Among the predisposing causes, the greatly increased activity of the sebaceous glands in and about the advent of puberty is the principal factor because the vast majority of cases occur between the ages of fifteen and twenty-five. Among other predisposing factors may be mentioned gastrointestinal, menstrual, genitourinary and catarrhal disturbances, sexual abnormalities, anemia, rapid growth with a weakened circulation, scrofula, tuberculosis and any debility from acute or chronic diseases. Besides the predisposing causes just mentioned which apply to acne in the young, acne in middle life may be due to sedentary living, gout, diabetes, respiratory, urinary, uterine and ovarian diseases, and intemperance of any sort or degree.

Acne is an inflmmatory condition involving the sebaceous ducts and attacking the lanugo hair-follicles, frequently extending to suppuration and destruction of the follicles. It consists briefly in a stoppage of the gland outlet from some extraneous material or comedo formation as a result of hyperkeratosis. Besides this mechanical factor there must be present an agent, unknown as yet, whether it be a microorganism, a chemical or irritating change in the secretion, or some substance eliminated by the glands, to complete the pathological picture. Seborrhea probably occupies the chief place among the local factors that prepare the soil for parasitic invasion.

Diagnosis. The characteristic location of acne, its course, type of lesions, frequency of occurrence, origin at puberty and association with comedones, especially in the simple variety, should make an easy differentiation from the following:

Rosacea usually occurs in mature life, begins with temporary hyperemia, gradually followed by more permanent redness of the skin of the face and dilation of the superficial blood vessels. Acnoid lesions are secondary in occurrence.

Papulopustular eczema has smaller lesions forming in patches with exudation, crusting and itching, unconnected with comedones.

The pustular syphilid occurs in groups and underneath the crusts will be found small ulcers. Besides, there is a history of other syphilitic manifestations and a much wider distribution than is found in acne. The tubercular or gummatous syphilid of the skin occurs in groups and degenerates into ulcers which often spread by one=sided extension. Although this form may resemble acne when the nose only is affected, other evidences of syphilis, together with the effects of treatment, should establish its nature.

Variola presents constitutional symptoms, with an acute course and a typically progressive eruption.

Sycosis is found in adult males, is limited to the bearded area and the center of the lesion is occupied by a hair instead of a comedo as in acne.

Prognosis. A cure may be expected if the proper treatment can be followed systematically and persistently. The duration of treatment depends upon the underlying factors and the ability of the patient to follow directions, even if they embrace continued self-denial. Scarring may be expected in cases of a deep, indurated or long standing nature.

Treatment. This is both constitutional and local and the latter may be all that is necessary in very mild cases, or in those approaching maturity with the well known tendency to spontaneous cure at that time. But ordinarily, systemic treatment is all important if permanent relief is to be expected.

External treatment is employed to insure absolute cleanliness and for stimulation, counterirritation and the destruction of pus. The simpler the local treatment, the better, because the aim is to produce a healthy state of the tissues with as little scarring as possible. Powders, ointments and lotions are employed. The first are best avoided; the second do well as intercurrent remedies; while the lotions should be used as a regular procedure.

Cleanliness is obtained by the use of simple soap and hot water or, rather more often, a salicylic acid, resorcin or ichthyol soap having solvent qualities may be indicated. Occasionally, hot boric acid lotion, or the same diluted with equal parts of alcohol, applied cold, may accomplish the purpose more successfully. When more stimulation is needed, hot and cold water compresses may be applied in alternation, or tincture of green soap may be applied with hot water, but it should not be continued indefinitely or applied too thoroughly, because the congestion desired must be temporary or it will defeat rather than aid the cure. These cleansing applications should be applied at night before retiring so that the irritation may subside before morning.

Frederick Dearborn
Dr Frederick Myers DEARBORN (1876-1960)
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war