Mild Papular Acne
- Definition: a chronic inflammatory
disorder of the pilosebaceous unit. The presence of a "comedone"
(follicular plug) is essential for the diagnosis.
- Clinical Features:
- Acne vulgaris and its variants do not exist in the absence
of comedones (see pathogenesis).
- A comedone is a plug that occurs in the follicle (pore)
and these are visible either as black dots (blackheads) or small white papules
- The black in the blackheads was originally thought to be
due to melanin but this is no longer obviously correct and the origin is uncertain. It is
- Comedones can generally be safely removed with the gentle
application of a "comedone extractor", and this may be a useful maneuver in
- Variation of the associated inflammatory response
determines the variety of the lesions found in acne. These vary from papules and pustules
at the milder end of the inflammatory spectrum to deep seated nodules, cysts and
connecting sinuses at the more severe end.
- Some lesions may show evidence for scratching
(excoriation) and crust formation which also indicates manipulation by the patient.
- The distribution of acne corresponds to the distribution
of the so-called "sebaceous follicles"; that is, hair follicles having very
large sebaceous glands and small hairs. These are characteristically found on the face,
chest and back.
- Individual patients, however, tend to have their own
patterns of involvement in one or more of the three areas, and within areas, there may
also be selective involvement such as the forehead, the jaw line or the presternal skin.
- Comedones develop slowly and persist for long periods of
time (on the order of months), whereas inflammation is more variable. Persistent
inflammation leads to scarring.
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