Acne

Acne is an inflammatory affection of the sebaceous glands.

Acne, in its mildest form of development, consists of a small papule; usually seated on the face, chest, or back. The papule is red, pointed, and may be slightly sore to the touch, presenting the usual features of a localized inflammation. The papules may vary in number from one or two to several hundred, scattered over the nose, cheeks, forehead, temples, chest, and back. The little pimple may, on pressure with the finger, present slight firmness, indicative of the inflammatory effusion. After a few days it may undergo spontaneous resolution and disappear, others appearing from time to time to take the places of those which have disappeared. This constant succession may be kept up for an indefinite period. Instead of undergoing resolution, pus may make its appearance, either at the summit of the papule or more deeply in its structure, thus converting the papule into a pustule. If the pustule be squeezed between the fingers, the pus is discharged, and with it the somewhat altered contents of the sebaceous glands. This form of acne, in which there is little or no implication of the tissues surrounding the follicle, is usually termed acne simplex, or on account of the age at which it is most prevalent, acne juvenilis.


The variety of acne just considered is the special appanage of youth, and occurs in both sexes between the ages of fifteen and twenty-five. Associated with it we frequently and perhaps usually find comedones in greater or less number scattered over the surface affected by the acne.

In more advanced life - from twenty-five or thirty up to fifty years - we may encounter a form of acne characterized by much larger lesions than those of acne simplex. In fact, they are large enough to be classed as tubercles and the affection has received the name of acne tuberculata, and, when seated on a hardened base, acne indurata. In this form there is more or less involvement of the tissues surrounding the follicles. These larger lesions are usually more sluggish in their development and coarser than those of acne simplex, but go through essentially the same phases as the smaller ones. That is, there is the same tendency to pus formation, and the larger ones may form veritable abscesses, followed by permanent cicatrices.


The causes of the affection are well-known to be local irritants, cosmetics, want of cleanliness, exposure to heat, cold winds, some varieties of soap, all debilitating causes, too rich or insufficient food, onanism or sexual excesses, liver, stomach or uterine derangements, and any cause that may lead to congestion of the face. Scrofulous subjects are very prone to this form of skin disease.

Acne tuberculata is not a very common affection in women; but when not associated with intemperance will usually be found accompanied by disease or derangement of the uterine or ovarian functions.

Gastric and hepatic disturbances, associated with constipation, are unquestionably important factors in the causation of acne, and too free indulgence in alcoholic stimulation is well recognized as the promoter of acne tuberculata in  men  who   are advancing from youth to middle age.