The diagnosis of acne is based on the history and physical examination, evidence of lesions characteristics of acne, and age.

Acne does not occur until puberty. The presence of the typical comedones, such as whiteheads and blackheads, along with excessively oily skin is its main characteristic.

Oiliness is more prominent in the midfacial area; other parts of the face may appear dry. When there are numerous lesions, some of which are open, the person may exude a distinct sebaceous odor.

Women may report a history of flare-ups a few days before menses. Biopsy of lesions is seldom necessary for a definitive diagnosis.

In Preventing Acne Scarring

Preventing scarring is the ultimate goal of diagnosis and therapy. The chance of scarring increases as the grade of acne increases.

For instance, Grades III and IV, normally 25 to more than 50 comedones, papules, or pustules, usually require longer-term therapy with systematic antibiotics or isotretinoin.

Patients should be warned that discontinuing these medications could exacerbate acne, could lead to more flare-ups, and increase the chance of deep scarring.

Moreover, manipulation of the comedones, papules, and pustules increases the potential for scarring.

When acne surgery is prescribed to extract deep-seated comedones or inflamed lesions or to incise and drain cystic lesions, the intervention itself may result in further scarring.

Dermabrasion, which levels existing scar tissue, can also increase scar formation. Hyperpigmentation or hypopigmentation also may affect the tissue involved. The patient should be informed of these potential outcomes before choosing surgical intervention for acne.

Preventing Infection

The key to acne scar prevention is preventing infection.

Female patients receiving long-term antibiotic therapy with tetracycline should be advised to watch for and report signs and symptoms of oral or vaginal candidiasis, a yeast-like fungal infection.

In addition to receiving instructions for taking prescribed medications, patients are instructed to wash the face and other affected areas with mild soap and water twice each day to remove surface oils and prevent obstruction of the oil glands. They are cautioned to avoid scrubbing the face. After all, acne is not caused by dirt and cannot be washed away.

Mild abrasive soaps and drying agents are prescribed to eliminate the oily feeling that troubles many patients. At the same time, patients are cautioned to avoid excessive abrasion because it makes acne worse.

Excessive abrasion causes minute scratches on the skin surface and increases possible bacterial contamination and infection. Soap itself can irritate the skin.

All forms of friction and trauma are avoided, including propping the hands against the face, rubbing the face, and wearing tight collars and helmets.

Patients are instructed to avoid manipulation of pimples or blackheads. Squeezing merely worsens the problem, because a portion of the blackhead is pushed down into the skin, which may cause the follicle to rupture.

Because cosmetics, shaving creams, and lotions can aggravate acne, these substances are best avoided unless the patient is advised otherwise.

Failure of the acne to heal may result from many factors, including infection and inadequate nutrition. Hence, it is extremely important for the nurse and other health practitioners to take care of patients with acne. Their responsibility will consist mainly of monitoring and managing potential complications of skin treatments.

Major activities in preventing acne scar include patient education, particularly in proper skin care techniques, and managing potential problems related to the skin disorder or therapy.

All of these things are boiled down to the fact that the most important means of preventing acne scar is to prevent infection.

In general, learning how to care for your skin, even if it is bombarded with lots of comedones or pimples, is still the best way to avoid acne scar.

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