Acne is a common skin disease with a high prevalence in adolescents and young adults; 85 percent of individuals age 11–30 are affected by acne while adult acne starts in the 30 or 40s.
Acne is a chronic inflammatory disease of the skin with a number of different causes.
It happens in association with increased sebum flow and hyperkeratinization (in which dead follicular cells don’t slough off like normal). It is followed by the formation of bumps and increasing bacteria.
Microcomedone is essentially the precursor to acne.
It can evolve to clinically inflamed lesions.
The severity of acne differs from patient to patient and treatment must be tailored to prevent physical and psychological scaring.
The first line of mild acne treatment is benzyl peroxide with or without topical antibiotic. Benzyl peroxide is a bleaching agent and can be irritant.
Topical retinoid is the next step; it should be applied on dry skin at night and be washed in the morning. It can be an irritant, especially on dark skin, and can cause dryness and peeling — a non-oily moisturizer (preferably with sunscreen) can help.
An oral antibiotic can be added if the topical treatment is not enough. Salicylic acid, azelaic acid, chemical peels and lasers are other options. For severe acne, or mild acne reluctant to treatment, oral isotretinoin is recommended.
The duration of therapy is related to natural history of patient’s acne — typically there is little improvement in the first four weeks of therapy; 50 percent improvement in two to three months is a good response. Patients need to be regularly reviewed for treatment modification if necessary.