Acne vulgaris

Patients with acne vulgaris often report a history of persistent skin lesions, commonly on the face, back, or chest. They may describe blackheads, whiteheads, or painful pustules, especially during hormonal changes like adolescence, menstruation, or periods of stress. Some patients may mention family history or prior ineffective treatments. 

Risk factors include genetics, hormonal shifts, and oily skincare products. Complications may involve scarring and hyperpigmentation, with prognosis often depending on early, consistent treatment adherence. 

Typical findings include a mix of comedones, papules, pustules, and nodules. In Black patients, post-inflammatory hyperpigmentation is common, which may complicate the aesthetic impact of acne even after lesion resolution. Severe cases may show cystic formations leading to possible scarring and keloid formation. 

Treatments for acne vulgaris range from topical agents to systemic therapies based on severity:

Topical Retinoids (e.g., Tretinoin 0.025%-0.1%): Apply once daily; useful for comedonal acne and mild inflammatory lesions.

Benzoyl Peroxide (2.5%-10%): Available as wash or leave-on gel; reduces bacterial load. Use daily to avoid irritation.

Antibiotics (e.g., Clindamycin 1% gel): Combine with benzoyl peroxide to prevent resistance, applied once daily.

Oral Antibiotics (e.g., Doxycycline 100mg daily): Effective for moderate to severe cases. Course duration should be minimized to 3-6 months.

Hormonal Agents (e.g., Oral contraceptives): Suitable for females with hormonal influences; requires assessment of risk factors.

Isotretinoin (0.5-1 mg/kg/day): For severe, resistant acne; duration typically 5-6 months under close monitoring. Note: Isotretinoin is teratogenic; women of childbearing age must use contraceptives!! Dapsone is a cheaper alternative worth trying if no isotretinoin available.