acne /ak″nē/ , a chronic disorder of the hair follicles and sebaceous glands characterized by pimple outbreaks, cysts, infected abscesses, and sometimes scarring. Characteristic lesions include open (blackhead) and closed (whitehead) comedones, inflammatory papules, pustules, and nodules. It seems to result from a combination of factors, such as thickening of the follicular opening, increased sebum production, the presence of bacteria, and the host’s inflammatory response. Also called acne vulgaris. Kinds include acne conglobata, acne fulminans, chloracne. See also comedo. ▪ OBSERVATIONS: Superficial acne presents with comedones, scattered pustules, and oily skin on the face, neck, upper back, and chest. In deep acne, the pustules are more numerous and accompanied by pus-filled cysts, inflamed nodules, abscesses, and scarring. ▪ INTERVENTIONS: Manual extraction is used for comedones and surgical excision may be used for persistent nodules and sinus tracts. Intralesional steroids may be used to treat inflamed nodules. Topical antimicrobial and antiinfective drugs, comedolytics, and oral antiinfective drugs are used to treat pustules. Isotretinoin may be used if antibiotics are unsuccessful. Oral estrogen-progesterone is often successfully used to treat acne in females. Dermabrasion can be used to treat scarring. ▪ PATIENT CARE CONSIDERATIONS: Patient education includes instruction to avoid picking or squeezing comedones or pustules, as well as to avoid exposure to coal tar products, cocoa butter, greasy cosmetics, or hair gels. Excessive cleansing is counterproductive. Patients should know that diet has been shown to have little or no influence on acne. Most over-the-counter preparations have no proven efficacy and may aggravate acne outbreaks. Therapy often includes a combination of a topical antibiotic combined with an antiinflammatory agent, such as the combination of clindamycin with benzoyl peroxide, and a topical retinoid. Patients started on oral isotretinoin should have baseline liver and lipid panels and a pregnancy test before use. Females should be counseled on the serious risks of this medication to a fetus should pregnancy occur. Females should be placed on two forms of birth control 1 month before starting therapy, during therapy and at least 1 month after therapy. All patients on this medication should avoid vitamin A supplements and prolonged exposure to the sun. Sunscreen and protective clothing should be used when exposed to sunlight.
