Acne vulgaris

Acne vulgaris
Classification and external resources

Acne of a 14-year-old male during puberty
ICD-10 L70.0
ICD-9 706.1
DiseasesDB 10765
MedlinePlus 000873
eMedicine derm/2
MeSH D000152

Acne vulgaris (or acne) is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring.[1] Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.[2] The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation.

Acne occurs most commonly during adolescence, affecting more than 96% of teenagers, and often continues into adulthood. In adolescence, acne is usually caused by an increase in male sex hormones, which people of both genders accrue during puberty.[3] For most people, acne diminishes over time and tends to disappear — or at the very least decrease — after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond.[4]

Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne.[5] The "cysts," or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts.[6] Cystic acne affects deeper skin tissue than does common acne.[7]

Aside from scarring, its main effects are psychological, such as reduced self-esteem[8] and, according to at least one study, depression or suicide.[9] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.[8]

Contents

Terminology

The term acne comes from a corruption of the Greek άκμή (acne in the sense of a skin eruption) in the writings of Aëtius Amidenus. Used by itself, the term "acne" refers to the presence of pustules and papules.[10] The most common form of acne is known as "acne vulgaris", meaning "common acne". Many teenagers get this type of acne. Use of the term "acne vulgaris" implies the presence of comedones.[11]

The term "acne rosacea" is a synonym for rosacea, however some individuals may have almost no acne comedones associated with their rosacea and prefer therefore the term rosacea.[12] Chloracne is associated with exposure to polyhalogenated compounds.

Signs and symptoms

Different types of Acne Vulgaris: A: Cystic acne on the face, B: Subsiding tropical acne of trunk, C: Extensive acne on chest and shoulders.

Typical features of acne include: seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and, possibly scarring.[1] It presents somewhat differently in people with dark skin.

Scars

Acne often leaves small scars where the skin gets a "volcanic" shape.

Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. There are a range of treatments available. Although quite rare, the medical condition Atrophia Maculosa Varioliformis Cutis also results in "acne-like" depressed scars on the face.

Pigmentation

Pigmented scars is a slightly misleading term, as it suggests a change in the skin's pigmentation and that they are true scars; however, neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful 'bumps' lying under the skin). They often leave behind an inflamed red mark. Often, the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. When sufferers try to 'pop' cysts or nodules, pigmentation scarring becomes significantly worse, and may even bruise the affected area. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although rarely can persist.

On the other hand, some people — in particular, those with naturally tanned skin — do develop brown hyperpigmentation scars due to increased production of the pigment melanin. These too typically fade over time.

Cause

Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands' becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation.[13]

Hormonal

Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum.[14] Use of anabolic steroids may have a similar effect.[15] Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).

Development of acne vulgaris in later years is uncommon, although this is the age group for rosacea, which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

Genetic

The tendency to develop acne runs in families. For example, school aged boys with acne often have other members in their family with acne, as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.[16]

Psychological

While the connection between acne and stress has been debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels."[17] The National Institutes of Health (USA) list stress as a factor that "can cause an acne flare."[18] A study of adolescents in Singapore "observed a statistically significant positive correlation […] between stress levels and severity of acne."[19]

Infectious

Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In vitro resistance of P. acnes to commonly used antibiotics has been increasing.[20]

Diet

A high glycemic load diet and cow's milk have been associated with worsening acne.[21] Other associations such as chocolate and salt are not supported by the evidence.[21]

Diagnosis

There are multiple grading scales for grading the severity of acne vulgaris,[22] three of these being:

Differential

Management

Benzoyl peroxide cream.

Many different treatments exist for acne including benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and kera-tolytic soaps.[23] They are believed to work in at least 4 different ways including: normalising shedding into the pore to prevent blockage, killing Propionibacterium acnes, anti-inflammatory effects, hormonal manipulation.

Medications

Benzoyl peroxide

Benzoyl peroxide is a first-line treatment for mild and moderate acne vulgarus due to its effectiveness and mild side-effects (primarily an irritant dermatitis). It normally causes just dryness of the skin, slight redness, and occasional peeling as part of some side-effects.[24] It has been found to be nearly as effective as antibiotics with all concentrations 2.5%, 5.0%, and 10% equally effective.[24] Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial resistance.[24]

Antibiotics

Antibiotics are reserved for more severe cases.[24] With increasing resistance of P. acnes worldwide, they are becoming less effective.[24] Commonly used antibiotics, either applied topically or taken orally, include erythromycin, clindamycin, and tetracyclines such as minocycline.

Hormones

In females, acne can be improved with hormonal treatments. The common combined estrogen/progestogen methods of hormonal contraception have some effect, but the antiandrogen cyproterone in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side-effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low-dose spironolactone can have anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

Topical retinoids

A group of medications for normalizing the follicle cell life-cycle are topical retinoids such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and, in general, have much milder side-effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death life-cycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar, but milder, effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use over 30 years, but are available only on prescription, so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare-up of acne and facial flushing.

Oral retinoids

A daily oral intake of vitamin A derivative isotretinoin (marketed as Roaccutane, Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of 4–6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side-effects (many of which can be severe). About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4–6 months may be indicated to obtain desired results. It is often recommended that one let a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also gives the body a chance to recover. On occasion, a third or even a fourth course is used, but the benefits are often less substantial. The most common side-effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare-up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, it is recommended that patients have blood samples taken and examined before and during treatment. In some cases, treatment is terminated or reduced due to elevated liver enzymes in the blood, which might be related to liver damage. Others claim that the reports of permanent damage to the liver are unsubstantiated, and routine testing is considered unnecessary by some dermatologists. Blood triglycerides also need to be monitored. However, routine testing are part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression, but, as of September 2005, there is no agreement in the medical literature as to the risk. The drug also causes birth defects if women become pregnant while taking it or take it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Because of this, the drug is supposed to be given to females as a last resort after milder treatments have proven insufficient. Restrictive rules (see iPledge program) for use were put into force in the USA beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.[25]

Anti-inflammatories

Nicotinamide, (vitamin B3) used topically in the form of a gel, has been shown in a 1995 study to be of comparable efficacy to topical clindamycin used for comparison.[26] Topical nicotinamide is available both on prescription and over-the-counter. The property of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also purported to result in increased synthesis of collagen, keratin, involucrin and flaggrin, and may also, according to a cosmetic company, be useful for reducing skin hyperpigmentation (acne scars), increasing skin moisture and reducing fine wrinkles.[27]

Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo-controlled study, although this drug has since been withdrawn.[28]

Naproxen or ibuprofen[29] are used for some moderate acne cases for their anti-inflammatory effects.

Calendula in suspension is used as an anti-inflammatory agent.[30]

Procedures

Dermabrasion

Dermabrasion is a cosmetic medical procedure in which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or "twilight anaesthesia", in which the patient is still partly conscious.[31] Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars.

In the past, dermabrasion was done using a small, sterilized, electric sander. In the past decade, it has become more common to use a CO2 or Er:YAG laser. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Microdermabrasion comes from the above mentioned technique dermabrasion. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum.

The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.

Phototherapy

'Blue' and red light Light exposure has long been used as a short term treatment for acne. Recently, visible light has been successfully employed to treat mild to moderate acne (phototherapy or deep-penetrating light therapy) - in particular intense violet light (405-420 nm) generated by purpose-built fluorescent lighting, dichroic bulbs, LEDs or lasers. Used twice weekly, this has been shown to reduce the number of acne lesions by about 64%[32] and is even more effective when applied daily. The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by 420 nm and shorter wavelengths of light.[33] Particularly when applied over several days, these free radicals ultimately kill the bacteria.[34] Since porphyrins are not otherwise present in skin, and no UV light is employed, it appears to be safe, and has been licensed by the U.S. FDA.[35][36]

It seems that the treatment works even better if used with a mixture of the violet light and red visible light (660 nanometer), resulting in a 76% reduction of lesions after three months of daily treatment for 80% of the patients;[37] and overall clearance was similar or better than benzoyl peroxide. Unlike most of the other treatments, few if any negative side-effects are typically experienced, and the development of bacterial resistance to the treatment seems very unlikely. After treatment, clearance can be longer-lived than is typical with topical or oral antibiotic treatments; several months is not uncommon. The equipment or treatment, however, is relatively new and reasonably expensive to buy initially, although the total cost of ownership can be similar to many other treatment methods (such as the total cost of benzoyl peroxide, moisturizer, washes) over a couple of years of use.

Photodynamic therapy In addition, basic science and clinical work by dermatologists Yoram Harth and Alan Shalita and others has produced evidence that intense blue/violet light (405-425 nanometer) can decrease the number of inflammatory acne lesion by 60-70% in four weeks of therapy, in particular, when the P. acnes is pretreated with delta-aminolevulinic acid (ALA), which increases the production of porphyrins. However this photodynamic therapy is controversial and not published in a peer-reviewed journal. A phase II trial, while it showed improvement occurred, failed to show improved response compared to the blue/violet light alone.[38]

Laser treatment Laser surgery has been in use for some time to reduce the scars left behind by acne[39], but research has been done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:

Since lasers and intense pulsed light sources cause thermal damage to the skin, there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long-term dryness of the skin.

In the United States, the FDA has approved several companies, such as Candela Corp., to use a cosmetic laser for the treatment of acne. However, efficacy studies have used very small sample sizes (fewer than 100 subjects) for periods of six months or less, and have shown contradictory results.[40] Also, laser treatment being relatively new, protocols remain subject to experimentation and revision,[41] and treatment can be quite expensive. Also, some Smoothbeam laser devices had to be recalled due to coolant failure, which resulted in painful burn injuries to patients.[42]

Surgery

For patients with cystic acne, boils can be drained through surgical lancing.[7]

Other

Prognosis

Acne usually improves around the age of 20 but may persist into adulthood.[23]

Epidemiology

Acne affects 40 to 50 million people in the United States (16%), and approximately 3 to 5 million in Australia (23%).[46] It affects people of all racial and ethnic groups.[47]

History

Research

A vaccine against inflammatory acne has been tested successfully in mice, but it is not certain that it would work similarly in humans.[52]

A 2007 microbiology article reporting the first genome sequencing of a Propionibacterium acnes bacteriophage (PA6) said this "should greatly enhance the development of a potential bacteriophage therapy to treat acne and, therefore, overcome the significant problems associated with long-term antibiotic therapy and bacterial resistance."[53]

See also

References

  1. ↑ 1.0 1.1 Adityan B, Kumari R, Thappa DM (2009). "Scoring systems in acne vulgaris". Indian J Dermatol Venereol Leprol 75 (3): 323–6. doi:10.4103/0378-6323.51258. PMID 19439902. 
  2. ↑ "Acne Vulgaris : Article by Julie C Harper". eMedicine. 2009-08-06. http://www.emedicine.com/DERM/topic2.htm. Retrieved 2009-12-21. 
  3. ↑ James WD (April 2005). "Clinical practice. Acne". N Engl J Med 352 (14): 1463–72. doi:10.1056/NEJMcp033487. ISSN 0028-4793. PMID 15814882. 
  4. ↑ Anderson, Laurence. 2006. Looking Good, the Australian guide to skin care, cosmetic medicine and cosmetic surgery. AMPCo. Sydney. ISBN 0 85557 044 X.
  5. ↑ Thiboutot, Diane M.; Strauss, John S. (2003). "Diseases of the sebaceous glands". In Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Fitzpatrick's dermatology in general medicine (6th ed.). New York: McGraw-Hill. pp. 672–87. ISBN 0-07-138076-0. 
  6. ↑ Boil Drawing Salve, lovetoknow.com
  7. ↑ 7.0 7.1 Boils (Skin Abscesses), medicinenet.com
  8. ↑ 8.0 8.1 Goodman G (July 2006). "Acne and acne scarring - the case for active and early intervention" (PDF). Aust Fam Physician 35 (7): 503–4. ISSN 0300-8495. PMID 16820822. http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2006issues/afp200607/20060705goodman.pdf. 
  9. ↑ Purvis D, Robinson E, Merry S, Watson P (December 2006). "Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school students". J Paediatr Child Health 42 (12): 793–6. doi:10.1111/j.1440-1754.2006.00979.x. ISSN 1034-4810. PMID 17096715. 
    One study has estimated the incidence of suicidal ideation in patients with acne as 7.1%:
    * Picardi A, Mazzotti E, Pasquini P (March 2006). "Prevalence and correlates of suicidal ideation among patients with skin disease". J Am Acad Dermatol 54 (3): 420–6. doi:10.1016/j.jaad.2005.11.1103. ISSN 0190-9622. PMID 16488292. 
  10. ↑ acne at Dorland's Medical Dictionary
  11. ↑ acne vulgaris at Dorland's Medical Dictionary
  12. ↑ acne rosacea at Dorland's Medical Dictionary
  13. ↑ Simpson, Nicholas B.; Cunliffe, William J. (2004). "Disorders of the sebaceous glands". In Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Rook's textbook of dermatology (7th ed.). Malden, Mass.: Blackwell Science. pp. 43.1–75. ISBN 0-632-06429-3. 
  14. ↑ "Frequently Asked Questions: Acne". U.S. Department of Health and Human Services, Office of Public Health and Science, Office on Women's Health. 2009-07-16. http://www.womenshealth.gov/faq/acne.cfm. Retrieved 2009-07-30. 
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  16. ↑ F. Ballangera, P. Baudrya, J.M. N'Guyenb, A. Khammaria, B. Dréno Heredity: A Prognostic Factor for Acne 5/2/2005
  17. ↑ Chiu, Annie, Chon, Susan Y., Kimball, Alexa B. (July 2003). "The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress" (abstract at [1]). Archives of Dermatology 139 (7).
  18. ↑ National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (January 2006). "Questions and Answers about Acne" [2], p. 5.
  19. ↑ Yosipovitch, Gil, Tang, Mark, Dawn, Aerlyn G., Chen, Mark, Goh, Chee Leok, Chan, Yiong Huak, Seng, Lim Fong (March 2007). "Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents" [3]. Acta Dermato-Venereologica 87(2), pp. 135-39.
  20. ↑ National Guideline Clearinghouse 11/12/2007
  21. ↑ 21.0 21.1 Ferdowsian HR, Levin S (March 2010). "Does diet really affect acne?". Skin Therapy Lett. 15 (3): 1–2, 5. PMID 20361171. 
  22. ↑ Leeds, Cook's and Pillsbury scales obtained from here
  23. ↑ 23.0 23.1 Ramos-e-Silva M, Carneiro SC (2009). "Acne vulgaris: review and guidelines". Dermatol Nurs 21 (2): 63–8; quiz 69. PMID 19507372. 
  24. ↑ 24.0 24.1 24.2 24.3 24.4 Sagransky M, Yentzer BA, Feldman SR (October 2009). "Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris". Expert Opin Pharmacother 10 (15): 2555–62. doi:10.1517/14656560903277228. PMID 19761357. 
  25. ↑ Bernadine Healy (2005-05-09). "Pledging for Accutane". US News Best Health. http://www.usnews.com/usnews/opinion/articles/050905/5healy.htm. 
  26. ↑ Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK (June 1995). "Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris". Int. J. Dermatol. 34 (6): 434–7. doi:10.1111/j.1365-4362.1995.tb04449.x. ISSN 0011-9059. PMID 7657446. 
  27. ↑ Procter & Gamble. "Niacinamide Research" (PDF). http://www.pgdermatology.com/images/learning_library/anti_aging/PG-Niancinamide-FINAL-090105.pdf. 
  28. ↑ Tehrani R, Dharmalingam M (1 November 2004). "Management of premenstrual acne with Cox-2 inhibitors: A placebo controlled study". Indian J Dermatol Venereol Leprol [serial online] 70 (6): 345–348. ISSN 0378-6323. PMID 17642660. http://www.ijdvl.com/text.asp?2004/70/6/345/13475. Retrieved 2007-06-23. 
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  30. ↑ Grow Your Own Drugs - BBC2 James Wong
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  33. ↑ Kjeldstad B (March 1984). "Photoinactivation of Propionibacterium acnes by near-ultraviolet light". Z Naturforsch [C] 39 (3-4): 300–2. ISSN 0341-0382. PMID 6730638. 
  34. ↑ Ashkenazi H, Malik Z, Harth Y, Nitzan Y (January 2003). "Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light". FEMS Immunol Med Microbiol 35 (1): 17–24. doi:10.1111/j.1574-695X.2003.tb00644.x. ISSN 0928-8244. PMID 12589953. 
  35. ↑ "New Light Therapy for Acne" (archive) U.S. Food and Drug Administration, FDA Consumer, November-December 2002, (Original URL)
  36. ↑ "510(k) Summary: CureLight's ClearLight Phototherapy Device" (PDF). FDA, Office of Device Regulation, Center for Devices and Radiological Health. 2002-08-16. http://www.accessdata.fda.gov/cdrh_docs/pdf/k013623.pdf. Retrieved 2009-07-30. 
  37. ↑ Papageorgiou P, Katsambas A, Chu A (May 2000). "Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris.". Br J Dermatol 142 (5): 973–8. doi:10.1046/j.1365-2133.2000.03481.x. ISSN 0007-0963. PMID 10809858. 
  38. ↑ "DUSA Pharmaceuticals (DUSA) to Stop Developing Phase 2 Acne Treatment". Biospace. 2008-10-23. http://www.biospace.com/news_story.aspx?NewsEntityId=114055. Retrieved 2009-07-30. 
  39. ↑ Brightman L, Chapas A, Geronemus R. "Ablative Fractional Resurfacing of Acne Scars". Lasers Surg Med. 40:381-386. 2008 [4]
  40. ↑ "Health | Doubts over acne laser treatment". BBC News. 2004-06-15. http://news.bbc.co.uk/2/hi/health/3808055.stm. Retrieved 2009-12-21. 
  41. ↑ By: (2004-03-28). "Manage Account - Modern Medicine". Dermatologytimes.com. http://www.dermatologytimes.com/dermatologytimes/article/articleDetail.jsp?id=93752. Retrieved 2009-12-21. 
  42. ↑ "Enforcement Report". Recalls, Market Withdrawals, & Safety Alerts. FDA. 2004-01-14. http://www.fda.gov/Safety/Recalls/EnforcementReports/2004/ucm120279.htm. Retrieved 2009-07-30. 
  43. ↑ 43.0 43.1 Mantle D, Gok MA, Lennard TW (June 2001). "Adverse and beneficial effects of plant extracts on skin and skin disorders" (Free full text). Adverse drug reactions and toxicological reviews 20 (2): 89–103. ISSN 0964-198X. PMID 11482001. http://www.nlm.nih.gov/medlineplus/herbalmedicine.html. 
  44. ↑ Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH (December 2002). "Tea tree oil reduces histamine-induced skin inflammation". Br. J. Dermatol. 147 (6): 1212–7. doi:10.1046/j.1365-2133.2002.05034.x. ISSN 0007-0963. PMID 12452873. 
  45. ↑ Khalil Z, Pearce AL, Satkunanathan N, Storer E, Finlay-Jones JJ, Hart PH (October 2004). "Regulation of wheal and flare by tea tree oil: complementary human and rodent studies". J. Invest. Dermatol. 123 (4): 683–90. doi:10.1111/j.0022-202X.2004.23407.x. ISSN 0022-202X. PMID 15373773. http://www.nature.com/jid/journal/v123/n4/full/5602507a.html. 
  46. ↑ White GM (August 1998). "Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris". J. Am. Acad. Dermatol. 39 (2 Pt 3): S34–7. doi:10.1016/S0190-9622(98)70442-6. PMID 9703121. 
  47. ↑ Shah SK, Alexis AF (May 2010). "Acne in skin of color: practical approaches to treatment". J Dermatolog Treat 21 (3): 206–11. doi:10.3109/09546630903401496. PMID 20132053. 
  48. ↑ "Tretinoin (retinoic acid) in acne" (Free full text). The Medical letter on drugs and therapeutics 15 (1): 3. January 1973. ISSN 0025-732X. PMID 4265099. http://www.nlm.nih.gov/medlineplus/acne.html. 
  49. ↑ Jones H, Blanc D, Cunliffe WJ (November 1980). "13-cis retinoic acid and acne". Lancet 2 (8203): 1048–9. doi:10.1016/S0140-6736(80)92273-4. ISSN 0140-6736. PMID 6107678. 
  50. ↑ Bérard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D (February 2007). "Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective". British Journal of Clinical Pharmacology 63 (2): 196–205. doi:10.1111/j.1365-2125.2006.02837.x. PMID 17214828. 
  51. ↑ Holmes SC, Bankowska U, Mackie RM (March 1998). "The prescription of isotretinoin to women: is every precaution taken?". The British Journal of Dermatology 138 (3): 450–5. doi:10.1046/j.1365-2133.1998.02123.x. PMID 9580798. 
  52. ↑ Kim J (October 2008). "Acne vaccines: therapeutic option for the treatment of acne vulgaris?". The Journal of Investigative Dermatology 128 (10): 2353–4. doi:10.1038/jid.2008.221. PMID 18787542. 
  53. ↑ Farrar MD, Howson KM, Bojar RA, et al. (June 2007). "Genome sequence and analysis of a Propionibacterium acnes bacteriophage". Journal of Bacteriology 189 (11): 4161–7. doi:10.1128/JB.00106-07. PMID 17400737. 

External links

Acne-treating agents (D10)
Antibacterial
Azelaic acid · Benzoyl peroxide · Blue light therapy · Tea tree oil
Keratolytic
Glycolic acid · Salicylic acid · Sulfur · Benzoyl peroxide
Anti-inflammatory
Antibiotics
Clindamycin · Dapsone · Erythromycin · Sulfacetamide · Minocycline · Tetracyclines
Hormonal
Antiandrogens · Contraceptives
Retinoids
Adapalene · Isotretinoin · Tazarotene · Tretinoin
Combinations
ZIANA · Duac · BenzaClin · PLEXION · Epiduo

: SKA

anat//devp

noco/cong/tumr, sysi/

proc, drug(D10)
Disorders of skin appendages (L60-75, 703-706)
Nail

thickness: Onychogryphosis · Onychauxis

color: Beau's lines · Yellow nail syndrome · Leukonychia · Azure Lunula

shape: Koilonychia · Nail clubbing

behavior: Onychotillomania · Onychophagia

other: Ingrown nail · Anonychia

ungrouped: Paronychia (Acute paronychia, Chronic paronychia ) · Chevron nail · Congenital onychodysplasia of the index fingers · Green nails · Half and half nails · Hangnail · Hapalonychia · Hook nail · Lichen planus of the nails · Longitudinal erythronychia · Malalignment of the nail plate · Median nail dystrophy · Mees' lines · Melanonychia · Muehrcke's lines · Nail–patella syndrome · Onychoatrophy · Onychocryptosis · Onycholysis · Onychomadesis · Onychomatricoma · Onychophosis · Onychoptosis defluvium · Onychorrhexis · Onychoschizia · Platonychia · Pincer nails · Plummer's nail · Psoriatic nails · Pterygium inversum unguis · Pterygium unguis · Purpura of the nail beds · Racquet nail · Red lunulae · Shell nail syndrome · Splinter hemorrhage · Spotted lunulae · Staining of the nail plate · Stippled nails · Subungual hematoma · Terry's nails · Twenty-nail dystrophy
Hair
Hair loss/
Baldness

noncicatricial alopecia: Alopecia/Alopecia areata (Alopecia totalis, Alopecia universalis, Ophiasis)
Androgenic alopecia · Hypotrichosis · Telogen effluvium · Traction alopecia · Lichen planopilaris · Trichorrhexis nodosa · Alopecia neoplastica · Anagen effluvium · Androgenetic alopecia · Alopecia mucinosa · Male-pattern baldness

cicatricial alopecia: Pseudopelade of Brocq · Central centrifugal cicatricial alopecia · Pressure alopecia · Traumatic alopecia · Tumor alopecia · Hot comb alopecia · Perifolliculitis capitis abscedens et suffodiens · Graham-Little syndrome · Folliculitis decalvans

ungrouped: Triangular alopecia · Frontal fibrosing alopecia · Marie Unna hereditary hypotrichosis
Acneiform eruption
Acne
Acne vulgaris · Acne conglobata · Acne miliaris necrotica · Tropical acne · Infantile acne/Neonatal acne · Excoriated acne · Acne fulminans · Drug-induced acne/Acne medicamentosa (Steroid acne) · Halogen acne (Iododerma, Bromoderma, Chloracne) · Oil acne · Tar acne · Acne cosmetica · Occupational acne · Acne aestivalis · Acne keloidalis nuchae · Acne mechanica · Acne with facial edema · Pomade acne · Acne necrotica · Blackhead · Lupus miliaris disseminatus faciei
Perioral dermatitis (Granulomatous perioral dermatitis) · Phymatous rosacea (Rhinophyma, Blepharophyma, Gnathophyma, Metophyma, Otophyma) · Papulopustular rosacea · Lupoid rosacea · Erythrotelangiectatic rosacea · Glandular rosacea · Gram-negative rosacea · Steroid rosacea · Ocular rosacea · Persistent edema of rosacea · Rosacea conglobata
Ungrouped
Granulomatous facial dermatitis · Idiopathic facial aseptic granuloma · Periorificial dermatitis · Periorbital dermatitis · Pyoderma faciale · SAPHO syndrome
Follicular cysts
Epidermoid cyst · Trichilemmal cyst · Sebaceous cyst · Steatocystoma multiplex · Milia
Folliculitis (Folliculitis nares perforans, Tufted folliculitis) · Pseudofolliculitis barbae
Ungrouped
Acquired perforating dermatosis · Acrokeratosis paraneoplastica of Bazex · Acroosteolysis · Bubble hair deformity · Disseminate and recurrent infundibulofolliculitis · Erosive pustular dermatitis of the scalp · Erythromelanosis follicularis faciei et colli · Hair casts · Hair follicle nevus · Intermittent hair–follicle dystrophy · Keratosis pilaris atropicans · Kinking hair · Koenen's tumor · Kyrle disease · Lichen planopilaris · Lichen spinulosus · Loose anagen syndrome · Menkes kinky hair syndrome · Monilethrix · Parakeratosis pustulosa · Perforating folliculitis · Pili (Pili annulati · Pili bifurcati · Pili multigemini · Pili pseudoannulati · Pili torti) · Pityriasis amiantacea · Plica neuropathica · Poliosis · Rubinstein–Taybi syndrome · Setleis syndrome · Traumatic anserine folliculosis · Trichomegaly · Trichomycosis axillaris · Trichorrhexis (Trichorrhexis invaginata · Trichorrhexis nodosa) · Trichostasis spinulosa · Uncombable hair syndrome · Wooly hair · Wooly hair nevus
Sweat glands

Hidradenitis (Hidradenitis suppurativa, Recurrent palmoplantar hidradenitis, Neutrophilic eccrine hidradenitis)

eccrine: Miliaria (Miliaria crystalline, Miliaria profunda), Granulosis rubra nasi, Ross’ syndrome, Anhidrosis, Hyperhidrosis (Generalized, Gustatory, Palmoplantar)

apocrine: (Body odor, Chromhidrosis, Fox–Fordyce disease)

: SKA

anat//devp

noco/cong/tumr, sysi/

proc, drug(D10)