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Severe acne: diagnosis and management

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Acne is a common disorder, accounting for a significant proportion of primary care time. While affecting almost all adolescents to some degree, approximately 60 per cent of teenagers will develop acne that is sufficiently severe to seek medical advice.

About 5 per cent of women and 1 per cent of men in their third decade will continue to get acne or develop it de novo at that age.1 Acne vulgaris often has a profound psycho-social impact upon a patient's life, an aspect often under-estimated by the medical profession.

There are several degrees of acne. Clinically, acne should be suspected in young adults who present with 'spots' commonly affecting the face and upper torso. On examination there is likely to be a shiny appearance to the skin owing to increased sebum (skin oil) production.

A mild acne eruption includes closed comedones (whiteheads), with an underlying erythema. Open comedones (blackheads) may also be abundant particularly in the T-zone regions (forehead, nose and chin). More severe acne will exhibit papules, which are small red raised lumps.

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