Acne vulgaris, by all accounts, is the most common skin concern seen regularly by dermatologists in their clinical practices. By some estimates, patient visits for treating acne vulgaris and dealing with its associated sequelae make up roughly one-third of all visits to dermatology offices in the United States.1 This is a very high percentage, and for this reason alone, we, as dermatologists, need to stay at the forefront of new therapeutic options and ideas, to foster new medical approaches for our patients when appropriate, and to offer alternative forms of therapy to best manage those suffering from acne vulgaris. These “other” forms of therapy may involve non-medical therapy for our patients, including the use of lasers and light sources, and may at times involve use of photosensitizers that sensitize the pilosebaceous glands to an appropriate laser or light source.
Why care about treating acne vulgaris, especially in a procedural manner, when there are many other procedures that make patients look and feel younger and more beautiful? Why care about a skin condition that occurs predominantly in children and in young adults? And why care about a skin disease that, more and more, is being cared for by our primary care colleagues so we can concentrate on the more glamorous cosmetic concerns?
Acne vulgaris affects almost all individuals at some point in their lifetime, with reports noting that as many as 94% of all females in the United States will suffer from acne vulgaris.2 The percentage in men is slightly lower than that in women but is still significant. It is important for dermatologists to be at the forefront of new therapies and modalities to enhance those therapeutic options. As a point of reference, it can be noted that 20 years ago, the dermatologist was the usual first point of contact care for those suffering with acne vulgaris. Over the past 20 years, many acne patients have first been treated by non-dermatologists, whether the pediatrician or family physician for the younger group of patients, or by a host of other physicians in the older patient population, including the family physician, the internist, and the gynecologist, among others. More recently, a variety of over-the-counter skin care and acne products have emerged as “wonder” products, which have become first-line therapy for patients who attempt to avoid a medical visit to their dermatologist.
Dermatologists need to embrace the care of those suffering from and with acne vulgaris. We need to be at the forefront of treating and counseling those with this skin concern and realize that the number of patients who will be helped by our skills is remarkable. With many of the newer therapeutic modalities now available, including the use of photosensitizers with lasers and light sources, we have incredible “tools” at our disposal to help almost every patient who suffers from acne vulgaris.
ETIOLOGY AND PATHOGENESIS OF ACNE VULGARIS