You are now leaving GSK’s website

You are now leaving a GSK Website. By clicking this link, you will be taken to a website that is not owned or controlled by GSK, and GSK is not responsible for the content provided on that site.

Continue

Go back

Stay informed

Report an adverse event

Live Chat

Clinical Presentation

The pathogenesis of acne involves four key processes 1–3

Go to Close Top

Four key processes

Androgens lead to increased sebum production 2 3

  • Sebum is produced by the pilosebaceous glands, which are predominantly found on the face, back and chest
  • This may be due to an increased response to normal levels of androgens

Comedone formation 2 3

  • Abnormal proliferation and differentiation of keratinocytes leads to comedone formation

Colonisation with Propionibacterium acnes (P. acnes) 2 3

  • Sebum and comedone formation alters the micro environment in the pilosebaceous duct, which leads to colonisation of the duct

Inflammation 2 3

  • Acne lesions begin with an initial inflammatory event, triggered by an infiltration of inflammatory cells

Stages of acne 4

Stages of acne

Stages of acne. (A) Normal follicle; (B) open comedone (blackhead); (C) closed comedone (whitehead); (D) papule; (E) pustule.

  • Non-inflammatory lesions

    Comedones are non-inflammatory acne lesions that may be open or closed. 7

    Open comedones (blackheads):

    • Open comedones or blackheads are raised brown/black lesions up to 5 mm in diameter 1
    • They are small follicles with dilated openings to the skin allowing oxidation of the debris within the follicle leading to the black colour 7
    Open comedones

    Closed comedones (whiteheads):

    • Closed comedones or whiteheads are small plugged follicles, which are often inconspicuous (up to 3 mm diameter) with no visible follicular opening 1 7 8
    Closed comedones

  • Inflammatory lesions

    Papules:

    • When lesions become red and/or tender bumps they are termed papules (3-5 mm in diameter) 1 7

    Pustules:

    • When lesions fill with purulent material (pus) they become pustules (5 mm or less in diameter) 1 7

    Papulopustular acne

    Pustules

    Nodules:

    • As lesions progress to become larger and more tender, they are termed nodules 7
    • Nodules are defined as firm, inflamed lesions >10 mm diameter, painful by palpation 8

    Nodularcystic acne

    Nodules

Common causes of acne 2

  • Increased androgens/sebum production in puberty
  • Hormones
  • Resistance bacteria
  • Use of cosmetics
  • Drugs
  • Smoking
  • Stress (increased androgen production)
  • Genetics

References:

  1. Bhate K et al. Br J Dermatol 2013;168(3):474–485.
  2. Yentzer BA et al. Cutis 2010;86:94–99.
  3. Ayer J et al. Postgrad Med J 2006;82:500–506.
  4. Williams C et al. Am J Clin Dermatol 2006;7(5):281–290.
  5. Dunn LK et al. Derm Online J 2011;17(1):1.
  6. Krakowski AC et al. Pediatr Dermatol 2008;25(Suppl 1):1–14.
  7. Primary Care Dermatology Society. Acne Vulgaris. Available at: www.pcds.org.uk/clinical-guidance/acne-vulgaris. (Accessed March 2017).
  8. Dawson AL, Dellavalle RP et al. Br Med J 2013;346:f2634.
  9. Goodman G. Am J Clin Dermatol 2009;10(Suppl. 1):1–6.
  10. Layton AM. Am J Clin Dermatol 2001;2(3):135–141.

Adverse events should be reported directly to the HPRA; Freepost, Pharmacovigilance Section, Health Products Regulatory Authority, Earlsfort Terrace, Dublin 2, Tel: +353 1 676 4971 medsafety@hpra.ie. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255.

Duac is a registered trademark of Stiefel, a GSK company.