Acne (probably a corruption of Gr. akmē, ‘a point’) is an important skin disease. It is placed by some dermatologists in the order Pustulae, and by others in the order Tubercula, which includes solid, hard elevations of the skin, much larger than Papulae. The sebaceous follicles of the Skin (q.v.) are the primary seat of the affection. Their natural secretion accumulates in their interior, and there is at the same time a tendency to inflammation of the follicle and surrounding tissue. It is by no means rare to find on the face and shoulders of young persons about or above the age of puberty a number of black spots, each of which is placed on a slightly-raised pale base. These black points are called comedones. Pressure at the base occasions the expulsion of a little, elongated, spiral, white mass, with a black point or anterior end, commonly but erroneously regarded as a worm; though in the midst of the white mass of sebaceous matter, a parasite, Acarus folliculorum (q.v.) is occasionally found. Interspersed are other spots, with the base more raised and inflamed, which become more or less perfect pustules, each of which rests on a comparatively large red base. Around some of the inflamed follicles, coagulated lymph (to use the old phraseology) is thrown out, and a small hardened mass is the result. According as one or other of these appearances preponderates, we have different varieties of this disease. When the pustule is the most striking feature, the affection is called Acne simplex or vulgaris; when the black points abound, it is Acne punctata; and when there is decided induration, it is Acne indurata. We have already mentioned the age at which this affection commonly occurs: it is never seen in children, and is rare in aged persons.
As long as there is no inflammation, the treatment simply aims at favouring the escape of the contents of the sebaceous follicles, by rubbing the face and other affected parts with cold cream at bedtime, washing on the next morning with soap and water, and vigorous friction with a towel or a piece of flannel. When acute inflammation is present, and the pustules are very tender, there is no better application than tepid water, with or without a little gelatine in solution; and subsequently the ointment of the hypochloride of sulphur has been found useful by Wilson and others. Acne indurata, which is the least tractable of the three forms, is sometimes benefited by the application of fly-blisters. In all these cases, the state of the digestive and sexual organs must be carefully attended to.
ACNE ROSACEA, also called Rosacea and Guttta Rosea, is so different from the forms of acne above described that it is regarded by most authorities as a distinct disease. It usually first appears at or near the end of the nose; and in some cases it is confined to the nose, while in others it extends to the cheeks, forehead, chin, or even to the whole face. The skin in the part affected assumes a deep red colour, usually transient at first, but returning either on no special provocation, or in consequence, apparently, of some gastric or other disturbance, and after a time becomes permanent; pimples resembling those of Acne simplex may appear, but are associated with itching and burning sensations not present in the ordinary forms of acne. The skin of the diseased part, in some cases, is irregularly swollen, and may become enormously hypertrophied, especially that of the nose. In such cases, it is marked with blue or red streaks, caused by congestion and enlargement of the capillaries; the whole surface, in a severe case, presenting a very disagreeable and repulsive appearance. This affection is no doubt often a result of intemperate living, but it may occur in persons of regular habits of life. Disorder of the digestive system is so often associated with it, as to exclude the idea that the combination is accidental, and the skin disease may often with great probability be referred to gastric disturbance as the exciting cause. In women, however, it is very frequently associated rather with disorder of the menstrual functions. The disease is confined almost exclusively to persons in middle or advanced life, and women are especially liable to it about the period in which what is popularly known as the 'change of life' occurs: moreover, it has occasionally been observed to be hereditary.
The general treatment must be governed by the digestive or menstrual disorders associated with it; and a nourishing but bland and non-stimulating diet—above all, abstinence from alcohol—is of great importance. In the early stages, and in irritable forms of the disease, the local treatment should be soothing. Emollient lotions, such as emulsion of bitter almonds, cream, glycerine, a bismuth and calamine lotion, &c. may be occasionally used during the day, and in severe cases a bread poultice may be applied to the face at night. When the affection becomes indolent, the emollients should be gradually replaced by stimulating applications, such as Eau de Cologne, or a solution of corrosive sublimate in alcohol, in the proportion of from one to two grains in the pint; and at a still later stage, a lotion or ointment containing sulphur is often useful. When the capillaries become enlarged, they must be destroyed by incisions or caustics; if the skin be much hypertrophied, removal or cauterisation may be necessary to effect any improvement.