Acne Vulgaris Clinical Manifestation

How to diagnose acne vulgaris disease? The clinical symptoms of acne vulgaris reviewed from the history taking of the disease and findings on the patients’ physical check-up. Below is the explanation.

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How To Diagnose Acne Vulgaris

Acne Vulgaris History Taking
Acne vulgaris signs and symptoms: The local symptoms of acne vulgaris probably involve tenderness, pain, and also erythema. While systemic symptoms rarely occurs in acne vulgaris. In a rare but severe case, acne vulgaris is able to cause acne conglobata with severe inflammatory nodulocystic acne as well as interconnected abscesses. The Acne fulminans is even worse than acne conglobata. The acne fulminans is even followed by systemic symptoms such as joint pain, fever, and general malaise.

Patients who are suffering from PCOS or Polycystic Ovarian Syndrome often come to dermatologist for acne. With the long-term complications of malignancy, obesity, and infertility, PCOS has to be considered when a female patient comes with acne, especially with medium to severe acne in adulthood that is refractory to conventional therapies. Besides, a history of oligomenorrhea or less than 9 menstruations per year or amenorrhea for more than 3 months should increase further suspicion for PCOS.

Acne vulgaris can bring psychological effects on the patients, regardless of how severe or the level of the disease.

Acne Vulgaris Physical Examination
Acne vulgaris is characterized by comedones, papules, nodules, and pustules in the distribution of sebaceous. For example, the face, back, and upper chest. A comedone is whitehead or closed comedo or blackhead or open comedo without clinical signs of inflammation. On the other hand, papules and pustules are bumps with inflammation. The face is probably the only involved skin surface. While upper arms, chest, and back are often involved.

In comedonal acne, the patients develop closed or open comedones but probably not develop inflammatory nodules or papules.

comedonal acne pictures
picture of comedonal acne

While mild acne is characterized by comedones and some papulopustules.

pictures of mild acne scars
pictures of mild acne

Moderate acne involves comedones, inflammed papules, and pustules. Bigger numbers of lesions come than in milder inflammed acne.

moderate acne pictures
picture of moderate acne

Inflammatory lesions, comedones, and big nodules with more than 5mm diameter are the characteristics of nodulocystic acne. Moreover, it also often causes scars.

nodulocystic acne images
nodulocystic acne picture

Studies have found that women who suffer from PCOS have a little bit increased comedones in their forehead, jawline areas, or perioral. Otherwise, acne lesion counts, types, and regional burden are mostly the same between women with PCOS and women without PCOS. Other skin manifestations can also indicate PCOS, including signs of insulin resistance. For instance, acanthosis nigricans and additional signs of hyperandrogenism such as hirsutism and hair loss.

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Acne Vulgaris Differential Diagnoses

Some diseases below show symptoms and signs which are pretty similar to acne vulgaris. Those diseases are:
  • Acne Conglobata.
  • Acne Fulminans.
  • Acne Keloidalis Nuchae (AKN).
  • Acneiform Eruptions.
  • Dermatologic Manifestations of Tuberous Sclerosis.
  • Folliculitis.
  • Perioral Dermatitis.
  • Rosacea.
  • Sebaceous Hyperplasia.
  • Syringoma.

Acne Vulgaris Investgation Examination

Laboratory Studies
The diagnosis of acne vulgaris is clinical. Doctors should consider PCOS in female patients with hirsutism, acanthosis nigricans, and oligomenorrhea. These patients should be evaluated with total and free androstenedione, follicle-stimulating hormone values, testosterone, luteinizing hormone, dehydroepiandrosterone sulfate, glucose value, insulin level, and also a lipid panel.

Skin cuts cultures to rule out gram-negative folliculitis are needed if patients do not respond to long-term antibiotic medications or antibiotic improvement is not maintained.

Histologic Findings
The microcomedo is signed by a dilated follicle with a plug of dense keratin. With the development of the disease, the follicular opening becomes widen and open comedo results. The follicular walls become thin and may break. Follicular rupture is followed by dense inflammatory infiltrate in the entire dermis.

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