Acne is a follicular skin disease most frequently occurring during
the adolescent or teenage years of a person’s life. It has
been found that around 85% of teenagers suffer from this skin
disorder worldwide. However, acne is not only restricted to teenagers,
but in many cases continues well into adulthood. The average age
when therapy is sought by the typical acne sufferer is 24 years.
Acne vulgaris is the most common skin disorder known medically.
It is a pleomorphic inflammatory disorder occurring mostly on
the face, but it can also extend to the areas of the neck, chest
and the back as well depending on the type and severity of the
It is thought that acne develops due to hyper sensitivity to
the stimulation of sebocytes and follicular keratinocytes by androgens
giving rise to the hyperplasia of sebaceous glands and seborrhea
that is seen externally in the form of acne.
Acne is characterized by open or closed comedones (both blackheads
and whiteheads), which either occur in isolation or may be found
grouped together with papules or pustules, mainly on the face
and upper trunk. How severe the acne is, is determined by the
number, type and distribution of the lesions.
Acne is not life threatening in the clinical sense, but it can
damage the emotional and psychological framework of the sufferer
leading to mild or extreme depression, anxiety and social withdrawal.
With the latest techniques, therapies and treatments available,
acne can indeed be treated effectively. In order to do this, however,
the disease needs to be graded according to severity and type,
keeping in mind several other factors as well. This skin disorder
varies from one person to the other so it needs to be classified
accordingly for appropriate treatment.
There are more than 25 methods for judging the severity of acne
and about 19 methods for counting lesions.
Severity of acne
Acne vulgaris is easily diagnosed. The presence of comedones
confirms its diagnosis. Acne can be broadly divided into two major
- Inflammatory acne characterized by the presence of nodules,
papules or pustules (having “pus” cells).
- Non inflammatory
lesions characterized by open or closed comedones (blackheads
Acne can also be divided by its severity as follows:
This can be of two types. One is mild comedonal acne where comedones
are the main lesions and generally non inflammatory. Topical
retinoid therapy is usually enough for treating this type of
acne. The other is mild papopustular acne where papules or pustules
maybe present, but are very few in number (less than ten). Several
open and closed comedones present with few inflammatory papsules
can also be described as mild acne. As these are slightly inflammatory,
they are treated by using topical retinoid drugs as well as
antibacterial preparations. Acetic acid may also be used to
treat mildly papopustular acne. Mild acne is almost always limited
to the face.
In moderate cases of acne there are many comedones, few or many
pustules, few nodules but no significant scarring. There may
be excessive pigmentation of the skin in some cases and this
type can be found on the face, shoulders, back and chest. This
type of acne can be treated with oral antibiotics and retinoids
as well as hormone therapy in women.
Moderately severe acne
Here erythematous papsules, pustules and nodules are present in
moderate distribution on the face and some scarring may be present.
In these cases, many painful and inflammatory nodules are present
all over the body. There may be the presence of innumerable
papopustules as well. There is bound to be scarring. For these
patients the use of a combination of topical and oral antimicrobial
agents is appropriate.
Very severe acne
There are some patients whose acne does not clear even with the
combination of oral and topical therapy. These types are characterized
by sinus tracts, comedone clusters, innumerable painful and
deep rooted nodules, excessive inflammation and inevitable scarring.
This mostly occurs in patients with excessive seborrhea and
who have a gram negative folliculitis infection. Excessively
severe acne can be treated with isotretinoin when other methods
Thus, sebaceous hyperplasia with seborrhea, heightened cornification
of the ducts, colonization of the follicles by the P acnes,
bacteria and inflammation, and immune responses are the various
factors which lead to different kinds of acne.
Treatment of severe acne
Severer forms of acne can be disfiguring and require years of
treatment. Dermatologists have the most experience treating the
different types of severe acne. It is important for patients and
their families to know that severe, disfiguring forms of acne
may require years of treatment and patients can experience one
or more treatment failures. During treatment, the support of family
and friends can greatly comfort patients.