The Acnes Jayakar Thomas, Parimalam Kumar, Deepthi Ravi
INDEX
Page numbers followed by b refer to box f refer to figure and t refer to table.
A
Acanthosis nigricans 10, 45f, 58f, 95f, 96f, 103f, 104f, 105107
Acetic acid peels 136
Acne 1, 8f, 9f, 10, 11, 13, 23, 31f, 37, 40, 41f-44f, 53, 54f, 64, 68, 73, 75, 83f, 84f, 90f, 92f, 96f, 97f, 103f, 106108, 110, 116b, 119, 125b, 128
adolescent 2, 63t
adult onset 22, 53, 62b, 63t
aestivalis 53, 68, 78, 114
aggravator of 8f
agminata 114
assessment of 101
psychosocial effects of 39
causation of 21b
childhood 40, 41f, 89, 89f, 111
chronicity of 9f
classical nodulocystic 33f
classification of 2, 2t
coal 65, 67
comedonal 8f
complications of 93, 99f
conglobata 53, 55f, 61f, 64, 76, 112
cosmetica 53, 67, 68
cysts 33f
detergent 67
development of 3, 11f
diabetic mimicking 84f
diet in 135
differential diagnosis of 82
drug-induced 53, 70
drugs used in 110
early onset of 90f, 106
endocrine 10
environmental factors influencing 13b
eruption 62f
etiology of 3f
etiopathogenesis of 3, 11, 11b
excoriée 53, 56f, 68, 92f, 114
facial 97f
flare 125
folliculitis mimicking pustular 85f
fulminans 12, 22, 23, 53, 64, 105, 112, 123, 125
genetic influence in 12
grading of 39, 46, 47, 116
granulomatous 53, 69, 114
histoclinical correlation of 22f
history of 89f, 131f
hormonal 40, 82, 129
therapy in 130t
in pregnancy 53, 81
infantile 2, 40, 89, 111
inflammatory 6f, 8f, 60f, 97f
lesions of 49f
papules of 83f
inverse 53
keloidalis nuchae 53, 61f, 76, 115
late onset 53, 128
lesions 84f
major pathogenic factors in 3b
management of 131
mechanica 53, 66
mid-childhood 2, 40, 45f, 46, 93
mild 33f, 34, 45f
mild-to-moderate 34f, 64
mimicking 85f
moderate 34f, 45f, 53, 123
neonatal 2, 21, 40, 89, 111
neoplastic conditions mimicking 88
neurophysiology of inflammation in 21
nodulocystic 95, 123
occupational 53, 65, 67t
oil 65, 114
on replacement therapy 54f
over male back skin 5f
papules 44f, 56f, 86f, 98f
excoriation of 59f
milia mimicking 85f
trauma of 59f
pathogenesis 18, 18f
pathogenic factor in 41f
pathophysiology of 22b
pediatric 22
penile 53, 79
persistent 104f
nodular lesions of 32f
pitch 53, 65, 114
pitted scar of 110f
pityrosporum 123
pomade 53, 65, 67
premenstrual flare of 14
prepubertal 2, 23, 41f, 46
presence of 106
propionibacterium 3, 11, 16, 19, 110
psychological effects of 100
pustules 84f
quality of life
four-item index 39
scale 39
radiation 53, 67, 114
recalcitrant 106
resistant 98f
role of genetics in 12b
rosacea 22, 24, 53, 61f, 77, 123
scarring, punch techniques for 145
scars 38, 94f, 145
severe 7f, 9f, 27, 35f, 103f
steroid 70, 71t
tarda 53
telltale evidence of 36f
temporal 32f, 43f
therapy resistant 33f
topical treatment in 120
treatment of 110f-113f, 113t, 115
tropical 53, 67, 114
truncal 30f, 91f, 93, 97f, 104f
types of 40, 80
unilateral 87f
variants 40, 53, 53b, 123
varioliformis 53, 76, 115
venenata 56f, 67
very severe 35f
vulgaris 1, 40, 44f, 46, 47, 49f-52f, 53, 66, 66t, 71t, 89, 89f, 93, 93b, 131, 132
early pustular lesion of 48f
papulopustule of 50f
with menstrual irregularity 96f
Acneiform eruption 53, 57f, 79, 79b
drugs inducing 17b
Acneiform lesions, drug-induced 114
Acneiform nevi 53, 81
Acneiform papules, development of 68
Actinomycin D 17
Adapalene 119, 120, 134
Adrenarche
exaggerated 10
premature 10
Adrenocorticotropic hormone 10, 17
stimulation test 107
Alcohol 14
Allantoin 119
Alopecia 10, 107, 125, 128
patterned 10
Amenorrhea 107
Amineptine 17
Amoxicillin 121, 134
Anaphylactic reaction 125
Androgen
excess 106
receptor blockers 129
secreting tumors 63, 107
Androgenetic alopecia 28f, 33f, 105, 106
Androstenedione 106
Angiogenic factor, platelet-derived 143
Ankles 64
Anorexia nervosa 10
Antiandrogen therapy 129f
Antibiotic 116
topical 113, 116, 116b, 119
Anticonvulsants 62, 70
Antiepileptics 62
Anti-inflammatory agent 135
Antimicrobial peptides 25
dysfunction of 24
Anxiety 125
APAAN (acne, patterned alopecia, acanthosis nigricans) syndrome 10, 53, 58f, 59f, 72, 73, 96f
Apert's syndrome 10, 12, 53, 72, 73, 123
Arthralgia 73, 125
Arthritis 73, 126
pyogenic 12, 53, 64
Aryl hydrocarbon 15
Atrophic perifollicular macules 26
Axillary hair, early development of 106
Azelaic acid 116, 118120, 134
Azithromycin 121, 134
B
Back pain 125
Bacterial pustular eruption mimicking acne 83f
Benzoyl peroxide 111, 113, 116, 118120, 132, 134
face wash 109f
Biphenyls
polychlorinated 15
polyhalogenated 15
Birth weight 11, 13
Blepharophyma 77
Blood
cholesterol 125
dyscrasias 122
glucose 125
sugar 106, 107
Blue light therapy 136
Body dysmorphic disorder 53, 68, 69
Body mass index 11, 13, 46
Body odor, early onset of 106
Bone
age 46
advanced 106
biopsy 105
pain 64, 73
Bowel disease, inflammatory 126
Box scars 26, 38
Breast tissue, lesions over 60f
Buserelin 17, 70
C
Cabergoline 17, 70
Calcinosis 126
Calcium
antagonist 17, 70
channel blockers 62
Candidiasis 82
Carbamazepine 17, 62, 70
Carbon dioxide laser 144
Cardiff acne disability index 39
Cataract 126
Cephalexin 121, 134
Cephalic pustulosis, benign 40
Cesarean section 63
Cetuximab 17, 70
Cheilitis 97f, 125
Chest pain 73
Chloracne 65, 66, 66t, 67, 104, 105
chemical inducing 15b
lesions 114
Chlorobiphenyls 65
Chloronaphthalene 65
Cisplatin 17
Clindamycin 116, 119, 120, 134
Clitoral enlargement 46
Clitoromegaly 105, 106
Clofazimine 17, 62, 70
Coccidioidomycosis 79
Colloid milia 82
Color blindness 126
Combination therapy 119
Comedogenesis 5f, 6f
Comedones 5f, 8f, 31f
extraction 136, 137
over back 30f
papule pustule 28f
types of 37b
Complementary therapy 135
Complete androgen insensitivity syndrome 10
Comprehensive acne severity system 39, 101, 102t
Conjunctivitis 125
Contact lens intolerance 126
Convulsions 126
Corneal opacity 126
Corticosteroid 17, 62, 129
intralesional 137
Cortisol 106
Cosmetic 11, 15, 79
chronic use of 15
intolerance syndrome 81
Cranial nerve paralysis 73
C-reactive protein 105
Creatine phosphokinase 126
Crohn's disease 64
Cryoslush 136
Cryotherapy 137
Cushing's syndrome 10, 106, 107
features of 107
Cyclooxygenase 20
Cyclophosphamide 17
Cyclosporine 17, 62, 70
Cyproterone acetate 119, 129131
Cystic lesion 32f, 84f
classical 33f
Cysts 88
aspiration of 138
drainage of 138
epidermoid 75
D
Dactinomycin 62, 70
Danazol 17, 70
Dantrolene 17, 70
Dapsone 116, 119121, 134
Darier's disease 82, 86f
papules of 86f
Deep irregular scars 55f
Dehydroepiandrosterone 22, 106
sulfate 23, 93, 106, 107
Demodex folliculorum 25
Depression 125
Dermabrasion 138, 139
Dermal matrix degeneration 24, 25
Dermaroller 136, 141
Dermatitis, perioral 79
Dermatology life quality index 101
Dermatosis
chronic inflammatory 24
papulosa nigra 83f
Dexamethasone suppression test 107
Diabetes 96f, 128
Diarrhea, chronic 73
Dibenzofurans, polychlorinated 15
Disulfiram 17, 70
Dizziness 126
Doxycycline 121, 122, 134
Drospirenone 127
Drowsiness 126
Dry eyes 125
Dry skin 125
Ductal hydration 9f
Ductal hypercornification 3f
Dysmenorrhea 107
E
Eating disorder 69
Edema 73
Endocrine
abnormality 42f, 44f, 45f
evaluation 45f
tests 105
workup 106, 106b
Enthesitis 73
Enzyme production 21
Eosinophilic pustular folliculitis 79
Epidermal barrier
dysfunctions 132
impairments innate to acne 132
Epidermal growth factor receptor
antagonists 17
tyrosine kinase 80
Epidermis 26
Epiphyseal fusion, premature 126
Epistaxis 125
Epithelial growth factor 143
Erbium: yttrium-aluminium-garnet 139
Erlotinib 17
Erythema 35f, 93
Erythematotelangiectatic rosacea 77
Erythrocyte sedimentation rate 105, 125
Erythromycin 116, 119122, 134
Esophagitis 122
Estrogen 106
Ethinyl estradiol 127, 131
Ethylenediaminetetraacetic acid 143
Exanthem 122, 126
Exostosis 126
Eye irritation 125
F
Facial
edema 59f, 75
solid 53, 100, 115
erythema 126
palsy 87f
skin 5f
Famotidine 17, 70
Fatty acids, polyunsaturated 13
Favre-Racouchot syndrome 67
Ferritin expression 24, 25
Ferrous fumarate 127
Fertility anovulation 107
Fever 107
Fluoroquinolone 116
Fluorouracil 17
Flutamide 128, 130
Follicle ruptures 104
Follicle-stimulating hormone 98, 103f, 108
Follicular
ducts 6f
epidermal hypercornification 3, 11, 16, 110
epithelial metaplasia, ionizing radiation induces 16
occlusion tetrad 76, 76t
wall, hyperproliferation of 8f
Folliculitis
bacterial 82
gram-negative 53, 67, 79, 114
Follitropin alfa 17, 70
Fractional lasers 144
Fracture, recurrent 73
G
Gabapentin 17, 70
Ganciclovir 17, 62, 70
Gefitinib 17
Genetic clotting factors 128
Genital maturation, advanced 106
Genitalia, external 75
Glomerulonephritis 126
Glucose tolerance test 96f
Glycolic acid 138
Gnathophyma 77
Gonadotropin-releasing hormone agonists 131
Granuloma, pyogenic 100, 115, 126
Granulomatous rosacea 78
Growth
accelerated 106
chart 46
factor
insulin-like 13, 106, 143
platelet-derived 143
factor-beta, transforming 12, 143
hormone 106
H
Hair cyst, eruptive 79
HAIR-AN (hyperandrogenism, insulin resistance, and acanthosis nigricans) 10, 72
Halogen 17, 70
Headache 122, 125, 128
Hearing, impaired 126
Heart disease 128
Helicobacter pylori 25
Hematuria 125
microscopic 24
Hepatic systems 65
Hepatitis 122, 126
Hepatotoxicity 126
Hidradenitis suppurativa 59f, 60f, 7476, 76t, 123
axilla mimicking 84f
Hips 64
Hirsutism 10, 42, 104f, 105107, 126, 128
Hormonal therapy 54f, 109f, 127
Hormone 11, 13, 16, 17, 70
luteinizing 98f, 103f, 106
profile 106, 107
Human growth hormone 17
Human leukocyte antigen 12
Hydrating gel 119
Hydroxyprogesterone 106
Hyperandrogenism 96f
Hyperinsulinemia 10
Hyperostosis 64, 73, 126
Hyperplasia
adrenal 54f
congenital adrenal 63, 106
nonclassical congenital 53
adrenal 10, 106, 107
Hypersensitivity reaction 125
Hypertension 107, 128
intracranial 122
Hyperuricemia 126
Hypervitaminosis A 126
I
Ice-pick scars 10f, 26, 38, 95f
Ileitis 126
Immunity, innate 21
Infertility 106, 107
Inflammation 3, 11, 110
pathophysiology of 20
recurrent 29f
Inflammatory lesions 37, 48f, 51f, 53
prepubertal midfacial 93
Insomnia 14
Insulin 106
resistance 10, 106, 107
serum 106, 107
Isoniazid 17, 62, 70
Isopropyl myristate 5f
Isosorbide mononitrate 17, 70
Isotretinoin 119, 120, 125
K
Keloidal scar 26, 55f, 95f
Keloids 38
Keratinocytes
ductal 4f
retention of 4f
Keratitis 126
Keratosis pilaris 82
Keratotic papules 31f
L
Lapatinib 17
Large intestine inflammation 73
Laron syndrome 10
Lasers 136, 139
Lesions
cutaneous 36
nodulocystic 33f, 50f, 55f
noninflammatory 37
noninflammed 31f
osteolytic 64
types of 47, 102
Leukemoid reactions 105
Leukocytosis 105
Levomefolate 127
Libido 105
Light electrodessication 136
Lipoprotein, high-density 125
Lithium 17, 62, 70
Liver disease 128
Lupus erythematosus 122
Lymecycline 121, 122, 134
Lymphadenopathy 126
Lymphatic system 126
Lymphoma 79
M
Macrocomedones 3f, 37
Macule
erythematous 26
pigmented 26
Mandelic acid peels 136
Mayer-Rokitansky-Küster-Hauser syndrome 10, 74
Medroxyprogesterone 17, 70
Menarche, age of 46
Menstrual abnormality 106, 107
Menstrual cycle
and pregnancy 11
irregular 106
Menstruation 14
Mesalazine 17, 70
Methotrexate 17
Metophyma 77
Metronidazole 116
topical 116
Microbial organisms 24, 25
Microbiologic tests 102
Microcomedone 42f
Microdermabrasion 136, 138, 139
Microneedle fractional radiofrequency 136, 142
Migraine 128
Milia, skin colored papules of 85f
Miliaria rubra 82
Minocycline 116, 121, 122, 134
induced pigmentation 94f
therapy 94f
Mitogen-activated protein kinase inhibitors 17
Moisturizers 133
Molluscum contagiosum 83f
Mood alterations 125
Musculoskeletal discomfort, mild 100
Myalgia 125
Myocardial infarction 128
Myofibroblasts 26
N
Nadifloxacin 116, 119
Nail dystrophy 126
Nandrolone 17, 70
Naphthalenes, polyhalogenated 15
Nasal crease, pseudoacne of 53, 68
Nasal dryness 125
Nasopharyngitis 125
Nausea 126
Neoangiogenesis 25
Nervous system 125
Neutropenia 125
Nevus comedonicus 79
Nicotinamide 119
topical 119, 135
Night vision 126
Nilvadipine 17, 62, 70
Nodular lesions 33f
Nodules 48f, 88
Nonsteroidal anti-inflammatory
agents 135
drugs 111
Norethindrone acetate 127
Norgestimate 127
O
Obesity 98f, 106, 128
central 107
earlier onset of 1
truncal 106
Oligomenorrhea 97f, 103f, 104f, 107
persistent 98f, 106
Open comedones 37, 42f
Oral contraceptive 127
pill 16, 113, 131
combined 119, 127, 127b
Oral isotretinoin 119
mechanism of action of 124f
Oral retinoids 97f, 134
complications of 126t
indications for 123b
Oral tetracyclines 119
Osteitis 64
Osteolysis 73
Osteoma cutis 100, 115
Osteomyelitis 73
Osteopenia 126
Osteosclerosis, craniofacial 73
Otophyma 77
Ovarian hyperandrogenism 128
Ovulatory dysfunction 106
Oxytetracycline 120, 134
P
PAC syndrome 72
Pain 99
abdominal 107
Palmoplantar pustulosis 73
Pancreatitis 122, 126
Panitumumab 17
PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndromes 10, 12, 53, 72, 74, 115
PAPASH syndrome 72
Papilledema 126
Papules 38, 48f
erythematous 48f
noninflammatory 31f
retroauricular 55f
Papulopustular eruption
epidermal growth factor receptor-induced 115
grading of 80t, 81t
Para-aminobenzoic acid 118
Paronychia 126
PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis) syndrome 10, 72
PASS syndrome 10
Peels 136
Pentostatin 17, 70
Perifollicular elastolysis 26
Periporitis 82
Peroxisome proliferator activated receptors 11, 18
Phenobarbitone 17, 70
Phenytoin 17, 62, 70
Photophobia 126
Photoprotection 133
Photosensitive reaction 126
Phototoxicity 122
Phymatous rosacea 77, 78
Pigmentation 122, 126
over
back 52f
scar 94f
postinflammatory 138
Pilonidal sinus 76
Pilosebaceous ducts 6f
Pilosebaceous unit 47
abnormalities 24, 25
Pimozide 17, 62, 70
Pityrosporum folliculitis 79, 82
Plane warts 82
Platelet-rich plasma 136, 143
Polybrominated dibenzofurans 15
Polychlorophenols 15
Polycystic ovarian
disease 106
syndrome 10, 35f, 37, 57f, 63, 90f, 106, 128
Polymorphic lesions 48f
Potassium
iodine 17, 70
titanyl phosphate 138, 144
Prednisolone 134
Pregnancy 14
Prerosacea 77
Progesterone 106
Prolactin 106
Prostaglandin production 21
Proteinuria 125
Pruritus 125
Pseudofolliculitis barbae 82
Pseudohermaphroditism 10
Psoriasis 73
Psychocutaneous disorders 68
Pubarche 46
Puberty
earlier onset of 1
premature 10
Pubic hair, early development of 106
Pulsed dye lasers 139, 144
Punch
excision 145
floatation technique 145
Pustules 8f
bacterial 84f
Pustulosis 64
Pyoderma gangrenosum 53, 64
Pyrazinamide 17, 62, 70
Q
Quinine 17, 70
R
Radiation 15
Ramipril 17, 70
Reactive oxygen species 24, 25
Renal toxicity 122
Resorcinol 116, 134
Respiratory hypersensitivity 122
Retinoic acid peels 136
Retinoid 116, 123
mode of action of 117b, 123
systemic 109f
therapy 109f
Rhinophyma 77
Ribavirin 16
Risperidone 17, 62, 70
Ritonavir 17, 62, 70
Rosacea
cause of 24
etiology of 24
factors aggravating 24b
fulminans 79
granulosa 61f
inflammatory 77
ocular 78
papulopustular 78
solid facial edema of 100
subtypes of 77b
vascular 77
S
Sacroiliac joint 64
abnormality 73
SAHA (seborrhea, acne, hirsutism and alopecia) syndrome 10, 53, 57f, 72, 98f
Salicylic acid 116, 118, 134, 135, 138
peels 136
Sandpaper comedones 29f, 37, 42f
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome 10, 12, 53, 7274, 104, 105, 115
acne of 74
diagnosis of 74b
treatment of 135
Scalp, dissecting cellulitis of 76
Scars 48f, 51f, 53, 88, 138
disfiguring 52f
formation, pathogenesis of 22, 26
hypertrophic 26, 38, 99
pigmented 56f
pitted 56f
rolling 38
Sclerosis 100
complex, tuberous 79
Sebolamellar sheath leading, rupture of 6f
Seborrhea 6f, 7f, 10, 43f, 48f, 90f, 93, 96f, 98f, 103f, 105, 109f, 128
stress-induced 19
sudden onset of 48f
Sebum production 3, 11, 18, 110
Selumetinib 17
Sensitive skin 81
syndrome 53
Sequelae 38, 93
Sertraline 17, 62, 70
Serum lipid 106, 107
Sex hormone binding globulin 106, 127
Sirolimus 17, 70
Skeletal systems, neoplasm of 73
Skin
biopsy 104
infections, recurrent 73
lesions 64, 74
polymorphic inflammatory disease of 31f
scars, chemical reconstruction of 136, 140
sensitivity 81
Sleep deprivation 11
Sneddon-Wilkinson disease 74
Sodium
fluoride 17, 70
sulfacetamide 116, 134
Spironolactone 119, 128, 130
Sporotrichosis 79
Stanozolol 17, 70
Staphylococcus aureus 102, 124
Steatocystoma 83f, 84f
cystic lesions of 84f
Steroid 79
anabolic 17
intralesional 136
Stevens-Johnson syndrome 122
Stratum corneum 132
Stress 11, 14
Striae 107
Submarine comedones 37
Suicidal attempts 126
Suicidal ideation 126
Suicide 126
Sulfamethoxazole 121, 122, 134
Sulfur 17, 70, 116, 119, 134, 135
topical 118
Sunlight 15
Superficial dermis 26
Superficial scar 26, 110f
post acne 94f
Sweating 9f
SWEET syndrome 74
Synovitis 64, 73
Syphilis, secondary 79
Syringoma 86f
skin colored papules of 85f
Systemic anti-acne drugs, pregnancy category of 134t
T
Tacrolimus 17, 70
Tanner stage 46
Tazarotene 118, 119
Tea tree oil 119
Tendinitis 126
Teratogenicity 126
Testicular enlargement 46
Tetrachlorodibenzo-P-dioxin 15
Tetracycline 120122, 134
Thelarche 46
Thiouracil 17, 70
Thiourea 17, 70
Thorax 75
Thrombocytopenia 125
Thrombocytosis 125
Tinea faciei 84f
Topical anti-acne
drugs, pregnancy category of 134t
medications, side effects of 120t
Topical retinoic acid 108f
Topical retinoid 113, 117, 119
combination of 111
Topiramate 17, 70
Toxic epidermal necrolysis 122
Trametinib 17
Transepidermal water loss 132
Tretinoin 119, 120, 134
Triazoloquinoxalines 15
Trichloroacetic acid 136, 140
Trichostasis spinulosa 86f
Triglyceride 125
Trimethoprim 121, 122, 134
Troxidone 17, 70
Truncal involvement 30f
Tumors
adrenal 10
ovarian 10
Turner syndrome 10
Tyrosine kinase inhibitor 17
U
Ultraviolet 11
radiation 11
Urine cortisol level 107
User-friendly grading system 39b
V
Varioliform scars 95f
Vascular cell adhesion molecule 26
Vascular endothelial growth factor 25, 143
Vasculitis 126
Venous thromboembolism, history of 128
Virilizing syndrome 107
Vision, blurred 126
Vitamin 62
B12 17, 62, 70
B12, high dose 16
B6, high dose 16
Voice, deepening of 105
Vulgus 1
W
Weight
gain 122
loss 107
Z
Zinc 116, 118, 119, 134
topical 118
×
Chapter Notes

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IntroductionCHAPTER 1

Acne vulgaris (Acme meaning prime of life and vulgus meaning common) is a common inflammatory disorder of the pilosebaceous unit seen primarily in adolescents. It is one of the most common skin diseases affecting the youth. Nevertheless acne is seen worldwide in all age groups from newborn to old age. It affects all ethnicities and races. The clinical manifestations of varying extents and severities pose a challenge to the treating physician. Although the course of acne may be self-limiting even without treatment in some of the affected individuals, the sequelae like scars persist lifelong in many. Despite best of treatment, not infrequently in disease results in significant psychosocial morbidity leading to tremendous stress in the affected individual. With proper understanding of the etiopathogenesis, astute knowledge about the various clinical presentations, and updated data on the therapeutic armamentarium currently available to treat the disease, every person with acne can be assured of the best medicosurgical assistance and better outcome to give the best cosmetic result possible.
 
EPIDEMIOLOGY
Acne is a disorder seen worldwide. It is a disorder primarily of the teenagers but can be seen even in newborn children and old adults. Apart from genetics, various factors play a role in the onset, course, severity, and response to treatment in an acne patient.
 
Age and Gender
Acne is, by and large, a disease of the teenagers. However, the age of acne can be from as early as newborn till as old as even 6th decade. The age of onset of acne varies considerably. Acne vulgaris can have its onset even in the prepubertal age and may start as early as 6–8 years of age. In some persons, the onset can be delayed to as late as 20 years of age or even later. It is not uncommon to see acne in the neonate and as a disturbing ailment in adults as late as in their 6th decade. Acne often heralds the onset of puberty and is not until such time is considered as a significant problem. Though more than 85% of adolescents develop acne, not all seek medical attention at an earlier date; may be because of the self-limiting nature of the disease in some if not all. Earlier onset of puberty, obesity, diet, and other lifestyle factors play significant role in earlier onset of the disease in addition to the positive family history. Awareness and recognition of the problem contribute to increased hospital attendance.
Acne most commonly presents between 10 and 13 years of age. There is no major gender difference in the onset and clinical2 manifestation. However, girls have an earlier onset which can be easily attributed to the earlier onset of puberty in girls than in boys.
No ethnic group is exempt from the development of acne and a higher prevalence was observed between 15 and 20 years. With the advancement of age of menarche in girls, so is the age of onset of acne in the female gender. However, the disease severity is more in boys during the late adolescence. Persistence of acne through the third decade is not uncommon. Both persistent and late or onset acne seen more frequently in females. Women with XYY genotype are more prone for such severe forms of acne. A more severe form of acne variant, acne fulminans, is more common in males as against females, which affects males between 13 and 22 years of age.
Based on the age of onset, acne is classified as given in table 1.
TABLE 1   Acne classification based on the age of onset
Age of onset
Classification of acne
Birth to 6 weeks
Neonatal acne
6 weeks to 1 year
Infantile acne
1–7 years
Mid-childhood acne
7–12 years
Preadolescent or prepubertal acne
12–19 years or after menarche in girls
Adolescent acne