Acne vulgaris, the common type of acne, occurs during puberty and affects the comedogenic areas of the face, back, and chest. There may be a familial tendency to acne. Acne vulgaris is slightly more common in boys, 30-40% of whom have acne between the ages of 18 and 19. In girls the peak incidence is between 16 and 18 years. Adult acne is a variant affecting 1% of men and 5% of women aged 40. Acne keloidalis is a type of scarring acne seen on the neck in men.
Patients with acne often complain of excessive greasiness of the skin, with “blackheads”, “pimples”, or “plukes” developing. These may be associated with inflammatory papules and pustules developing into larger cysts and nodules. Resolving lesions leave inflammatory macules and scarring. Scars may be atrophic, sometimes with “ice pick” lesions or keloid formation. Keloids consist of hypertrophic scar tissue and occur predominantly on the neck, upper back, and shoulders and over the sternum.
The changes of acne are often minimal but the patient, often a young girl, picks at the skin producing disfiguring erosions. It is often very difficult to help the patient break this habit. Infantile acne Localised acne lesions occur on the face in the first few months of life. They clear spontaneously but may last for some years. There is said to be an associated increased tendency to severe adolescent acne.
This is a severe form of acne, more common in boys and in tropical climates. It is extensive, affecting the trunk, face, and limbs. In “acne fulminans” there is associated systemic illness with malaise, fever, and joint pains. It appears to be associated with a hypersensitivity to P. acnes. Another variant is pyoderma faciale, which produces erythematous and necrotic lesions and occurs mainly in adult women. Gram negative folliculitis occurs with a proliferation of organisms such as klebsiella, proteus, pseudomonas, and Escherichia coli.
Acne-like lesions occur as a result of long term contact with oils or tar as mentioned above. This usually results from lubricating, cutting, or crude oil soaking through clothing. In chloracne there are prominent comedones on the face and neck. It is caused by exposure to polychlortriphenyl and related compounds and also to weedkiller and dicophane.
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