Clinical Symptoms and Classification of Acne

     Acne vulgaris is a chronic inflammatory disease of the follicles pilosebacea, which has the characteristics of comedones, papules, pustules, and nodules. Blackheads are the primary lesions of acne. This can be seen as a papule, flat or slightly elevated with a wide central opening containing keratin black (open comedones).
Closed comedo is usually a yellowish papules measuring 1 mm in need of stretching the skin to be seen. Macrocomedone, in rare cases, can reach sizes of 3-4 mm. Papules and pustules measuring 1-5 mm and are usually caused by inflammation, so it must have erythema and edema. Forms can be enlarged and form combine to form nodules and indurated plaques and sinus tract containing fluid or whether it serosaginosa yellowish pus.
      Patients will generally have a variety of lesions. In patients with lighter skin, macular lesions usually rupture with reddish to purplish with a shorter period. In patients with darker skin color, macular hyperpigmentation will look and last for several months. Scars from acne have a heterogeneous appearance.
      Morphology is formed including the scars are deep, narrow ice-pick is seen mostly on the forehead and cheeks, canyon-type atrophic lesions on the face, yellowish-white papular scars on the body and chin, scars on the body type of anetoderma, and hypertrophic and keloidal scars are elevated on body and neck.
      Generally predilection acne on the face, neck, upper trunk, and upper arms. In the face of it most often occurs on the cheeks, and a small portion of the nose, forehead, and chin. Ear can be involved, with a large blackheads on Concha, cysts on the lobes, and sometimes blackheads and cysts pre-and retro-aurikuler. In the neck, especially in the area nuchae, a large cystic lesions can dominate.
      Acne usually appears during puberty and is often an early sign of an increased production of sex hormones. When acne appears at the age of 8-12 years, which seems usually berupak blackheads that appear mainly on the forehead and cheeks. It can still be mild in its expression by inflammatory papules that sometimes occur. However, as hormone levels increased in the mid-teen ages, pustules and nodules more severe inflammation can occur which can spread to other places. Young men tend to have a more complex oily and spread the disease more severe than young women. Women may experience a severe disease course of papulopustular lesions week before menstruation. Acne can also appear in women aged 20-35 years who do not get acne as a teenager. Acne is mostly manifests as papules, pustules, and nodules in a persistent pain in the chin and upper neck.

      There is no uniform grading system and standardized for severity of acne suffered. Acne is generally classified by type (comedoneal / papular, pustular / nodulocyst) and / or severity of the disease (mild / moderate / moderate-weight / weight). Skin lesions can be described as an inflammatory and non-inflammatory.

A. simple classification
1. Mild acne (mild acne): comedone is the primary lesion. Papules and pustules may exist but have a small size and very small amounts (generally <10).
2. Acne is (Moderate acne): The number of papules and pustules are quite a lot (10-40). Comedone considerable number (10-40) also exist. Sometimes accompanied by a mild disease in the body.
3. Acne is severe (Moderately severe acne): The number of papules and pustules are very many (40-100), usually with lots of comedone (40-100) and sometimes contained within the nodular lesions and inflamed large (up to 5). Large areas usually involve the face, chest and back.
4. Very severe acne (Very severe acne): Acne and acne nodulocyst konglobata with severe lesions; many nodular lesions / pustular  and tenderness along with many comedone, papules, pustules and comedone smaller.

2. FDA global grade
Grade 0: The skin is clean with no inflammatory lesions 
Grade 1: Almost clean with non-inflammatory or inflammatory lesions
Grade 2: Mild, grade 1 plus several non-inflammatory lesions with very little existing inflammatory lesions (papules / pustules, no nodular lesions)
Grade 3: Moderate, grade 2 plus a lot of non-inflammatory lesions and may have some inflammatory lesions, but not more than one nodular lesion
Grade 4: Severe, grade 3 plus a lot of non-inflammatory and inflammation lesions , with slightly nodular lesions.

Do you wanna know more informations about acne?
check here!
1. About Acne Vulgaris
2. What are causes of Acne Vulgaris?
3. Pathogenesis of Acne Vulgaris
4. How to diagnose of Acne Vulgaris
5. What are skin diseases which similar with acne vulgaris?
6. How to treat Acne Vulgaris?


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