Introduction

Of all the skin diseases, acne is the most common with approximately 85% of people affected to some degree at some time in their lives (Rapp et al., 2004). In males, acne typically presents in early adolescence, with the greatest disturbance to skin being observed between the years of 16 to 19 (Hurwitz, 1993). In females, acne tends to present at an earlier age and then subsequently lasts longer than in males (Fallon, 1992). Acne therefore unfortunately tends to occur during adolescence, precisely at a time of simultaneous and significant psychological, physical and social changes (Yazici et al., 2004).

The biological model of acne points to the increased metabolism of androgens in the dermis, in combination with sebaceous gland sensitivity to androgens creating varying degrees of comedones, papules and pustules (‘spots’)(Cunliffe & Simpson, 1998). The most common form of acne is that of acne vulgaris. In about 20% of such cases, the disease necessitates contact with health services (Munro-Ashman, 1963). There are a number of less common variants of acne termed nodular and cystic acne, which have a far more serious prognosis for ongoing and distal physical appearance; acne conglobata, acne fulminans and Gram-negative folliculitis (Cunliffe & Simpson, 1998). The raison d'être of physical intervention with regard to treating all variants of acne, is the prevention of physical scarring, by limiting the number of skin lesions and thereby minimizing the potential psychological implications of the disease (Healy & Simpson, 1994).