Acne is the most common skin disease. Acne word is used for various skin eruptions that have different causes. It is usually used for the synonym for acne vulgaris. Acne occurs when hair follicles are clogged with dead skin cells and oil from the skin or we can say it is an inflammatory disease of the sebaceous follicle of skin. It is characterized by comedones, papules, pustules and oily skin. Acne usually affects the area of skin with the high number of oil glands such as the face, upper part of the chest, back and shoulders. Acne is less common in adulthood.

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Etiology

There are many factors which trigger acne but main causes are hereditary tendencies and imbalance of androgen and estrogen hormones. Acne begins at puberty in both male and female. Increased secretion of androgen causes skin follicle glands to grow larger and makes skin more oily. Many types of hormones have been linked to acne such as some women have a breakout that occurs or worsens at certain points in the menstrual cycle or during pregnancy.

Some of the medicinal drugs like corticosteroid, lithium, isoniazid, iodides, bromides, hydantoin can cause acne.

Other factors which trigger the acne are diet, stress, some environmental factors.

Classification

On the basis of severity, acne vulgaris can be classified as mild, moderate and severe. This classification helps to determine an appropriate treatment regimen.

Clogged skin follicles with occasional inflammatory lesions are seen in mild acne. In moderate acne, some higher number of inflammatory papules are seen. When there is higher number of nodules and cysts are seen then we can say it is severe acne.

Symptoms

Signs and symptoms depend on the severity of acne. Typical signs are increased secretion of sebum by the skin, comedones, papules, pustules, nodules.

Whiteheads and blackheads are the most common lesion seen in acne.

Scars - 95% of people with acne vulgaris are affected by scars after inflammation within dermal layer. Severe acne can produce a large number of pimples that cover the large area of skin. Cystic lesions are pimples that are large and deep. These are often painful and leave scars on skin.

Pigmentation - Post-inflammatory hyperpigmentation is the result of nodular acne lesion.
Some other side effects of acne on the personality of the people suffering from acne are:

• Low self-esteem
• Depression
• Anxiety

Treatment

Many different treatments are available for acne. Treatment depends on mild to severe form of acne. Common treatment includes the local application of antibiotics, benzoyl peroxide, retinoids creams and systemic therapies.

• Antibiotics - Some topically applied skin creams like clindamycin, erythromycin are antibiotic creams which are helpful in controlling inflammatory conditions. Some systemic antibiotics are useful in acne. These are tetracycline, doxycycline, minocycline, and erythromycin.
• Benzoyl Peroxide - It is used in mild to moderate acne. Some of the benzoyl peroxide containing creams come with the antibiotics which are very useful for the severe type of acne. In acne, it kills the surface bacterias but the common side effect is dryness of the skin.
• Retinoids - These are vitamers of vitamin A. First generation retinoids include retinol, retinal, tretinoin, isotretinoin, and alitretinoin which are commonly used in acne treatment.
• Systemic therapies - These include oral intake of antibiotics, hormonal treatment and oral intake of isotretinoin.
• Other topical creams and gel - Azelaic acid comes in cream or gel base. It has antibacterial and anti-inflammatory properties. Dapsone is other topical gel which has same property.

There are some procedures available which have to be done under observation of dermatologist for example, chemical peel, microdermabrasion, light therapies like laser treatment and steroid injections etc.

Skin care

• Wash your face twice a day with lukewarm water,
• Use gentle face wash and gentle skin products
• Daily scrubbing can worsen your skin acne
• If you have oily hair then shampoo regularly

Acne though is usually used as a synonym for Acne Vulgaris but may also refer to following conditions:

1) Common acne - Acne vulgaris is the medical name for common acne. Most commonly experienced around puberty typically occurs on the face, shoulder, and chest.

2) Acne aestivalis - It is also known as Mallorca acne. These are very common during the summer. It is mainly characterized by the rash that affects face lateral aspect of upper limb, shoulder girdle back and chest. They occur after sun exposure. It forms small papular lesions and pustules some of them reddish and sore due to inflammation.

3) Acne albida - Acne caused by milia. A small whitish or yellowish papules, the size of a pinhead or smaller, due to retention of sebum beneath the epidermis. Typically appears on the nose and cheeks. Most common in newborn.

4) Acne artificialis - This type of acne are produced by external irritants such as tar or orally administered drugs, exposure to various chemicals, cosmetics or some environmental factors.

5) Acne agminata - It is the rare form of skin disorder which commonly occurs in young adults. It is characterized by red-brown lumps and bumps on face, partially around eyelids, forehead, cheeks, and sometimes in armpits.

6) Acne atrophica - It is a skin disorder characterized by small scars or pits left by an earlier occurrence of acne vulgaris. Also, we can say acne with residual pitting and scarring.

7) Excoriation acne - It is also known as picker’s acne. It is a mild acne accompanied by extensive excoriations, usually involving only the epidermis.

8) Acne cachectorium - Acne occurring in persons who have a debilitating constitutional disease, characterized by large, soft, purulent, ulcerative, cystic, and scarred lesions.

9) Acne ciliaris - Follicular papules and pustules on the free edges of the eyelid.

10) Acne conglobata - It is highly inflammatory, nodulocystic acne. It presents with comedones, nodules, abscesses, and sinuses. It presents with blackhead and appears on face, neck, chest, upper arm and buttocks.

11) Acne cosmetica - These type of acne are because of repeated application of comedogenic agents in cosmetics. Mainly low-grade non inflammatory acne lesions occur on the face.

12) Cystic acne - It is the severe form of acne vulgaris. It can occur anywhere on face and body. Cystic acne form when oil and skin cells build up deep within hair follicles. The resulting rupture of the skin may form boil-like infection.

13) Acne decalvans - Mainly occurs in the males. It is rare neutrophilic of inflammation of the scalp. A papular or pustular inflammation of the hair follicles of the scalp seen. This resulting in scarring and loss of hair in the affected area of the scalp. It is also known as alopecia follicularis.

14) Acne erythematosa - Also known as acne rosacea. It is chronic dermatitis of the face. It mainly affects nose, forehead, and cheeks and characterized by rosy red coloration and acne-like pimples caused by dilation of capillaries.

15) Acne fulminans - Also known as acute febrile ulcerative acne. It is a rare condition and occurs after unsuccessful treatment of acne conglobata. This is an immunologically induced disease. In it testosterone level elevated and cause the rise in sebum and population of Propionibacterium acnes bacteria. These bacteria may trigger the immunological reaction in some individuals and lead to the occurrence of acne fulminans.

16) Acne generalis - Acne lesions involving the face, chest, and back.

17) Halogen acne - These type of acne are caused by exposure to halogen just like iodides, bromides, and fluorides, that induce an acneiform eruption similar to that observed with steroids. Bromide acne is a type of halogen acne, occurs due to bromide ingestion or hypersensitivity. In this type follicular eruption occurs on the face, trunk, around the hairline, on neck and extremities.

18) Acne indurata - It is the progression of papular acne with deep-seated and destructive lesions that may produce severe scarring.

19) Acne inversa - it is also known as Hidradenitis suppurativa. It is severe chronic recurrent pus production infection of the apocrine sweat glands.

20) Acne keloidalis nuchae - In this condition follicular-based papules and pustules form hypertrophic or keloid like the scar. It also is known as “dermatitis papillaris capillitii”.

21) Acne keratosa - It is characterized by indurated keratin plugs located especially at the corner of the mouth.

22) Acne neonatorum - Also known as acne infantum. The cause is unknown but it could be due to the increased sensitivity of infant’s sebaceous glands to maternal hormones during pregnancy. This condition present at 3 to 6 month of age.

23) Acne papulosa - It is the type of acne in which acne characterized by papules with very little inflammation. It is a papular form of acne vulgaris.

24) Pomade acne - It is caused due to excessive use of pomade, a hair styling product. Excessive use of pomade cause acne breakout on scalp, forehead, and hairline. This acne occurs due to clogged skin pores. Discontinuation of the product can reduce the developing acne.

25) Acne pustulosa - It is the state of acne vulgaris in which pustular lesions occur and may result in scarring.

26) Steroid acne - Acne caused by the systemic or topical use of corticosteroid. It is also known as Acne Medicamentosa. It presents with small, firm follicular papules on the forehead, cheeks, and chest. Steroid acne mostly affects adolescents or adult patients who have been taking oral steroid.

27) Summer acne - These kind of acne appear after sun exposure, hot and humid weather. People who have excessive sweating can suffer from summer acne. Sun can cause thickening of the skin. This causes pores to be clogged and increase accumulation of sebum. After few weeks acne appear at those places.

28) Tropical acne - Acne caused by living in humid and hot weather. It is a severe type of acne vulgaris characterized by large painful cysts, nodules, and pustules that lead to the formation of rounded abscesses and frequent scarring.

29) Acne urticaria - This is a form of acne marked by papules that are predominantly edematous and wheal like and that have been aggravated by scratching.

30) Acne varioliformis - Acne frontalis or it also known as acne miliaris necrotica. It is a rare condition. A pyogenic infection involving follicles occurring mainly on the temples and margins of the scalp face and chest, followed by scar formation.

31) Acne mechanica - This type of acne is common in students, soldiers, and athletes. These type of acne are caused by skin friction, heat, pressure on the skin.