Acne vulgaris in Adult
Acne, or acne vulgaris (typical teenage acne), 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. Women are more likely than men to have acne in adulthood, which in many cases is thought to be hormonally driven. 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
L70.0 – Acne vulgaris
11381005 – Acne vulgaris
- Perioral dermatitis
- Pomade acne
- Cosmetic-induced acne
- Steroid acne
- Acne conglobata
- Lupus miliaris disseminatus faciei
- Pityrosporum folliculitis
- Eosinophilic pustular folliculitis
- Demodex folliculitis
- Flat warts
- Molluscum contagiosum
- Sebaceous hyperplasia
- Disseminated histoplasmosis, disseminated cryptococcosis, disseminated coccidioidomycosis, iododerma, and bromoderma may all present as an acneiform eruption.