Scientific approach to the treatment of acne vulgaris
Wilma F. Bergfeld, M.D.
Department of Dermatology, Department of Pathology
Acne vulgaris is a dermatosis which involves the pilosebaceous apparatus of the skin; namely, the sebaceous gland and hair follicle (Fig. 1). Clinically, the skin changes are those of increased numbers of comedones (blackheads), milia (white-heads or closed comedones), inflammatory papulopustular lesions, cysts, and atrophic or hypertrophic scars. These acne lesions are most frequently observed on the face and less frequently on the chest and back. This distribution follows the embryonic development of the sebaceous gland with the greater number of glands being distributed over the face and lesser number and smaller glands distributed over the scalp, chest, and trunk. Acneform lesions may involve other areas such as arms, legs, and intertriginous skin. Acne vulgaris has been associated with other diseases of the pilosebaceous apparatus such as seborrheic dermatitis of the face and scalp, dissecting folliculitis of the scalp, and hidradenitis suppurativa predominately of the axilla and groin.1 Recognition and treatment of these associated entities result in concomitantly good response to therapy.
The onset of acne vulgaris is usually associated with the increased androgen stimulation of the sebaceous follicle which occurs either prepubertally or at puberty. Acneform lesions develop in 42% of girls and 36% of boys between the ages of 8 and 10 years,2 and in the remainder of the adolescent group acneform lesions develop between the ages of 10 and 15 years. Acne vulgaris, a disease of the adolescent, is relatively self-limited, but on occasion it will continue into adulthood.
Clinically, acne vulgaris can be divided into two. . .