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Acne Nursing Guide

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

Acne General overview 

Acne is a common disorder of the sebaceous glands, leading to inflammation and the development of skin lesions such as papules, pustules, and cystic nodules. It can manifest as either non-inflammatory or inflammatory acne, impacting a significant portion of the population, particularly adolescents and young adults. 

Acne Etiology and epidemiology 

Acne Vulgaris is the most prevalent chronic skin condition in the United States, affecting nearly 50 million people annually. This disorder primarily targets adolescents and young adults but can persist into adulthood, especially among females. There are several specific types of acne, including: 

  • Acne Conglobata: A rare and severe form featuring burrowing lesions and cysts, sometimes with abscesses. 
  • Acne Fulminans: Marked by sudden onset, severe ulcerative acne, may be accompanied by fever, and joint pain. 
  • Acne Keloidalis Nuchae: Characterized by papules, plaques, and keloid formation on the scalp or neck, predominantly seen in Black males. 

Pathophysiology 

Sebaceous glands produce sebum, a fatty substance that, combined with keratin and bacteria, can obstruct hair follicles (pilosebaceous units). This obstruction leads to various forms of acne: 

  • Non-inflammatory acne: Includes open comedones (blackheads) and closed comedones (whiteheads). 
  • Inflammatory acne: Results from the rupture of follicles, expelling sebum and bacteria into surrounding tissue, leading to inflammation. 
  • Cystic acne: A severe form of inflammatory acne, often involving deeper skin layers. 

Gender and racial considerations 

  • Females may experience acne at different life stages due to hormonal fluctuations, contraceptive use, or conditions like polycystic ovary syndrome (PCOS). 
  • Males are more frequently affected by acne, particularly during adolescence. 
  • Acne is more prevalent among North American white individuals, with Black individuals more prone to pomade acne. 

Contributing factors 

  • Hormonal dysfunction: Hormonal surges, especially during puberty, can exacerbate acne. 
  • Excessive sebum production: Overactive sebaceous glands contribute to pore blockage. 
  • Bacterial overgrowth: Increased Propionibacterium acnes levels can trigger inflammation. 
  • Other factors: Conditions like PCOS, mechanical irritation, certain cosmetics, and medications (e.g., steroids, lithium) can worsen acne. 

Acne Diagnosis 

Acne is diagnosed through a combination of clinical assessment and consideration of psychological and physical impacts: 

  • Physical assessment: Varies from comedonal acne to severe nodulocystic acne, often accompanied by scarring. 
  • Psychological impact: Consider the patient’s mental health, body image, and potential social isolation. 

Acne Nursing Care Plan

Nursing considerations 

Assessment 

  • History: Evaluate the patient's diet, family history, hormonal status, stress levels, and use of oily substances or acne-aggravating factors. 
  • Physical Examination: Document the type and severity of acne, noting the presence of comedones, papules, pustules, and nodules. 

Acne Nursing diagnoses 

  • Anxiety related to body image 
  • Low self-esteem due to altered skin integrity 
  • Impaired skin integrity linked to acne lesions 
  • Social isolation stemming from visible acne lesions 

Interventions 

  • Education: Emphasize the importance of a consistent skincare routine and the proper use of prescribed medications 
  • Support: Encourage patients to share their feelings and concerns about acne 
  • Monitoring: Regularly assess skin response to treatment, particularly with medications like isotretinoin, which require close supervision due to potential adverse effects 

Expected outcomes 

  • Reduction in acne severity: Patients should experience fewer breakouts and improved skin appearance. 
  • Improved self-esteem: As acne diminishes, patients often feel better about their appearance. 

Patient education 

  • Medication adherence: Educate patients about the correct use of topical and systemic treatments, including potential side effects. 
  • Lifestyle adjustments: Advise on a low-glycemic diet, increased zinc intake, and smoking cessation, all of which can help manage acne. 

Medical and surgical management 

  • Medications: Includes topical retinoids, antibiotics, and, in some cases, hormonal therapy for women. 
  • Surgical Options: Cryosurgery, dermabrasion, and laser therapy may be considered for severe cases. 

Prevention and long-term care 

  • Skincare: Advise on gentle cleaning routines and avoiding harsh scrubbing. 
  • Monitoring: Regular follow-up with a dermatologist may be necessary for chronic or severe cases. 

ICD-10 Code for Acne 

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2029

References 

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