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KMID : 0378019990420030052
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New Medical Journal
1999 Volume.42 No. 3 p.52 ~ p.68
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Acne Prevention and Treatment Research
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김문주/Kim Moon Ju
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Abstract
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-Abstract-
Inflammatory reactions in the sebaceous follicles are quite common and usually are
accompanied by formation of papules, pustules, and abscesses-especially in areas where
sebaceous glands are large, such as the face, chest, and upper back.
Acne is a disease of a specific pilosebaceous structure known as the sebaceous
follicle, which is characterized by a wide follicular canal (the orifice is visible on the
skin surface), a short vellus hair, and large, multiacinar sebaceous glands.
Primarily a disease of teenagers, acne is not restricted to adolescence and may be
seen much later, particularly in women, in whom it is common in the third decade.
Acne affects 70-80% of all individuals in their second and third decades. The disease is
slightly more common in males, as is severe involvement. Cosmetic disfigurement
frequently results in emotional problems.
While there have been reports of greater and lesser incidence in various regions, this
has not been proved; the reported differences may be related to differences in the
socioeconomic acceptance of disease.
There is no method of preventing acne vulgaris.
precipitation exogenous agents should be avoided when possible.
Priciples of therapy is that reverse the altered pattern of keratinization within the
follicle; decrease the intrafollicular P acnes population or the generation of extracellular
inflammatory agents; decrease sebaceous gland activity. Decrease inflammation.
Specific Agents
Topical therapy;
Vitamin A acid is indicated chiefly for comedonal acne, it also has some benefit in
inflammatory acne and helps to prevent inflammatory lesions as they arise from
comedones.
Salicylic acid is comedolytic but probably not as effective as vitamin A acid. It may
be of particular use in patients intolerant of vitamin A acid.
Benzoyl peroxide is an exremely effective topical antibacterial agent; topical application
results in marked suppression of P acnes.
Sulfur and resorcinol;
These agents are found in a few over-the-counter preparations. Their mechanism of
action is unknown.
Topical antibiotics;
Tetracycline, erythromycin, clindamycin, and meclocycline have been used topically for
acne. Their effect, as with benzoyl peroxide, is antibacterial.
Physical therapy
Acne surgery; Surgery removes open comedones, closed comedones, and sometimes
the very small pustules.
Intralesional therapy
The direct injection of corticosteroids intralesionally (eg. triamcinolone acetonide,2.5-5
㎎/mL) has an anti-inflammatory effect and is of great benefit in reducing inflammation
in nodulocystic lesions.
Ultraviolet light
This therapy has been used commonly to mask erythema.
Systemic therapy-
Antibiotics
Ten percent of all tetracycline sold in the USA is used for acne. The major effect is
probably antibacterial.
Dapsone
This drug has been used for treatment-resistant disease with variable but in some
cases excellent results.
Corticosteroids
Systemic corticosteroids have 2 mechanisms of action. Systemic corticosteroid therapy
is of great value in the management of patients with acne fulminans.
Sebum-suppressive agents
Because sebum is essential in the pathogenesis of the inflammatory disease, methods
of inhibiting sebaceous gland activity have been used to control the disease, including
corticosteroids.
Oral retinoids
Orally administered 13-cis-retinoic acid (isotretinoin) is very effective in trite
management of patients with severe nodulocystic acne unresponsive to other-treatment
regimens.
The course of acne varies greatly. Untreated acne probably lasts for about 7 years,
but the duration can easily be influenced by environmental factors. The prognosis is
excellent in most cases, but when acne is severe, considerable scarring may result
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