Acne Vulgaris: Pathogenesis and Management
Sidney Hurwitz MD1
1 Clinical Professor of Pediatrics and Dermatology, Yale University School of Medicine, New Haven, CT.
Acne, a problem well known to pediatricians and general practitioners alike, never should be dismissed as being of no consequence, with the reassurance that the patient will outgrow it. The psychological scars of individuals affected with severe forms of this disorder often are far deeper and more disastrous than the blemishes appearing on the cutaneous surface. For years the treatment of acne was hindered by: 1) mythical concepts of etiology, 2) a lack of concern for the physical and emotional trauma of those afflicted with severe forms of this disorder, and 3) the perpetuation of ineffective therapeutic regimens based on misconceptions and misinformation. Although the basic cause of acne remains unknown, considerable data concerning its pathogenesis and treatment accumulated in recent years now allow a rational and therapeutically successful approach to its management. Therapy must be individualized, however, with variations and modifications appropriate to the fluctuating severity of the disorder. Today, this goal can be achieved easily by proper selection of available medications, coupled with the cooperation of the patient and the knowledge, continued interest, and enthusiasm of the physician and his or her staff.
Etiology
Although generally considered a disorder of adolescence, acne vulgaris, a chronic inflammatory process at the pilosebaceous follicles, usually begins 1 or 2 years prior to the onset of puberty as a result of androgenic stimulation of the sebaceous glands.
