Acne is a disease rarely associated with systemic medical problems;
however, the importance and morbidity of acne should not be
underestimated because its disfiguring can have important negative
psychosocial consequences for affected individuals including
diminished self-esteem, social embarrassment, social withdrawal,
depression and even unemployment [1, 3].
Risk factors/Triggers
1. Food/Diet
Foods such as nuts, cola, milk, cheese, fried foods and iodised salts
have been implicated as triggers of acne vulgaris; however, the
connections between nutrition and acne has not definitely been proven
as they are rarely supported by good analytical, epidemiological or
therapeutic studies [4, 5]. On the other hand, recurrent acne as noted
by Niemeier et al (2006) may be a cutaneous sign of an underlying
eating disorder.
2. Genetics
A genetic background is supported by a case control study by Goulden
et al, as noted by Rzany et al (2006). This stated that the risk of
adult acne vulgaris in relatives of patients with acne as compared
with those of patients without acne is significantly higher [4].
3. Hormones
According to Rzany et al (2006), hormonal influences on acne vulgaris
are undisputed as shown by the higher incidence of acne in male
adolescents. Premenstrual flare has also been recorded as causing acne
[5].
4. Nicotine
Smoking has also been named as a risk factor for acne vulgaris;
however, conflicting data exists as to the link between smoking and
acne. Some population based studies have found links between smoking
and acne whilst some others have not [4].
Important!
Contrary to popular misconceptions by young patients and occasionally
their parents, acne does not come from bad behaviour nor is it a
disease of poor hygiene. It also has nothing to do with lack of
cleanliness [2].
Types of acne vulgaris
There are two main types of acne vulgaris, inflammatory and
non-inflammatory; these can be manifested in different ways,
1. Comedonal acne, which is a non-inflammatory acne
2. Papules and pustules of inflammatory acne
3. Nodular acne (inflammatory acne)
4. Inflammatory acne with hyperpigmentation (this occurs more commonly
in patients with darker skin complexions) [1]
Clinical manifestations
In general, acne is limited to the parts of the body, which have the
largest and most abundant sebaceous glands such as the face, neck,
chest, upper back and upper arms. Among dermatologists, it is almost
universally accepted that the clinical manifestation of acne vulgaris
is the result of four essential processes as described below [1, 6],
