Acne Vulgaris

Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne can present as non-inflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest (Dawson & Dellavalle, 2013). Acne vulgaris develops as a result of follicular epidermal hyperproliferation with subsequent plugging of the follicle, excess sebum production, inflammation, and mainly the presence and activity of the commensal bacteria Propionibacterium acnes. On the other hand, Staphylococcus epidermidis, an aerobic microorganism, normally involves superficial infections within sebaceous unit (Burkhart et al., 1999).

Propionibacterium acnes is a slow growing, aerotolerant anaerobic gram positive bacterium that colonizes sebaceous glands (Ross et al., 1997). Acne is affected by several factors, specifically hormonal imbalances, bacterial infections, stress, food, or cosmetic application (Burkhart et al., 1999). Acne vulgaris is characterized by non-inflammatory, open or closed comedones, and by inflammatory papules, pustules, and nodules (Vowels et al., 1995). During puberty in the adolescence in both sexes, acne proliferates more due to excess sebum production accordance to fluctuation in hormone, mainly androgens (James, 2005). At these ages, the severity of present lesion may be perceived as 10-fold, 100-fold or more and may lead to very severe psychological problems including mainly depression. Acne vulgaris does not affect the general health status and has no vital cause for any kind of illness but it appears as a simple disease which may constitute a big and important problem just with its appearance in the present social life in which human communication has reached top level, because of the our face is the first organ for contact and is very important in terms of body perception (Aydemir, 2014).

Although general symptoms of acne vulgaris may include pain, tenderness, or erythema, it may include the following features.

·         Comedonal acne: Presence of open and closed comedones but usually non inflammatory papules or nodules.

·         Mild acne: Presence of comedones and a few papulopustules.

·         Moderate acne: Presence of comedones, inflammatory papules, and pustules; a greater number of lesions are present than in milder inflammatory acne.

·         Noduloscystic acne: Presence of comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter, scarring is often evident.

As therapeutic agents for acne, antibiotics are normally used to inhibit inflammation or kill bacteria (Guin et al., 1979). Triclosan, benzoyl peroxide, azelaic acid, retinoid, tetracycline, erythromycin, macrolide and clindamycin are the used antibiotics for acne vulgaris (Betttley & Dale, 1976; Breathnach et al., 1984; Zouboulis & Piqero-Martin, 2003). Although these medications are being used for treatment of acne vulgaris, various side effects have been induced. Benzoyl peroxide and retinoid (mostly used topical agents for treatment till now) cream cause xerosis cutis and skin irritation; tetracycline, doxycycline, metronidazole, erythromycin, macrolide, and clindamycin are associated with the appearance of resistance bacteria, organ damage, and immuno-hypersensitivity, photosensitivity reactions if taken for long time (Ochsendorf, 2006; Leyden et al., 2007; Patel et al., 2010; Kurokawa et al., 1999; Leyden, 1997; Ellis et al., 2001).