Acne vulgaris is the most common skin disease in the United States. This condition has a multifactorial pathogenesis, of which the key factor is genetics. Diagnosis Examination in patients with acne vulgaris includes the following features: Comedonal acne: Presence of open and closed comedones but usually no inflammatory papules or nodules Mild acne: Presence of comedones and a few papulopustules Moderate acne: Presence of comedones, inflammatory papules, and pustules; a greater number of lesions are present than in milder inflammatory acne Nodulocystic acne: Presence of comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter; scarring is often evident Laboratory tests Acne vulgaris is a clinical diagnosis. However, laboratory testing may be indicated in the following situations: Female patients with dysmenorrhea or hirsutism: Consider a hormonal evaluation with levels of total and/or free testosterone, dehydroepiandrosterone sulfate, luteinizing hormone, and follicle-stimulating hormone Cases refractory to treatment or when improvement is not maintained: Culture skin lesions to rule out gram-negative folliculitis See Workup for more detail. Management Treatment of acne vulgaris should be directed toward the known pathogenic factors, including follicular hyperproliferation, excess sebum, P acnes, and inflammation. The most appropriate treatment is based on the grade and severity of the acne. Pharmacotherapy The following medications are used in the treatment of Propionibacterium acne vulgaris: Retinoid-like agents (eg, topical tretinoin, adapalene, tazarotene, isotretinoin) Antibiotics (eg, tetracycline, minocycline, doxycycline, trimethoprim/sulfamethoxazole, clindamycin, topical clindamycin, topical erythromycin, daptomycin) Selective aldosterone antagonists (eg, spironolactone) Estrogen/progestin combination oral contraceptive pills (eg, ethinyl estradiol, drospirenone, and levomefolate; ethinyl estradiol and norethindrone; ethinyl estradiol and norgestimate; ethinyl estradiol and drospirenone) Acne products (eg, erythromycin and benzoyl peroxide, clindamycin and tretinoin, clindamycin and benzoyl peroxide, azelaic acid, benzoyl peroxide) When a topical or systemic antibiotic is used, it should be used in conjunction with benzoyl peroxide to reduce the emergence of resistance. Nonpharmacotherapy Diet therapy, such as a low-glycemic diet and avoidance of “junk foods,” has been suggested as a nonpharmacologic measure to manage acne vulgaris. Procedures Procedural treatments for acne vulgaris include the following: Manual extraction of comedones Intralesional steroid injections Superficial peels that use glycolic or salicylic acid source:http://emedicine.medscape.com/article/1069804-overview
