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AcnePathogenesis of Acne

Acne Variants

  • Childhood acne: This may be of three forms: neonatal acne, infantile acne or early onset acne vulgaris.
    • Neonatal acne: This is very common and usually involves open and closed comedones, although some papules and pustules may also be present. The development appears to be related to hormonal activity in utero and will resolve spontaneously 1-3 months after delivery without evidence of scarring. No treatment is required except reassurance for parents who may be extremely anxious.
    • Infantile acne: This develops usually at 3-6 months of age and may be more extensive and inflammatory and does require treatment. It may resolve spontaneously or persist.
    • Early Onset Acne Vulgaris: In acne prone families, lesions may start to become numerous from the age of about 6 or 7 years and persist into adulthood. Exacerbation of the inflammation usually occurs at puberty but may precede this by several years.

      Particularly extensive or inflammatory acne in children should alert clinicians to the possibility of an underlying virilizing disorder.

  • "Follicular Occlusion Triad": This includes three variants, one or more of which may be present in individual patients. All represent a very inflammatory form of acne, and consist of: acne conglobata, hidradenitis suppurativa, and dissecting cellulitis.
    • Acne conglobata: This is a very serious form of inflammatory acne that is characterized by large cysts, large interconnecting comedones, draining abscesses and sinus tract formation. Extreme scarring is common and difficult to prevent. Aggressive treatment is essential.
    • Hidradenitis suppurativa: Chronic inflammatory variant, the areas principally affected are the axillae, groin, and perianal skin. The essential lesions are deep cysts and nodules and again sinus tract formation is possible. Scarring is again common and secondary infection can occur. In contrast to acne conglobata, women are involved more frequently than men.
    • Dissecting cellulitis of the scalp: Like acne conglobata, nodules, cysts, and interconnected sinuses are present, but in this case, within the scalp, and this may be accompanied by scarring and irreversible hair loss. Secondary infection is common. Aggressive treatment is required.


Acne fulminans
Acne fulminans

  • Acne fulminans: This a very rare variant characterized by the sudden onset of severely inflamed lesions and accompanied by systemic signs and symptoms including fever, arthralgias, anorexia, leukocytosis and occasional evidence for focal lytic bone lesions. The disorder typically occurs in young males and the common areas of involvement are the chest, shoulders and back where extensive crusting is also characteristic.

Acne excoriée
Acne excoriée

  • Acne excoriée: This is essentially mild acne that has been gouged, picked, scratched or otherwise attacked, invariably by the patient. The typical findings are of underlying mild acne with evidence for scratching and crusting on individual lesions. This may be so extensive as to disguise the underlying acne.



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