Acne vulgaris in Child
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Synopsis
Acne vulgaris is an extremely common, usually self-limited chronic inflammatory condition of the pilosebaceous unit. The pathogenesis involves multiple factors, including (1) increased sebum production, (2) follicular hyperkeratinization, (3) proliferation of the bacterium Cutibacterium acnes (formerly known as Propionibacterium acnes), and (4) inflammation. It typically begins at puberty as a result of androgen stimulation of the pilosebaceous unit and changes in the keratinization at the follicular orifice.
There is a wide spectrum of clinical disease, ranging from a few comedones to many inflamed papules, pustules, and nodules. Acne vulgaris is most commonly found on areas of skin with the greatest density of sebaceous follicles, such as the face, back, and upper chest. There is no racial predilection. Acne can last through the teenage years into adulthood. While a benign condition, acne can lead to permanent scarring and significant psychosocial distress. Therefore, initiation of treatment in the earliest stages is preferable.
A number of medications have been reported to cause acne vulgaris or an acneiform eruption. Most commonly, this is seen in patients who have received systemic corticosteroids or are using topical corticosteroids, or individuals using anabolic steroids (see steroid acne). Acneiform eruptions also have been reported in patients treated with cetuximab, gefitinib and erlotinib (see papulopustular eruption), danazol, stanozolol, testosterone, lithium, iodides, bromides, isoniazid, phenytoin, cyclosporine, granulocyte-colony stimulating factor (G-CSF), medroxyprogesterone, low-estrogen oral contraceptives, progesterone-only birth control, phenobarbital, and vitamins B2, B6, and B12. While the onset of the eruption varies among the different agents, it typically occurs within 1-2 weeks of initiating systemic corticosteroid therapy.
Related topics: Acne fulminans, Acne conglobata
Codes
ICD10CM:L70.0 – Acne vulgaris
SNOMEDCT:
11381005 – Acne vulgaris
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Perioral dermatitis
- Pomade acne
- Cosmetic-induced acne
- Steroid acne
- Acne conglobata
- Milia
- Folliculitis
- Pityrosporum folliculitis
- Eosinophilic pustular folliculitis
- Demodex folliculitis
- Flat warts
- Molluscum contagiosum
- Syringomas
- Disseminated histoplasmosis, disseminated cryptococcosis, disseminated coccidioidomycosis, iododerma, and bromoderma may all present as an acneiform eruption.
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed: 04/17/2019
Last Updated: 04/22/2019
Last Updated: 04/22/2019
Acne vulgaris in Child
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