Acne vulgaris is a common skin condition

Acne vulgaris is a common skin condition that exists all over the globe
mostly affecting adolescents. This condition is related to skin’s sebaceous
glands that results in clogged pores and lesions, commonly called pimples or
zits. Acne lesions generally occur on the face, neck, back, chest, shoulders
and body locations having high density of pilosebaceous units (Taylor, Gonzalez
et al. 2011).

        This
disease mostly affects adolescents both males and females, an age when people are
conscious about their
physical appearance adversely generates a subconscious anxiety. It has impact on patient’s quality of life, affecting both self-
esteem and psycho-social development. Any patient and treating doctor would therefore look for an effective and safe therapy
with a quick positive outcome, and total elimination of recurrence.
Acne vulgaris affects as much as 80% of the adolescent population ages 11to 30 years and persists in approximately
3% of middle-aged adults (Susun
Bellew, Diane Thiboutot
et al. 2011)

 

Supporting
point1: Interestingly, Acne vulgaris is more common in
males during adolescence, than it is in females. However as the adulthood stage sets in, acne
vulgaris becomes more common in women than in
men.  Although, Acne vulgaris may
be present in the first few weeks and months of life, when a new-born is still under
the influence of maternal hormones this neonatal acne
seems to resolve on its own. However,
if treated with a mild retinoid impacted follicles will resolve. Adolescent acne usually
begins with the onset of puberty. This happens when the gonads begin to produce and release more and more androgens. But acne is not limited only to adolescence. By age 45 years, 5% of
both men and women still have
acne (Kligman
1991).

The
classification of acne is based on the severity (mild, moderate, or severe) and the types of
lesions present (comedones, papules, pustules,
and nodules) as well as the presence
or absence of scarring (Kaisar, Vaibhav et al.
2012).

Supporting2: Long-known classic
pathogenic factors which play an important role in acne pathogenesis are
hormonal effects,
abnormal keratinocyte
function, hypercolonization
by Propionibacterium acnes (P. acnes) bacterium, and genetics. Earlier sporadic reports also suggested the effect of various environmental and lifestyle factors, but their true importance was under scientific debate
(Kornelia and Lajos 2011). The pathogenesis of acne is complex and dependent on the interplay
of multiple factors (Harper and
Thiboutot 2003).

Presently, three leading hypothesis
have been proposed to explain why the follicular epithelium produces cells at a
faster rate that are retained in individuals with acne. First, androgenic
hormones have been referred to as the initial trigger (Thiboutot, Gilliland et
al. 1999). Additionally, it has been noticed that androgen hormone receptors
are present in sebaceous glands. This gives the reason why individuals with
malfunctioning androgen receptors do not develop acne (Holland, Cunliffe et al.
1998). Secondly, excess sebum production is another key factor in the
development of acne vulgaris. Sebum production and excretion are regulated by a
number of different hormones including androgens and mediators (Pochi and
Strauss 1988). As a result, inflammation may be a primary phenomenon or a
secondary phenomenon.

 

Interleukin 1-alpha expression has
also been identified in microcomedones, and is supposed to have a role in the
development of acne (Ingham, Eady et al. 1992). The main and the third
underlying cause of acne is a genetic predisposition. The condition is
inherited in an autosomal dominant pattern with incomplete penetrance.

 

Supporting 3 TRETATMENT:

The
management of acne scars should follow an algorithmic approach that targets
each component of scarring (Figure 2). Treatment should begin with targeting
erythema, if present. Once scar-associated erythema has been addressed,
treatment should focus on addressing atrophic scarring, with the approach
determined by the types of scar present and whether generalized or individual
scars predominate. Combination treatment in a patient-specific way can offer
the best chance of significant improvement. Early treatment of active acne
remains the best way to prevent or limit acne-related scarring.16 it is also
imperative to ensure active acne has been treated before approaching scar
treatment so as not to create a cycle where active lesions continue to scar in
areas already addressed.

Acne treatment can be done by
either systemic route or topical route. Whenever small nodes or scarring
occur, systemic co-medication is indicated. Topical treatment affects at least three of the
four main pathogenic factors responsible for the development
of acne.
The management of acne is very complex. Since it is known that no single topical or oral treatment can suffice each component
of therapy, several medications in combination are usually
required. Management of acne requires four main factors of its pathogenesis to be understood: disease duration
and severity, past
response
to treatment, and skin colour.

 

Conclusion: In brief, acne is the commonly found disease mainly in
certain age groups, it can be treated through conventional therapy, combination
therapy, systemically or it can be treated from topical route with novel
nanostructured drug delivery systems, which can be obtained with extensive experimental
exercise but it is the safest and cost effective method for long term acne
care. This is necessary to treat in time otherwise it can also convert into
skin cancer as well.