Notes
Definition
- Acne vulgaris is an inflammatory disease of the sebaceous follicles.
Risk Factors
- Highest incidence at puberty
- Genetics
- Hormonal factors
- Bacterial infection
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Pathophysiology
- Acne eruptions are initiated by increased sebum production activated by androgenic hormones. Sebum is secreted into dilated hair follicles containing normal skin bacteria. The bacteria secrete the enzyme lipase, which reacts with sebum to produce free fatty acids to trigger inflammation. At the same time, keratin produced by the hair follicles combines with sebum to form plugs in dilated follicles.
Assessment/Clinical Manifestations/Signs and Symptoms
- Closed comedones (i.e. whiteheads)
- Open comedones (i.e. blackheads)
- Papules, pustules, nodules, cysts
- Primarily appear on the face, shoulders, and upper back
Medical Management
The goals of management are to reduce bacterial colonies, decrease sebaceous gland activity, prevent the follicles from becoming plugged, reduce inflammation, combat secondary infection, minimize scarring and eliminate factors that predispose the person to acne.
Topical Pharmacologic Therapy
- Benzoyl peroxide
- Topical antibiotics
Systemic Pharmacologic Therapy
- Antibiotics
- Oral Retinoids
- Hormone Therapy
Surgical treatment
- Extraction of comedo contents
- Drainage of pustules and cysts
- Excision of sinus tracts and cysts
- Intralesional corticosteroids for anti-inflammatory action
- Cryotherapy
- Dermabrasion for scars
- Laser resurfacing of scars
Nursing Diagnosis
- Impaired skin integrity
- Deficient knowledge
- Disturbed body image
Nursing Management
- Administer prescribed medications, which may include acne products containing benzoyl peroxide (explain that these products initially cause skin redness and scaling but that the skin adjusts quickly); topical agents, such as vitamin A acid; and antibiotics such as tetracycline.
- Provide client and family teaching
- Advise the client that heat, humidity, and perspiration exacerbate acne. Explain that uncleanliness, dietary indiscretions, menstrual cycle, and other myths are not responsible for acne.
- Explain that it will take 4 to 6 weeks of compliance with the treatment regimen to obtain results.
- Instruct the client to wash his face gently (do not scrub) with mild soap twice daily.
- Instruct the client not to squeeze blackheads, not to prop hands on or rub the face, to wash hair daily and keep it off the face, and to use cosmetics cautiously because some may exacerbate acne.
- nstruct the female client to inform her health care provider if she is possibly pregnant. Some medication, such as systemic retinoic acid, have teratogenic effects, therefore a pregnancy test is required prior to treatment and strict birth-control measures are use throughout pregnancy.
Nursing Care Plan
Nursing Diagnosis: Impaired Skin Integrity related to the destruction of skin tissue characterized by papules, pustules, nodes and lesions.
Nursing Interventions
- Encourage clients to avoid all forms of friction (touched, scratched by hand) on the skin.
- Rationale: Preventing the spread of bacteria that can worsen the infection in the skin lesions.
- Instruct the patient to be able to treat the skin with a clean and correct.
- Rationale: the right skin care reduces the risk of accumulation of dirt on the skin.
- Motivation of patients to keep taking the drugs and foods that contain enough nutrients.
- Rationale: To expedite the healing process.
- Observations of erythema and palpated for warmth around the area.
- Rationale: The warmth is a sign of infection.
- Collaboration of topical antibiotics.
- Rationale: To inhibit the growth of bacteria.
