Mild acne vulgaris
Acne vulgaris is a common problem for the majority of people in their teenage years. It affects more girls than boys and causes big problems for their self-esteem. Most (but not all) cases will clear in adult life.
Acne vulgaris is an inflammatory condition affecting the pilosebaceous glands of the hair follicles. Excess production of sebum plugs the follicles and inflammation develops owing to Propionibacterium acnes, which is normally present on the skin. The initial trigger is androgen hormones.
Management depends on the severity of the problem. This patient with white comedones (whiteheads), open comedones (blackheads), and a few inflamed papules and pustules (mild acne) was offered topical applications, such as benzoyl peroxide, azelaic acid, clindamycin, erythromycin, or tretinoin, once or twice per day.
Should the topical applications cause skin irritation or scaling, less frequent use may still be effective and less troublesome. Tretinoin is contraindicated in pregnancy or in women of child-bearing age unless they are using effective contraception.
Moderate acne vulgaris
Moderate acne describes a situation in which there is a much larger number of comedones and inflammatory papules. As in this boy, the lesions nearly always occur on the face, but in many cases there are also lesions on the back and chest.
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