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Acne & Acneiform EruptionsIntroduction

Sebaceous glands develop in the human body along withthe hair and, hence, constitute the pilosebaceous unit.In some situations, the hair is lost and only the glandremains, eg, on the prepuce and on the nose. The mainfunction of sebaceous glands is production of a materialcalled sebum which has anti-bacterial and anti-fungalproperties. One of the important constituents of sebumis fatty acids. These glands are distributed maximally onthe scalp, face, axillae, chest and back. Diseases particular to sebaceous glands are maximally located inthese areas. The glands are hormonally controlled,being stimulated by androgens and progesterone andinhibited by oestrogens. They, therefore, function mostfrom puberty onwards. This is approximately the timewhen acne first appears.Acne begins with formation of a plug in the pilosebaceous opening described as a comedone (blackhead). It appears black because of oxidative changes inmelanin and dirt accumulated from the outside environment. Should skin grow over the pilosebaceous opening,it may appear as a whitehead. Blackheads, and theirvariation whiteheads, should be considered within thephysiological range of normality. With secondarybreakdown of fatty acids by lipases contained in bacteria and fungi, inflammation in these comedones occursand the acne is then described as inflammatory acne.This may go on to pus formation or develop into cysts

(pilar cysts), which, owing to secondary infection, giverise to abscesses tunnelling below the skin surface of theaffected sites. Lesions of acne may occur along withhydradenitis of the axillary region or wherever apocrineglands occur. Severe degrees of acne are seen with XYYchromosomal combinations and with immunoglobulindeficiencies. Healing of acne, particularly on the chest,may be accompanied by keloidal changes.Rosacea is a disorder characterised by easy ability toblush, which ultimately leads to forms of erythema andhyperplasia of skin tissue, eg, rhinophyma. Rosaceatends to be produced with emotional disturbances and isaggravated by solar exposure in the tropics and the miteDemodexfolliculorum, hence, the often dramaticrespons~ to the application of crotamiton. Rosacea andacne may overlap and may at times simulate each other.The treatment of acne is based on control of bacterial population on the face with systemic administrationof tetracyclines, erythromycin, cotrimoxazole andadequate local therapy. Oral retinoeic acid is advised inthe most severe form of disease. Surgical drainage ofabscesses, removal of comedones and use of peelingagents should be considered. Avoiding contact withmineral oils as in the treatment of oil acne or stoppingthe administration of corticosteroids in steroid-inducedacne are the specific measures carried out in thesesituations.

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Acne & Acneiform Eruptions8.1 Acne vulgaris (grade I)

Oily face with follicular plugs described asblackheads and called comedones.8.2 Acne vulgaris - papular (grade II)

Small, erythematous folliculopapules on the face.Note the scarring, suggestive of recurrent attacks.

8.3 Acne vulgaris (grade II)Erythematous, papular and pustular lesions onthe chest. Lesions at this site, if irritated, tend tobeconie keloidal.8.4 Papulopustular acne (grade II)Inflamed papules and pustules over the face are

associated with scarring.

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Acne & Acneiform Eruptions

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8.5 Acne vnlgaris - advanced stageMultiple papular and pustular lesions along witha few comedones, abscesses and scars of healedlesions. All stages of acne are present in thispicture, hence, the difficulty in grading thedisorder.

8.6 Acne (grade III)Severely inflamed, widespread acne withscarrmg.

8.7 Acne vnlgaris (grade IV)Prominent pustular acne. Note the grouping andcoalescence.

8.8 Acne vnlgaris - nodnlopnstnlar (grade IV)The differential diagnosis of this is pyodermafaciale.

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Acne & Acneiform Eruptions3.9 Acne vulgaris - dominantly nodularNote the inflammatory nodules on the face.Shaving becomes difficult for such patients.3.10 Keloidal acne

Keloids developing in a milieu of acne. This formof keloidal change following acne is common inthe coloured population. Acne need not reachnodulo-cystic proportions to produce this effect.

3.11 Oil acneProminent follicular papules on the forearm of amotor mechanic. The most common cause of oilacne is contact with cutting oil and petroleumproducts, thus constituting an occupationalhazard. Vegetable oilsmay rarely produce this.

3.12 Oil acneFollicular papules, comedones and pustules overthe thigh of a motor mechanic. Note the brokenhair, a result offriction.

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Acne & Acneiform Eruptions

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8.13 Steroid acneFolliculopapular acneiform eruptions on thetrunk and arm of a subject on systemiccorticosteroid therapy.

8.14 RosaceaErythematous, papular and nodular lesions onthe face. Note telangiectasia on the tip of thenose.

8.15 Acne mimicking rosaceaMultiple, erythematous papules and pustules ofacne mimicking rosacea.8.16 RhinophymaThis may be the result of long-standing rosacea orarise sui generis and probably has nothing to do

with alcoholism. Demodex folliculorum is oftenisolated from these follicles.