Question

Case Study 13.1:

David is a 15 year old patient of yours at the family practice clinic you work at. He is generally healthy with no medical history, but presents today with his mother. David was hesitant to come in to the clinic but his mother insisted that his acne has been getting so bad over the past 6 months that it is significantly impacting David’s confidence and social life outside of school. She tells you that she needs help since they have tried “everything” over the counter but none of it is helping.

On examination, you indicate that David has numerous white and blackheads with some surrounding redness and irritation. Some are very large in size. They are located on his cheeks, neck, nose, and forehead. You notice some new scarring on the cheeks. You make the right diagnosis by recognizing that David has the common adolescent disease called Acne Vulgaris.

Discussion 13.1:

Identify and describe the pathophysiologic factors that are responsible for David’s acne. What is the etiology of the disease? Clearly, indicate how inflammation and infection are indicated in the disease process. Identify treatment methods.

Answer 1

* Pathophysiologic factors of acne vulgaris

                 * During adolescence stage growth and development of integument increases and

                    due to increased androgen production result in increasing sebum production in

                    sebacious glands.

                 * This type of abnormal production of sebum result in enlargement of sebacious glands,

                    obstruction of sebacious follicles and keratinization in follicles.

                  * Obstructions in the sebacious follicles result in inflammation of sebacious gland and

                    development of acne vulgaris.

* Etiology

         * Overproduction of hormone androgen (Hyperandrogenism)

         * Propionibacterium found in sebacious follicles aggrevate inflammatory process.

         * Side effect of cosmetics or corticosteroid therapy.

         * Mechanical traumas result in inflammation of sebacious glands.

* Inflammation and infection indicated through clinical signs and symptoms like,

                          * Redness.

                          * Irrritation.

                          * Pain over the inflammed area.

                          * White and black heads.

                          * Tenderness on the acne area.

      * Treatment

              * Pharmacological therapy

                         * Anti-inflammatory drugs.(eg;Benzoyl peroxide)

                         * Antibiotics.(eg;Tetracyclin,Erythromycin,clindamycin)

                     * Topical antiseptics.

                       * Vitamin a derivatives.

                       * Antibacterial soaps.

        * Maintain skin hygiene

                       * Proper bathing and shampooing help to eliminate oily hair.

                           * Use of sun protective lotions or creams when going outside.

                           * Use of face washes based on your skin texture or type.