Teenagers and Acne: The Role of the Pharmacist

Joshua J. Pray, Pharm.D. Candidate, W.Steven Pray, Ph.D., R.Ph.

US Pharmacist. 2003;28(6) 

In This Article

The Genesis of Acne

Many factors coalesce to produce acne. The so-called seat of acne is the pilosebaceous unit, which consists of a normal hair follicle, associated sebaceous glands, and the piloerector muscle apparatus.[7] The inside of each hair follicle is lined with outer epidermal skin -- not living dermis -- that grows and sheds just as the outer epidermis does. At puberty, the shed skin cells, which are normally carried upward by sebaceous flow, exhibit an androgen-stimulated abnormal cohesion that prevents them from being shed as easily.[8] As a result, the ductal lumen of the follicle narrows as it becomes plugged with cellular debris.[9] In addition to this hypercornification, puberty-related changes cause the sebaceous glands to become multilobular and increase daily output of sebum. Unfortunately, the amount of sebum that must reach the skin surface increases just as its sole outflow channel progressively narrows.

The causative organism for acne is Propionibacterium acnes, an anaerobic diphtheroid normally present in the pilosebaceous unit.[10] The organism remains quiescent prior to puberty, but it reacts to increased levels of sebum by proliferating and producing free fatty acids, which irritate the skin. This causes inflammatory acne, which produces papules, pustules, and nodules. If the inflammation reaches a sufficiently severe level, the skin will scar.

The initial acne lesion is the microcomedo, which evolves into a closed comedo (whitehead). As debris continues to accumulate in the follicle, the hair is lost and the pore opens. Oxidation of the pore's upper substances produces the discoloration known as the typical blackhead (open comedo). Inflammation of the follicle leads to more severe acne lesions, papules, pustules, and nodules. Manipulating the lesion may also cause inflammation.

While most patients no longer have acne by their late teens or early 20s, its presence can cause long-term consequences.[4] Patients with acne are often acutely embarrassed and/or highly apprehensive in the pharmacist consultation. There are several reasons for this. First, acne is a disfiguring condition, constantly visible to anyone with whom the individual has face-to-face interaction.[1,11,12] Second, even a minor case of acne can cause a great deal of stress, embarrassment, frustration, anger, and/or depression, since the patient cannot predict the duration of the condition, the degree of severity it will assume, or the likelihood of a favorable treatment outcome.[1,13] Further, acne is often perceived by others to be a minor condition of little consequence; the patient is denied the "sick role" granted freely to those with other minor conditions such as the common cold or a headache. Finally, the onset of acne coincides with the onset of puberty. Thus, just when adolescents gain a new appreciation of the opposite sex, their self-image may be marred by a condition that can cause them to enter a cycle of self-recrimination and self-doubt.

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