Acne: Nursing pathophysiology

Acne, vulgaris often just called acne is a skin condition that can be noninflammatory or inflammatory. First, let's look at the skin which is the largest organ in the body.

It provides important functions like protection, sensory perception, temperature regulation, and Vitamin D production. Its two main layers, the dermis and epidermis rest on the hypodermis or subcutaneous tissue.

Starting with the most superficial layer of skin. The epidermis is composed of layers of stratified squamous epithelial cells.

There are various bacteria that live on the outer layer of the epidermis as part of its natural flora. Under normal circumstances, these bacteria don't grow into numbers large enough to become pathogenic meaning they typically don't cause infection.

Next is the dermis, which is made up of connective tissue that allows the skin to contract and stretch with body movement.

It also contains hair, follicles, oil and sweat glands, nerves, immune cells and blood and lymphatic vessels. Now, each hair follicle in the dermis is part of a pilosebaceous unit composed of a short thin nonpigmented hair called a vellus hair that extends to the epidermis through a pore called the follicular canal, an erector pli muscle which makes the hair stand up when it contracts and one or more sebaceous glands which produce and secrete oily sebum into the follicular canal and onto the skin surface.

The sebum acts as a lubricant for the skin and protects from moisture loss. Finally, the hypodermis consists mainly of adipose or fat tissue that provides insulation and padding and loose connective tissue that helps anchor the skin to the underlying muscle.

So, the main cause of acne is blockage of the follicular canals by dead skin cells. Bacteria and sebum.

A primary risk factor is being an adolescent or young adult. This is because sebaceous glands are stimulated by the increased amounts of circulating androgens and puberty causing the glands to grow and increase sebum production, which allows acne to develop more easily.

Another risk factor is genetic susceptibility. So, an individual is more likely to develop acne if other members of their family have acne.

Now, acne is made up of comedones which are small bumps on the skin that can be flesh colored, white or dark. These comedones form when a follicular canal becomes blocked.

There are a few factors that can contribute to the blockage including hyperkeratinization, which is when the cells lining the follicular canal accumulate because they don't shed normally onto the surface of the skin altered production of sebum.

The presence of certain hormones like androgens, insulin and insulin like growth factor. One and proliferation of cutibacterium acnes also just called C acnes, which was previously known as propionibacterium acnes.

When the follicular canal is open, it's an open comodo where exposure to air oxidizes the melanin of the plug, turning it black, which is why they're called blackheads.

Conversely in a closed comodo, the canal is not open to air so it remains flesh colored, also called a whitehead. These blackheads and whiteheads that are not swollen or tender are characteristic of noninflammatory acne.

On the other hand, sometimes a closed Chone can develop into inflammatory acne first with nowhere in the follicular canal, anaerobic bacteria that are normally part of the skin's natural flora can grow to numbers large enough to cause infection.

Typically, the bacterium present in inflammatory acne is c acnes mixed as sea acnes continue to grow. Immune cells are retracted which eventually produce an exudate called pus along with surrounding tissue inflammation.

This results in the formation of a pustule commonly called a pimple. As pressure builds within the follicular canal.

The canal wall can rupture allowing exudate to seep into the surrounding tissue causing further inflammation. Acne typically appears on the face, back shoulders and upper chest and often includes both noninflammatory and inflammatory types.

With a mix of small black or flesh colored bumps, pustules and surrounding reddened and irritated skin. When the inflammation is deeper in the skin, painful papules, nodules or cysts can develop, this can result in scarring and increases the risk of hyperpigmentation or colloidal scars.

For individuals with darker skin. Additionally, those with acne may experience negative mental health effects and they are at higher risk for decreased self esteem, anxiety and depression.

All right. As a quick recap acne vulgaris is a skin condition that's made of Chromos that form when a follicular canal becomes blocked.

Risk factors include being an adolescent or young adult and having a positive family history. Clinical manifestations range from noninflammatory acne appearing as blackheads and whiteheads to inflammatory acne appearing as pustules, papules, nodules and cysts.