Acne Vulgaris pathogenesis & treatment

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Acne Vulgaris: Pathogenesis & Management

Acne Vulgaris is a multifactorial inflammatory disorder of the pilosebaceous unit. Understanding the four key pathogenic pillars is essential for targeted therapy.

The Four Pathogenic Pillars

  1. Increased Sebum Production: Androgen-stimulated sebaceous gland hypertrophy.
  2. Follicular Hyperkeratinization: Obstruction of the follicular canal (comedone formation).
  3. Microbial Colonization: Proliferation of Cutibacterium acnes (anaerobic).
  4. Inflammatory Response: Immune reaction to bacterial antigens.

Treatment Strategy

Severity First-Line Treatment
Mild (Comedonal) Topical Retinoids (e.g., Tretinoin, Adapalene).
Moderate (Inflammatory) Retinoid + Benzoyl Peroxide (BPO) +/- Topical Antibiotics (e.g., Clindamycin).
Severe (Nodulocystic) Oral Isotretinoin (or Oral Antibiotics + Topical Retinoid).
High-Yield Exam Pearl:

  • Benzoyl Peroxide (BPO): Use it to prevent antibiotic resistance when topical antibiotics are used.
  • Isotretinoin: Absolutely teratogenic; requires strict birth control (iPLEDGE program).
  • Antibiotics: Oral Doxycycline/Minocycline are effective, but never use as monotherapy—always combine with a topical retinoid to maintain results.