Acne

Abstract

Acne vulgaris is the most common dermatologic diagnosis in the United States. Almost 20 % of these young people endure moderate to severe acne. It is a multifactorial disorder of the sebaceous glands characterized by inflammation, comedones, and lesions of the skin. There are several methods for grading acne, but to assess the severity of acne for clinical reasons a four categories measure is part of many methods like global acne grading system (GAGS). Based on the multifactorial nature of the disease current guidelines agree on necessity of combination therapy. Topical retinoids are cornerstone of therapy for most patients except those with the most severe disease. Antimicrobial agents such as benzoyl peroxide or antibiotics help with inflammatory lesions. Nowadays a topical retinoid plus an antimicrobial agent is considered first-line therapy for acne. Oral antibiotics or hormone therapy should be added to treatment regimen for moderate acne cases. For many patients with lower grade acne outbreaks these treatments have a high success rate. Isotretinoin is preferred for severe acne patients. Although it has undeniably great effects in acne treatment, severe birth defect risk remains the main concern. Karp introduced cryotherapy for treatment of acne and acne scars in 1939. Allington used liquid nitrogen applied with a cotton swab for treatment of different skin disorders including acne in late 1940s. In 1971 Graham reported liquid nitrogen to be effective in treating acne. Coherent Anti-Stokes Raman Scattering (CARS) microscopy has proved a gradual loss of subcellular structures in sebocytes after cold exposure. Cryosurgical treatment of acne is a simple procedure and produces quick results with no scarring, patients seeing clearing of pustules and papules in as early as 3 days. The more severe the individual case of acne, the more beneficial cryospray treatment proves to be.