Overview

Acne vulgaris is an inflammatory disorder of the pilosebaceous unit which is composed of the sebaceous gland and the hair follicle. The sebaceous glands are the glands responsible for producing and secreting sebum, or oil,  into a nearby hair follicle to lubricate the skin. During puberty, the level of androgens, such as testosterone, in the body rises which increases the production of sebum. This causes the hair follicles to clog creating a favorable medium for bacteria to grow. The most common bacteria associated with acne is the Cutibacterium acne and it is part of the normal bacterial flora of the skin. However if the hair follicles get clogged, these bacteria can grow and multiply, and start to break down sebum into particles that irritate the skin, triggering an inflammatory reaction. This reaction is characterized by the formation of pus and a red inflammatory bump, commonly called a pimple.

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Prevalence & Risk factors

Acne vulgaris is the most common skin disorder in adolescents and young adults and its prevalence decreases with increasing age. It typically starts at the age of 11-12 years old. Acne is more common in men during adolescence but more common in women during adulthood.

External factors such as the climate, drugs (anabolic steroids, progestin-only contraceptive pills and corticosteroids) and food, especially dairy products and high glycemic food can trigger acne vulgaris.  

Conditions favoring hormonal changes such as polycystic ovary syndrome as well as menstruation and pregnancy, can episodically worsen acne.

Smoking, stress and inconsistent skin care routines are also aggravating factors.
   
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Genetics‍

Multifactorial disorder

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Signs & Symptoms

Mild acne usually consists of the presence of whiteheads and blackheads, known as comedones. Comedones consist of dead skin cells, keratin and the pigment melanin that block the hair follicle. If the blocked hair follicle is still open to the surface and exposed to air, melanin will oxidize and darkened, forming the blackheads. Whiteheads, on the other hand, happen when the hair follicle is closed and not exposed to air, still preserving their white appearance.

If a whitehead becomes inflamed it can progress to papules, the so-called pimples, and pustules, pimples with pus at their tips. In severe cases, nodules, cysts and even cavities can occur.

Complications of acne vulgaris include hyperpigmentation of the skin and scarring of the pimple.

Diagnosis

Acne vulgaris is diagnosed with a physical examination of the skin.

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Therapy‍

Benzoyl peroxide and salicylic acid are the first-line therapy for mild cases. In more severe cases, antibiotics or oral isotretinoin, a vitamin A derivative, can be prescribed.
Psychodermatology is a new method of therapy using anti-anxiety medication and cognitive-behavior therapy to help reduce stress-related acne.

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Prevention‍

Healthy diet, a consistent skin care routine and a stress-free life can help you prevent acne vulgaris. 

Prognosis‍

‍Acne vulgaris typically fades spontaneously by the early to mid 20s and heals without scars.

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Recommendations

• Make sure to wash your face every day using a foaming cleanser to remove all the dead cells and dirt off your face
• Do not attempt to squeeze your pimples as it increases inflammation and makes scarring more likely
• Make sure all of your cosmetic products are non-comedogenic (as they do not cause blackheads by blocking the pores of the skin)
• If acne is something that bothers you deeply, psychological counseling can help you to better cope with this condition
• If you are pregnant, do not take any vitamin A derivates, including retinoids and isotretinoin, as they may cause congenital defects to the baby

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