Saturday, May 15, 2010

Juvenile Acne (Acne in Adolescence)

Acne Vulgaris (acne of adolescence) is one of the most common disorders of the skin and affects nearly 85% of the population between 12 and 25. There are other varieties of acne, but are much less common and will not be developed in this content.
Acne has a significant hereditary component. Its peak incidence is at 14 years for females and 16 males, who are more frequent and severe.

Its clinical presentation does not provide diagnostic difficulties or the doctor or patient. Contributes significantly to the scope psychosocial problems such as depression, anxiety and isolation. Successful management of acne is, therefore, of vital importance to the practice of family doctor.

Acne lesions develop from a structure called the pilosebaceous unit. It is formed by the association of sebaceous glands in the hair follicle. Acne vulgaris is a chronic disorder of the pilosebaceous unit that occurs mainly on the face, back and chest. These are areas of highest density of pilosebaceous units.
The pathogenesis is: androgens stimulate sebum production, which in turn determines a germ that grow anaerobic part of the normal flora:

Propionibacterium acnes. This splits the fat into glycerol and fatty acids, which would be responsible for the hyperkeratinization (overgrowth of the epidermis) and the impairment of the desquamation of follicular epithelium. This process leads to plug formation and inflammation, represented clinically by erythematous papules and comedones.
Fr acnes can cause an inflammatory response that leads to the formation of pustules and, if there is an exaggerated response of cysts and nodules.

Some authors believe that acne is not a disease but a normal developmental process with functions related to a subconscious olfactory communication system of the human species. It is unknown why improvement in almost all patients in their 20s and disappears before age 25, taking into account that sebum production remains the same and P. acnes does not disappear from the surface of the skin (only 1% of men and 5% of women have acne at 40 years).

Evaluation of adolescent patients with acne.
The interview of the patient with acne should be framed on the principles developed in the class of adolescents. The family doctor can occupy an important place in the management of these patients since it knows the family and patient. While acne is a benign entity, can be devastating from the standpoint of psychosocial.

Therefore, the most interesting aspect of the assessment of acne is to determine how the disease is concerned about the patient. To assess how concerned the acne (and, consequently, how aggressive the treatment) is necessary to use indirect questions like: Who is more worried about acne, you or your parents?, Have you ever not because you went somewhere acne was wrong?, etc. Many times the doctor has a misleading impression of the concern that each patient with acne.

For example, a 14 year old boy with severe acne can be annoying and a little girl of 16 years with few comedones may be very concerned and willing to do everything possible to control them.
The examination of patients with acne is very important. You must ask yourself at great length about the treatments to fight acne previously used and the circumstances that aggravate acne (menstruation, certain foods, etc.)..

It is also important to know whether the patient is receiving medication that may exacerbate or cause acne (corticosteroids, lithium, iodine, phenytoin, anabolic steroids and high doses of vitamin B2, B6 and B12). Oral contraceptives may improve acne, but those are high in progesterone can exacerbate it.


There is evidence that the severity of acne is a risk factor for suicide in adolescents and that individuals with acne have higher rates of unemployment.
Since acne is a benign self-limiting disease many physicians do not nest within their clinical practice. However, if not treated properly and can leave emotional scars on the skin that can last a lifetime.
One should not underestimate the psychological impact of acne in patients. As a general rule, the physician should think that this organization cares more teenagers than they recognize in the office.

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