Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

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SUMMARY Quantitative aerobic cultures were obtained from fifty patients with chronic plaques, and from twenty with exudative lesions of atopic dermatitis. In the former, Staphylococcus aureus was isolated from 90% and the density exceeded 1 × 106/cm2 in 45% of the samples. In the exudative form, Staph. aureus was recovered in every case with a mean density of 14 × 106 organisms per cm2. Staph. aureus was the dominant organism not only in the lesions but in nearby clinically normal skin. Despite these high numbers, clinical signs of infection were lacking. Systemic and topical antibiotic therapy pro‐duced a profound decrease in Staph. aureus density. It is proposed that high numbers of Staph. aureus may aggravate the underlying lesion and be the source of Staph. aureus infections in contacts.

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SummaryBackground-Human skin emits a variety of volatile metabolites, many of them odorous. Much previous work has focused upon chemical structure and biogenesis of metabolites produced in the axillae (underarms), which are a primary source of human body odour. Nonaxillary skin also harbours volatile metabolites, possibly with different biological origins than axillary odorants.

Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

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The axillary microflora of 229 subjects was characterized quantitatively and the results correlated with whether the odor was pungent body odor or instead a faint "acid odor". The axillary flora was found to be a stable mixture of Micrococcaceae, aerobic diphtheroids and Propionibacteria. Significantly higher numbers of bacteria were recovered from the axilla of those with pungent axillary odor than in those with acid odor. Aerobic diphtheroids in high numbers were recovered in all subjects having typical body odor. These included lipophilic as well as large-colony diphtheroids. When droplets of apocrine sweat placed on the forearm were inoculated with various bacteria which reside in the axilla, only diphtheroids generated typical body odor. Cocci produced a sweaty odor attributable to isovaleric acid.