Definition And Description

Acne is an inflammatory disease of the sebaceous glands, affecting by preference, if not exclusively, those which are connected with rudimentary hairs and is usually located on the face, neck chest, or back, or on two or more of these localities at the same time. It is characterized by papules, pustules, tubercles, and indurated nodules, which, on disappearing, may leave cicatrices. It affects both sexes, and is most common between the fifteenth and forty-fifth years, corresponding to the period of most active sexual life. Its course is usually chronic, and when untreated may persist for years. The principal varieties are acne vulgaris and acne indurata. The former of these is most frequently met with in early life, and may be said to consist in an eruption of small or medium sized discrete papules or pustules, not surrounded by much infiltration, but frequently accompanied with comedones. This affection may pass, by insensible gradations, into acne indurata, which consists of larger papules, tubercles, and pustules, with reddened, infiltrated, and hardened bases, and more or less surrounding congestion and infiltration.

Diagnosis

The diagnosis is usually easy, the only affections with which it is liable to be confounded being a papulo-pustular or tubercular syphilide, a papular eczema, rosacea, lupus, and certain medicinal rashes.

From syphilis it can be distinguished by the previous history, duration, and in early syphilis the more or less general diffusion of the lesions over the whole body. In late syphilis the lesions most nearly resembling an indurated acne usually exhibit an ulcerative tendency. A papular eczema of the face may sometimes closely simulate a mild acne vulgaris. In the former affection the papules do not necessarily correspond to the sebaceous follicles, and, besides, if the eczema has lasted for any length of time, there is usually more interpapular infiltration, and a disposition to the formation of scales. Advanced rosacea is frequently complicated by acne, but when existing alone and in an early stage is characterized by localized congestions, not specially involving the sebaceous glands. In some cases of superficial lupus a plentiful development of papules might suggest an acne, but in acne the individual lesions usually run their course in from one to three or four weeks, while in lupus they persist for months.

Prognosis

In young subjects the prognosis, under judicious treatment, is usually good, and also in older ones in cases where there is no irremediable internal cause for the eruption.

Etiology

We have elsewhere (87, 220) placed acne in the group of reflex affections, in consequence of a firm belief that in the great majority of instances it is not a primary condition, but one dependent on irritation, derangement, or disease of other organs reflected on the skin. The organs specially involved are those connected with the sexual and digestive systems. Acne vulgaris is pre-eminently a disease of youth, frequently first showing itself at the inception of puberty, or shortly after, and lasting, with varying severity, for several years. In young adolescents there is little doubt that it is often connected with too frequent sexual excitement, more especially of an unnatural kind. In young women menstrual irregularities play a not unimportant role. In one case it may be a scanty or deferred menstruation; in another, a too frequent or profuse one, and in still another more or less dysmenorrhoea. In other cases again these functions may be performed in a comparatively normal manner, but constipation or dyspepsia is present, and seems to constitute the principal etiological factor.

Acne indurata is more common in older persons. In women it is most frequently due to menstrual or gastric trouble, while in men its origin must be sought in gastro-enteric or hepatic derangement, the latter not rarely due to excessive use of spirituous beverages.