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Acne vulgaris - Management
How should I assess a person with acne?

  • Ask about the problems the person has experienced with their acne. Enquire about:
    • The reasons for the person presenting, how long they have had acne, and whether it is worsening.
    • Any treatments the person has already tried (for example over-the-counter medication).
    • Possible causes or aggravating factors (for example, occupational exposure to halogenated hydrocarbons).
  • In women, consider whether the acne could be secondary to a hormonal cause. Features of hyperandrogenism include: irregular periods; androgenic alopecia or hirsutism; acne resistant to conventional treatment (or relapse immediately after a course of oral isotretinoin); and premenstrual flares of acne or a sudden onset of severe acne.
  • Assess the severity of the acne. Physically, acne can be categorized as mild, moderate, or severe, but other factors, such as the extent of acne and evidence of scarring, should also be considered.
    • Mild acne predominantly consists of non-inflammatory comedones.
    • Moderate acne consists of a mixture of non-inflammatory comedones and inflammatory papules and pustules.
    • Severe acne is characterized by the presence of nodules and cysts, as well as a preponderance of inflammatory papules and pustules.
    • Scarring often indicates previous episodes of severe acne (its presence may warrant more aggressive treatment to prevent further scarring).
    • Acne conglobata and acne fulminans are severe variants that require immediate referral.
  • Ask about the psychosocial impact of the acne (such as problems at work or school). If the psychological impact seems to be particularly severe or disproportionate, consider using a validated quality of life scale, such as the Cardiff Acne Disability Index (which can be downloaded from www.dermatology.org.uk). This can be used to monitor the person's psychological state during subsequent management.

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