Acne vulgaris. Diagnosis How severe your acne is will determine where you should go for treatment and what treatment you should have.

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1 Acne vulgaris Acne is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms. Acne is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19 puberty age Acne most commonly develops on the: face this affects almost everyone with acne back this affects more than half of people with acne chest this affects about 15% of people with acne Types of spots There are 6 main types of spot caused by acne: blackheads small black or yellowish bumps that develop on the skin; they're not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (coloring) whiteheads have a similar appearance to blackheads, but may be firmer and won't empty when squeezed papules small red bumps that may feel tender or sore pustules similar to papules, but have a white tip in the center, caused by a build-up of pus nodules large hard lumps that build up beneath the surface of the skin and can be painful Cysts the most severe type of spot caused by acne; they're large pusfilled lumps that look similar to boils and carry the greatest risk of causing permanent scarring. Risk factors include genetics, the menstrual cycle, anxiety and stress, hot and humid climates, using oil-based makeup, and squeezing pimples. Diagnosis How severe your acne is will determine where you should go for treatment and what treatment you should have. The severity of acne is often categorized as: Mild mostly whiteheads and blackheads, with a few papules and pustules. Moderate more widespread whiteheads and blackheads, with many papules and pustules.

2 Severe lots of large, painful papules, pustules, nodules or cysts; you might also have some scarring. Acne in women If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if it's accompanied by other symptoms such as: Excessive body hair (hirsutism). Irregular or light periods. The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests. The approach to acne management is largely determined by: Severity index. Lesion type: predominantly non inflammatory or inflammatory. Treatment preferences including patient choices. Cost implications. Skin type and/or ethnic group. Patient age. Adherence. Response to previous therapy. Presence of scarring. Psychologic effects. Family history of persistent acne. Non pharmacological Diet: It is unclear what role diet plays in worsening acne. Scientists have found that people who consume a diet that offers a good supply of vitamins A and E and of zinc may have a lower risk of severe acne. But suggests that a diet with a low glycemic load may help. Tea-tree oil: may help treat mild to moderate acne. Tea: There is some evidence that polyphenols from tea, including green tea, applied in a topical preparation, may be beneficial in reducing sebum production and treating acne. However, the compounds in this case were extracted from tea, rather than using tea directly. Moisturizers: These can soothe the skin, especially in people who are using acne treatment such as isotretinoin, say researchers. Moisturizers containing aloe vera at a concentration of at least 10 percent or witch hazel can have a soothing and possibly anti-inflammatory effect.

3 Desired Outcomes (Goals of Treatment) Basic goals of treatment include alleviation of symptoms by reducing the number and severity of lesions and improving appearance, slowing progression, limiting duration and recurrence, prevention of long-term disfigurement associated with scarring and hyperpigmentation, and avoidance of psychologic suffering. Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.

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10 References: 1. DiPiro J, Talbert R, Yee G, Matzke G, Wells B, Posey L. Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York: McGraw-Hill; Chapter 96, Acne Vulgaris; P Marie A. Chisholm-Burns, Patrick M. Malone, Terry L. Schwinghammer, Jill M. Kolesar, Barbara G. Wells, Joseph T. DiPiro. Pharmacotherapy Principles & Practice. 4 th ed. New York: McGraw-Hill; Chapter 65, Common Skin Disorders; P Acne [Internet]. nhs.uk; [cited 2018 Sep 26]. Available from: 4. Management of acne guidelines [Internet]. Slideshare.net: Sukviwatsirikul.U; 2016 [cited 2018 Sep 26]. Available from: ?from_action=save Prepared by pharm D student: Raya Marashdeh& Wa ad Tahat Supervised by pharm D : Eshraq Al-Abweeny