R.Kraft, PharmD Acne Review August 2007

August 2007

Basic Acne Pharmacotherapy
1. Review of Clinical Features
Affected population

~80% of all persons aged 11 to 30 years are affected at some point in time.
~14% of these people will consult their PCP
~12% of female, 3% of male population continue to acne until the age of 44


Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which is notable for
open and/or closed comedones (blackheads and whiteheads) and inflammatory lesions including
papules, pustules, or nodules. It tends to be most active for 2 – 3 years in mid-adolescence. In
addition to the physical attributes of acne, studies have demonstrated a significant psychological
and social factor including direct links with anxiety, depression, social isolation and interpersonal
difficulties. Therefore, these aspects of the disease should not be overlooked or taken lightly.


Complete pathogenesis is not understood, yet, at least 4 events lead to acne lesion formation.
ƒ Androgen-mediated stimulation of sebaceous gland activity
ƒ Abnormal desquamation of ketinocytes within the pilosebaceous unit, leading to follicular
plugging (comedo formation)
ƒ Proliferation of Propionibacterium acnes (gram+ and normal flora)
ƒ Inflammation
The accumulation of cells and sebum, via
above events, results in the formation of
the microcomedo, which is the initial step
in all acne lesions (inflammatory and noninflammatory).
The relative contribution of these factors
determines whether the lesion will be:
ƒ Non-inflammatory
9 open comedo, ’blackhead’
9 closed comedo,
ƒ Inflammatory
9 Papule, pustule, nodule
Severity of acne related to interactions
a) normal, b) blackhead (open comedone), c) whitehead
between the bacterium and antibody,
(closed comedone), d) papule, e) pustule
complement, and cell mediated immune responses, not to...

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