Incidence , Prevalence , and Pathophysiology of Acne * —

Acne is the most common dermatologic condition encountered in clinical practice, affecting nearly all adolescents and young adults to some degree. The pathophysiology of acne is complex. Increased sebum production by sebaceous glands and abnormal desquamation of hair follicles occur in response to increasing androgen levels with the onset of puberty. Obstruction of follicles causes follicular distention, which is often accompanied by the proliferation of the bacteria Propionibacterium acnes and the activation of an inflammatory response. Although the diagnosis of acne is usually straightforward, some conditions are occasionally confused with acne, including periorificial dermatitis, keratosis pilaris, angiofibromas, bacterial folliculitis, and demodex folliculitis. In addition to physical discomfort, acne is associated with considerable psychological distress, limitation of activities, and increased risk of depression and suicide. The relationship between acne and diet is controversial. Some studies have demonstrated that diets that are high in minimally processed plant or animal foods or low in highly processed carbohydrates are associated with lower rates of acne, although other studies have failed to demonstrate important differences in diet between subjects with and without acne. Recent research suggests that some dairy products may increase acne risk during adolescence. (Adv Stud Med. 2008;8(4):100-105) A cne vulgaris is the most common skin condition that is treated by physicians, accounting for more than 14 million office visits per year. Acne typically appears for the first time during early adolescence, and is present to some degree in approximately 85% of individuals between the ages of 15 and 17 years. The first acne lesions often appear before the emergence of secondary sexual characteristics, and are one of the earliest signs of impending puberty. Acne presents several significant challenges, including a complex etiology, concerns about antibiotic resistance, and the potential for scarring. The effects of acne are not limited to the skin—acne lesions among adolescents and young adults generally occur at a time of heightened emotional sensitivity, and may contribute to significant psychological distress, depression, and even increased risk of suicide. ACNE PATHOPHYSIOLOGY AND CLINICAL PRESENTATION The pathophysiology of acne is a multifactorial process that begins with the obstruction of the piloseba*Based on proceedings from a satellite symposium held during the American Academy of Pediatrics Annual Meeting on October 28, 2007, in San Francisco, California. †Head, Division of Pediatric Dermatology, Children’s Memorial Hospital, Associate Professor of Pediatrics and Dermatology, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois. Address correspondence to: Anthony J. Mancini, MD, FAAP, Head, Division of Pediatric Dermatology, Children’s Memorial Hospital, Box 107, 2300 Children’s Plaza, Chicago, IL 60614. E-mail: [email protected].