Acne Vulgaris
Definition
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that produces comedones, papules, pustules and sometimes cysts, most often on the face, chest and back.
Causes / Etiology
- Increased sebum production (stimulated by androgens)
- Follicular hyper‑keratinisation leading to blockage of the pore
- Colonisation by Propionibacterium acnes (now Cutibacterium acnes)
- Inflammatory response to bacterial products and sebum
Types or Classification
- Comedonal acne – only open (blackhead) or closed (whitehead) comedones, no inflammation.
- Papulopustular acne – inflamed papules and pustules predominate.
- Cystic acne – large, painful deep‑lying cysts or nodules.
- Acne conglobata – severe, chronic disease with interconnected nodules, abscesses and sinus tracts.
Pathology (step‑wise)
step 1 → Androgen excess → sebaceous glands enlarge and secrete more oily sebum.
step 2 → Follicular epithelium sheds irregularly → keratin plugs the follicle opening.
step 3 → Plug + excess sebum creates an anaerobic environment → Cutibacterium acnes multiplies.
step 4 → Bacterial enzymes and metabolites attract neutrophils → release of inflammatory mediators.
step 5 → Inflammation produces redness, swelling and pus formation → papules, pustules or cysts.
Clinical Features
General – lesions appear on face, neck, chest, upper back and sometimes shoulders; may be acute flare‑ups with periods of remission.
Specific –
• Open comedones (blackheads) – dilated pores with oxidised melanin.
• Closed comedones (whiteheads) – sealed plugs under the skin surface.
• Papules – small solid red bumps without pus.
• Pustules – papules that have become filled with pus.
• Nodules / cysts – deep, tender, often scar‑forming lesions.
Complications
Acute – pain, secondary bacterial infection, sudden worsening with stress or hormonal change.
Chronic – atrophic or hypertrophic scarring, post‑inflammatory hyperpigmentation, psychological distress, low self‑esteem.
Diagnosis / Investigations
Routine – thorough skin examination, history of onset, diet, stress and drug intake.
Special – hormonal profile (testosterone, DHEAS) if atypical distribution or adult‑onset; bacterial culture only when resistant infection suspected; skin biopsy rarely needed for atypical lesions.
Management
General measures – gentle cleansing twice daily, avoid harsh scrubs, do not pick or squeeze lesions, keep hair products non‑comedogenic.
Modern treatment –
• Topical retinoids (adapalene, tretinoin) to normalise desquamation.
• Benzoyl peroxide for antibacterial effect.
• Topical antibiotics (clindamycin, erythromycin) combined with benzoyl peroxide.
• Oral antibiotics (doxycycline, minocycline) for moderate‑severe disease.
• Hormonal therapy (combined oral contraceptives, anti‑androgens) in females.
• Isotretinoin for severe, refractory nodulocystic acne (under strict monitoring).
Dietary advice – balanced diet rich in fruits and vegetables, adequate water intake, limit high‑glycaemic foods, dairy and excess saturated fats if they appear to aggravate lesions.
Homeopathic Therapeutics
Acne (Boericke)
- Eruptions on face, chest, back.
- Both comedones and inflamed papules/pustules.
- Painful, hot, worse from heat and sunlight.
- Better from cold applications.
- Associated with digestive disturbances.
- Useful when lesions are stubborn and recurrent.
Sulphur
- Greasy, foul‑smelling skin eruptions.
- Intensifies with warmth, sweating, tight clothing.
- Burning, itching, especially at night.
- Improves with cool fresh air and bathing.
- Good for oily skin with persistent comedones.
Pulsatilla
- Eruptions appear on face and may spread to genitals.
- Lesions change rapidly in size and shape.
- Worse from warm rooms, rich foods, emotional upset.
- Better from gentle motion, open air.
- Often indicated when acne follows hormonal fluctuations.
Kali bromatum
- Itchy, burning papules and pustules.
- Aggravated by heat, sun exposure and tight collars.
- Relief with cold compresses.
- May be accompanied by anxiety or restlessness.
Graphites
- Thick, crusted lesions on face, ears, neck.
- Pus may be thick and yellowish.
- Worse in cold, damp weather; better from warmth.
- Frequently linked with constipation or other digestive complaints.