Acne: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing).
    • Skin [Leading symptoms:
      • Primary, non-inflammatory efflorescences (so-called blackheads) – microcomedones, closed comedones (whitish small skin entities), open comedones (skin entities with a dark sebaceous plug).
      • Secondary, inflammatory efflorescences – papules (nodular thickening of the skin), pustules (pustules), nodules, abscesses.
      • Tertiary, no longer inflammatory efflorescences – scars, cysts (lump filled with fluid in the body tissues), fistula comedones (connecting ducts between individual comedones)]

      Predilection site (body regions where the changes occur most frequently):

      • Face, less frequently neck, décolleté, back and upper arms.
• Dermatological examination [due todifferential diagnoses:
  • Acne aestivalis (Majorca acne) – formation of papules on light-exposed (exposed to sunlight) areas of the body; sunscreens are probably involved in the formation.
  • Acne excoriée des jeunes filles – mild acne due to constant manipulation of the efflorescences, occurring mainly in girls and young women.
  • Acne fulminans – in the case of existing acne conglobata, it can come to a febrile infection, which shows up with polyarthralgias (joint pain) and necrosis (dead areas) of the skin areas altered by acne
  • Acne inversa (also spelled acne inversa; synonyms: Acnetetrade; Hidradenitis suppurativa (misleading term, since the disease does not originate from the sweat glands, but from the sebaceous glands and terminal hair follicles), Pyodermia fistulans sinifica, sweat gland abscess) – chronic inflammatory and relapsing skin disease; preferred sites of manifestation are submammary (“below the female breast (mamma)”), genital and perianal (“in the vicinity of the anus“); Perifolliculitis (inflammation of the tissue surrounding a hair follicle, usually originating from folliculitis (hair follicle inflammation) caused by bacteria (usually Staphylococcus aureus)) especially in the armpits and groin and a pilonidal sinus (coccygeal fistula) lead to pronounced scarring overall.
  • Acne mechanica – occurrence of acne vulgaris due to inflammation at pressure points.
  • Acne necroticans – belongs to the pyoderma (purulent skin inflammation).
  • Acne neonatorum – mild acne with papules and pustules, which recedes within a few months.
  • Acne venenata (contact acne) – acne occurring due to contact with various substances such as oil, pitch or dioxin; especially in people who have a predisposition to acne vulgaris.
  • Allergic contact dermatitis – special form of allergy. This is expressed exclusively with eczematous changes on the skin. As a trigger, depending on the localization, different substances can come into question.
  • Cosmetic acne – can occur with incorrect skin care]

  [due topossible secondary disease: acne fulminans – in the presence of acne conglobata may develop a febrile infection, which manifests itself with polyarthralgias (joint pain) and necrosis (dead areas) of the skin areas altered by acne]

• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.