ABSTRACT

DIFFERENTIAL DIAGNOSIS Acne Vulgaris The term ‘acne’ is derived from the Greek word acne, which means ‘skin eruption’. It is a very common skin condition (>85%) that affects male and female teenagers equally. Peak incidence is at 18 years of age, however, it usually begins prior to the onset of puberty when the adrenal gland begins to produce and release more androgen hormones. It is characterised by papules, open and closed comedones (blackheads and whiteheads), pustules, nodules and scars in the sebaceous gland distribution such as the face, neck, back and chest. Abscesses and sinuses with scaring (conglobate acne) are seen only in the most severe presentations. It is believed that androgen hormones act as the initial trigger resulting in increased sebum production and oily skin, which causes the blockage of pilosebaceous ducts giving rise to comedones. The ducts become colonised with Propionibacterium acnes bacteria that release a number of infl ammatory markers. The body’s hypersensitive response to P. acnes gives rise to infl ammatory acne. Rarer external causes include endocrine disorders (PCOS, Cushing’s, congenital adrenal hyperplasia), cosmetic agents and drugs (lithium, steroids and androgens).