Acne Vulgaris

In the simplest terms, acne vulgaris is a condition in which the sebaceous follicles are inflamed. Acne eruptions are a result of increased sebum production, which is activated by androgenic hormones. This sebum is secreted into dilated hair follicles that contain normal skin bacteria. What essentially happens is that the enzyme secreted by the aforementioned bacteria, lipase, reacts with the sebum, producing free fatty acids that trigger inflammation. At the same time, keratin produced by the hair follicles combines with sebum to form plugs in those dilated follicles. 

Nursing Diagnoses 

Impaired skin integrity 

Related to 

• Destruction of skin tissue characterized by
  • Papules 
  • Pustules 
  • Nodes 
  • Lesions 

Nursing interventions 

INTERVENTION	RATIONALE
Encourage clients to avoid all forms of friction (touched, scratched by hand) on the skin.	Preventing the spread of bacteria that can worsen the infection in the skin lesions.
Instruct the patient to be able to treat the skin with a clean and correct.	The right skin care reduces the risk of accumulation of dirt on the skin.
Motivation of patients to keep taking the drugs and foods that contain enough nutrients.	To expedite the healing process.
Observations of erythema and palpated for warmth around the area.	The warmth is a sign of infection.
Collaboration of topical antibiotics	To inhibit the growth of bacteria

Nursing Notes

Assessment, Clinical Manifestations, Signs and Symptoms 

• Closed comedones (i.e. whiteheads)
• Open comedones (i.e. blackheads)
• Papules, pustules, nodules, cysts
• Primarily appear on the face, shoulders, and upper back

Medical Management 

The following are the goals of the medical management of acne vulgaris: 

• reduce bacterial colonies
• decrease sebaceous gland activity
• prevent the follicles from becoming plugged
• reduce inflammation
• combat secondary infection
• minimize scarring
• eliminate factors that predispose the patient to acne

Pharmacologic Therapy 

Topical 

• Benzoyl peroxide
• Topical antibiotics

Systemic 

• Antibiotics 
• Oral retinoids 
• Hormone therapy 

Surgical Treatment 

• Extraction of comedo contents
• Drainage of pustules and cysts
• Excision of sinus tracts and cysts
• Intralesional corticosteroids for anti-inflammatory action
• Cryotherapy
• Dermabrasion for scars
• Laser resurfacing of scars