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Management of acne vulgaris

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Acne vulgaris is a common skin condition, experienced at some level by up to 95 per cent of teenagers (the term 'acne' is derived from 'acme', a Greek term meaning 'the prime of life')1 but 20 to 35 per cent of cases are severe.

While our understanding of the inheritance of acne is incomplete, a genetic element has been observed with a high concordance rate among twins and severe patterns of disease noted in those with a strong family history.2 Genes involved in steroid hormone processing and the immune response have been implicated in recent genetic studies.

There are several environmental factors purported to be associated with acne and many conflicting reports. Health professionals should note that there is no definitive evidence that acne is caused by poor hygiene, sunlight, or eating large quantities of chocolate or dairy products.3 Furthermore, excessive washing or rubbing of the face may actually worsen acne. Acne is not infectious, and bacteria contribute only a part to the pathogenesis of acne.

Iatrogenic causes of acne-like eruptions include topical and systemic steroid treatments. Progesterone-only contraceptive pills and some anti-epileptic drugs can worsen acne.

Acne can also have a negative psychological effect on individuals, and this can result in low self-esteem, confidence problems, and low mood. Therefore, when reviewing patients with acne, practitioners must enquire about these issues.

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