27/10/2025
Observe. Analyze.Diagnose Learn. Each case reveals the depth of homoeopathic healing. ”
🔍 Clinical Observation
Multiple dark pigmented macules and shallow pitted scars mainly on the cheeks.
Fine hair growth (vellus hair) visible on the face.
Few closed comedones or papular elevations still present.
Background shows post-inflammatory hyperpigmentation (PIH) and post-acne scarring.
Skin texture looks slightly coarse and oily.
⚕️ Likely Diagnosis
1. Acne Vulgaris (Grade II–III) with
Post-inflammatory hyperpigmentation (PIH)
Atrophic acne scars (superficial pitted scars)
2. Associated condition:
There appears to be increased facial hair (mild hirsutism), which — in a 17-year-old girl — suggests a possible hormonal imbalance, often linked to Polycystic Ovarian Syndrome (PCOS) or androgen sensitivity.
Excellent — let’s go through Acne Vulgaris in a complete, clinically structured way — including its pathophysiology, classification, differential diagnosis, investigation, complications, and management (allopathic + homeopathic approach).
This will serve as both a clinical reference and a teaching note for your students or followers.
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🌿 ACNE VULGARIS – Complete Clinical Overview
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🔷 Definition
Acne vulgaris is a chronic, inflammatory disease of the pilosebaceous unit (hair follicle + sebaceous gland) characterized by:
Comedones (blackheads & whiteheads)
Papules, pustules, nodules, and cysts
Occurring mainly on the face, upper chest, and back
It’s most common during adolescence, but may persist into adulthood.
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🔬 Pathophysiology
Acne develops due to four main interrelated factors:
1. Increased sebum production
Triggered by androgens (especially DHT) during puberty.
Sebaceous glands enlarge and over-secrete oil.
2. Abnormal keratinization of the follicular epithelium
Leads to plug formation → formation of comedones.
3. Colonization by Cutibacterium acnes (Propionibacterium acnes)
Anaerobic bacteria multiply in the blocked follicles.
Produce inflammatory mediators.
4. Inflammatory response
Leads to papules, pustules, nodules, and later scarring.
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🧩 Lesions of Acne
Type Description
Open comedones (Blackheads) Plugged follicle with oxidized melanin on surface.
Closed comedones (Whiteheads) Plug under skin; not exposed to air.
Papules Small, red, tender bumps.
Pustules Papules with visible white or yellow center (pus).
Nodules Larger, deep, painful swellings.
Cysts Large, fluctuant lesions filled with pus or fluid.
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📊 Grading of Acne Vulgaris
Grade Lesions Severity
I Comedones only Mild
II Papules and comedones Moderate
III Pustules and inflamed papules Moderately severe
IV Nodules, cysts, scarring Severe
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💡 Distribution
Face (cheeks, forehead, chin)
Chest, shoulders, upper back
Occasionally arms or buttocks
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⚕️ Epidemiology
80–90% of adolescents are affected.
Peak: 13–19 years.
Girls: may start earlier (puberty onset).
Family history positive in 40–50%.
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⚠️ Aggravating Factors
Hormonal fluctuations (me**es, puberty, PCOS)
Oily cosmetics / creams
High glycemic diet
Emotional stress
Certain drugs: corticosteroids, lithium, isoniazid
Excessive cleansing or scrubbing
Humidity / sweating
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🧠 Pathogenetic Summary
Androgens → Sebum hypersecretion → Follicular plugging →
C. acnes colonization → Inflammation → Lesions & scars
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🔍 Investigations
Usually clinical diagnosis.
If persistent or in females with hirsutism:
Hormonal profile:
LH, FSH, Testosterone, DHEAS, Prolactin.
Pelvic ultrasound: To rule out PCOS.
Thyroid function test – if menstrual irregularities or weight gain.
Blood sugar & lipid profile – for metabolic evaluation.
🩸 Differential Diagnosis
Condition Distinguishing feature
Rosacea No comedones; flushing, telangiectasia in adults.
Perioral dermatitis Papules around mouth, sparing vermilion border.
Folliculitis Pustules around hair follicles, often itchy.
Drug-induced acne Monomorphic papules; history of steroids/lithium.
Seborrheic dermatitis Greasy scales, erythema, no pustules.
⚕️ Complications
Post-inflammatory hyperpigmentation (PIH)
Scarring:
Ice pick, boxcar, rolling scars.
Keloid formation
Psychological distress, low self-esteem
🌸 Management
🌞 General Measures
Wash face 2×/day with gentle cleanser (non-comedogenic).
Avoid oily cosmetics or creams.
Do not squeeze pimples.
Eat low-sugar, low-dairy diet; include fruits, veggies, omega-3.
Adequate sleep, hydration, stress control.
💊 Allopathic Approach
1. Topical therapy (mild to moderate)
Benzoyl peroxide – antibacterial, comedolytic.
Topical retinoids (adapalene, tretinoin) – normalize keratinization.
Topical antibiotics (clindamycin, erythromycin) – reduce C. acnes.
Azelaic acid – for pigmentation and comedones.
2. Systemic therapy (moderate to severe)
Oral antibiotics: Doxycycline, Minocycline (short term).
Oral isotretinoin: For nodulocystic acne (strict monitoring).
Hormonal therapy (in females):
Oral contraceptives with anti-androgenic effect.
Spironolactone in resistant cases.
🌿 Homeopathic Approach
Homeopathy treats the constitution, not just the skin.
Below are key remedies with differentiating features:
🔸 Note: The constitutional remedy must be selected after full case-taking — physical generals, mental state, me**es, digestion, cravings, etc.
🧴 External Care (Safe adjuncts)
Fresh Aloe vera gel or Cucumber juice – cooling, healing.
Calendula Q lotion in distilled water – as mild antiseptic wash.
Berberis aquifolium cream – helps reduce marks and pigmentation.
📈 Prognosis
Excellent with early and consistent treatment.
Scars are permanent but can improve with time and skin renewal.
Homeopathic treatment helps prevent new eruptions and lighten old marks.
🧘♀️ Preventive Tips for Adolescents
Keep hair off face and scalp clean.
Avoid touching or pressing pimples.
Maintain bowel regularity.
Avoid refined carbs, fried food, and chocolates.
Practice stress-reducing habits (yoga, meditation, walking).
