesion
- Cutibacterium acnes: a normal resident
- Not all C. acnes strains are equal
- How C. acnes triggers the immune system
- How acne inflammation escalates
- Two innate immune cell types from C. acnes
Clinical Features
From comedones to nodules, and the marks acne leaves behind
- Where acne appears and how it is grouped
- Closed comedones (whiteheads)
- Open comedones (blackheads)
- Comedonal acne on the cheek and forehead
- Open comedones in scarring cystic acne
- Comedonal acne of the forehead
- Inflammatory acne: papules and pustules
- Papulopustular and papulonodular acne on the cheek
- Papulopustular acne with erythema and microcysts
- Moderate to severe acne with scarring
- Coalescing papules, pustules, and nodules
- Nodules, cysts, and coalescing plaques
- Severe to very severe nodular acne and acne conglobata
- Severe nodular acne of the forehead and temple
- Nodulocystic acne of the chest
- What acne leaves behind
- Postinflammatory hyperpigmentation after acne
- Postinflammatory hyperpigmentation in darker skin
- Atrophic and hypertrophic acne scarring
- Dome-shaped scars on the nose
- Acne variants
- Post-adolescent acne in women
- Acne fulminans
- Acne fulminans
- Treating acne fulminans
- Acne conglobata and the follicular occlusion tetrad
- PSTPIP1-related autoinflammatory syndromes
- The PSTPIP1/autoinflammatory acne spectrum
- Solid facial edema (Morbihan disease)
- Solid facial edema (Morbihan disease)
- Neonatal cephalic pustulosis ("neonatal acne")
- Infantile acne
- Infantile acne
- Infantile acne severity spectrum
- Treating infantile acne
- Mid-childhood and preadolescent acne
- Acne excoriee
- When to suspect hyperandrogenism
- Working up suspected hyperandrogenism
- Tracing the source of excess androgen
- Adrenal causes of hyperandrogenism
- Ovarian causes of hyperandrogenism
- Acne linked to genetic syndromes
Acneiform Eruptions
Look-alikes triggered by drugs, occupation, heat, or friction
- What makes an eruption "acneiform"
- Drug-induced acne: general pattern
- Corticosteroid-induced acneiform eruption
- Steroid-induced acne and rosacea
- Drug-induced acne from isoniazid
- Common vs uncommon drug causes
- Causes of drug-induced acne
- Causes of drug-induced acne (continued)
- EGFR and kinase inhibitor eruptions
- EGFR inhibitor-induced acneiform eruption
- Occupational, cosmetic, and pomade acne
- Chloracne
- Acne mechanica
- Tropical and radiation acne
- "Pseudoacne" of the nasal crease
- Idiopathic facial aseptic granuloma
- Childhood flexural comedones
Pathology
What acne lesions look like under the microscope
- Histology mirrors the clinical stages
- Histology of an inflamed comedo
- From rupture to scar
Differential Diagnosis
Conditions that can be mistaken for acne vulgaris
- Conditions that mimic acne
- Mimics of acne vulgaris
- Trichostasis spinulosa mimicking comedonal acne
- Folliculitis vs acne vulgaris
- Other clinical mimics worth knowing
- The acne differential, tabulated
- Differential diagnosis of acne
- Differential diagnosis of acne (continued)
- Differential diagnosis of acne (continued)
Treatment
Topical, systemic, hormonal, and procedural options
- Building the treatment plan
- What the exam should record
- History and physical examination of the acne patient
- Acne severity spectrum
- Acne severity and matching treatment approach
- Why adherence fails - and how to fix it
- Tips for topical acne therapy
- Tips for topical acne therapy (continued)
- Tips for topical acne therapy (continued)
- General treatment principles
- Topical retinoids: how they work
- Using topical retinoids
- The main topical retinoids
- Benzoyl peroxide
- Topical antibiotics
- Azelaic acid and sodium sulfacetamide
- Topical dapsone and clascoterone
- Other topical options
- Systemic antibiotics: the tetracyclines
- Choosing between tetracyclines
- Other systemic antibiotic options
- Hormonal therapy: combined oral contraceptives
- Oral contraceptive risks to know
- Roles of commonly used contraceptives for acne
- Roles of commonly used contraceptives for acne (continued)
- Roles of commonly used contraceptives for acne (continued)
- Antiandrogens: cyproterone acetate
- Antiandrogens: spironolactone
- Isotretinoin: the most effective option
- Isotretinoin dosing strategy
- Isotretinoin side effects
- Cutaneous complications of isotretinoin therapy
- The isotretinoin safety program
- Surgical and procedural treatment
- Treating acne scars
Summary
Putting the pieces of acne management together
- Key takeaways
- Red flags that change the workup
References
Sources referenced throughout this deck
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- Dermatology, 5th Edition (2-Volume Set)