ACNE VULGARIS

• Acne vulgaris is a self-limited disease seen frequently in adolescents and primarily involves the sebaceous follicles. The hallmark of acne is comedones, which can develop further into inflammatory papules, pustules or even abscesses and nodules. As a sequelae to active lesions –pitted or hypertrophic scars will be formed
• Symptoms typically begin in early puberty and cease spontaneously during the third decade of life

• Genetic predisposition
• Hormonal factors : Increased androgens during puberty and increased production of sebum ; In women – Menstrual cycle
• Follicular Hyperkeratosis : Higher keratinocyte activity and decreased keratinocyte shedding in pilosebaceous units leads to the formation of comedones
• Bacterial colonization with cutibacterium acnes
• External factors : Climate , drugs, food (dairy products and high glycaemic index diet)

• Occurs predominantly on the face (99%), back (60%) and chest (15%). Infraorbital area is spared even in severe acne
• Two type of lesions are seen : Non inflammatory (comedones) and inflammatory
• Comedones are the pathognomonic lesions of Acne. They are conical, raised lesions with a broad base and plugged apex. Two types of comedones are seen – blackheads/ open comedones and white heads/ closed comedones
• Inflammatory lesions include papules, pustules, and nodules or nodulocystic lesions. In the most severe variant, acne can present with cyst and abscesses
• Some amount of scaring occurs in 90% acne .These could be hypertrophic scars, keloids, atrophic scars or ice pick scars
• Nodular Acne (>5mmin diameter) commonly occurs on the back and neck
• Acne conglobata : rare type of acne, which is highly inflammatory and presents with comedones, nodules, abscesses, and draining sinus tract. Healing occurs with severe scarring

Differential diagnosis

• Rosacea : has facial flushing, typically pustules occurring over erythematous background
• Perioral Eczema : lesions itch, skin is dry and there are no comedones
• Acneiform drug eruptions : sudden onset, follicular monomorphous eruptions characterized by papules and pustules resembling acne

• Usually clinical diagnosis is made
• Elevated serum androgens(>150 ng/ml) and DHEAS(>8000 ng/ml)
• In patients with associated PCOD - LH: FSH ratio, serum progesterone, Prolactin, fasting insulin

Internal medicines

• Nimbadi kashaya – In initial stages
• Patolakaturohinyadi kashaya- in infective stages
• Sonitamrutam kashaya
• Guduchyadi kashaya
• Manjishtadi kashaya
• Chandraprabha gutika – reduce inflammatory response
• Kaisora guggulu
• Vilwadi gutika – for microorganisms associated with acne
• Avipathy choorna – in samana matra
• Khadirarishtam + Nimbamritasava- Normalise desquamation
• Abhayarishta + Aragwadharishta
• Madhusnuhi rasayana, Tiktaka ghrita – in later stages

Procedures

• Nimbadi / Eladi choorna in takra - Lepa
• Triphala + yasthi choorna Lepa
• Triphala / Ksheeri vriksha (Nalpamara ) kashaya kshalana