Acne Vulgaris

THE object of this paper is to set out shortly some of the etiological factors in acne vulgaris, and to indicate the bearing which they have on treatment. It is, unfortunately, often regarded as a condition about which nothing is known, and to which treatment makes very little difference; and patients are too frequently told that they must just wait until it disappears. Acne is so common as to need no description. Its onset is, as a rule, synchronous with the onset of puberty, and if untreated, it remains with remissions until 25 to 30 years of age, then possibl) to be followed b) rosacea. WVithin recent vears it has become recognised by most dlermatologists that acne is merely a phase in what has been called "the seborrhoeic diathesis." A good deal of prominence has been given to this recently, but it max be helpful to recall in an abridged form the description of it given by Barber "The skin as a wlhole appears thickened, coarse, and dirty, particularly in darkcomplexioned personis; the horny layer is improperly formed and hvpertrophied, the pilosebaccous follicles are cnlarged and patulous, and eitherexude visible droplets of oily sebum, or are filled with solid plugs-the so-calledl seborrheeic cocoons-containinzg countless acne bacilli; there is often visible lhvperidrosis in certain situations; the scalp after puberty is greasy, covered with adlherent dandruff which swarms with the pityrosporon and the staphylococcus albus, ancl the hair is dank and lifeless. To this picture must be added the infective complications-the comedones, pustules, and nodules of acne, the various forms of seborrhceic dermatitis, the superficial pustules due to the staphylococcus albus, and the deeper folliculitis of svcosis and boils due to the staphylococcus aureus. In middle-life, rosacea occurs, which sooner or later becomes complicated by a superadded infection of the flushed area of the face with seborrhceic organisms. Gingivitis and dental caries are ofteni seen, ancd chronic naso-pharyngeal catarrh with frequent exacerbations is almost invariablyr present in severe cases of the seborrheeic state. "True flatulence, as distinct from arophagy, is common, due apparently to the fermentation of carbohydrate, since it is usually relieved by the exclusion of soft carbohydrate foods from the dietary. "The urine of seborrhoeics has been studied by several observers. The alkali tolerance is, as a rule, markedly raised, so that very large doses of alkali are required to render the urine alkaline." It will be appreciated, therefore, from this description, which holds for practically all cases of marked acne, that there is a general constitutional disorder underlying the condition; and the recognition and adjustment of this should be as much a part of treatment as the local applications to the "spots. " Apart from this, perhaps the most striking feature of acne is its relation to