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Acne Vulgaris

What is acne vulgaris?

Acne is a skin condition in which oil (sebum) and dead skin cells clog the pores (hair follicles), causing pimples or spots to develop. Acne differs from regular pimples in that it tends to consist of multiple pimples at once and is usually recurrent. Acne is quite common, especially among males, with most people experiencing it at least once. It tends to affect people between the ages of 12 and 25, though is most typical during the teenage years. In most cases, it will improve later in adulthood. Acne may cause scarring of the skin, but generally causes no long-term health problems.

Causes of acne vulgaris

Pimples occur when dead skin cells and oil clog the pores of the skin. As more oil builds up behind the blockage, the pore becomes inflamed, and the pimple becomes painful and swollen. Acne typically appears for the first time during adolescence, triggered by the hormones (androgens) which begin to circulate in the body during puberty.

Acne will often improve in early adulthood, but can persist longer. The condition affects teenage boys more often than girls, but, in adults, women develop it more commonly than men. There are a number of triggers that can make the development of acne more likely, including:[1]

  • The use of the progesterone-only contraceptive pill
  • The hormonal changes triggered by menstrual periods
  • Some types of makeup
  • Picking or squeezing existing pimples
  • Sweating heavily
  • Humid weather
  • Tight clothing, headbands or collars, for example
  • Some medicines. Do not stop taking medication which is causing acne before talking to a doctor
  • Steroids, including anabolic steroids and steroid creams used to treat eczema

Genetics may also play a role in the development of acne; a person’s family history is relevant when visiting a dermatologist.

Symptoms of acne vulgaris

Typical symptoms of acne include skin pimples, cysts and nodules. The pimples are often on the face, although the shoulders, back, chest and other body parts can also be affected. The skin around and over these pimples is sometimes red and sore. With time, the affected skin may become darker or scarred.

Types of pimples

There are six main types of pimples:[2]

  • Blackheads: Small black or yellowish bumps.
  • Whiteheads:Small white or yellowish bumps, usually firmer than blackheads.
  • Papules: Small red bumps that can be sore.
  • Pustules: Similar to papules but will have a white spot in the center caused by a buildup of pus.
  • Nodules: Large hard bumps that are typically painful.
  • Cysts: Large lumps, similar to boils, filled with pus that may be painful. A severe form of acne that may cause scarring.

Acne vulgaris diagnosis

A doctor or dermatologist will diagnose acne following a skin examination, taking note of where the acne is located and its severity. These factors are important in determining how the condition should be treated.

Professionals typically use a grading system to categorize acne:[2]

  • Grade 1: Mild acne, probably limited to blackheads and whiteheads.
  • Grade 2: Moderate acne with papules and pustules, mostly confined to the face.
  • Grade 3: Moderately severe acne affecting the face, back and chest. Papules and pustules will be present, and inflamed nodules are possible.
  • Grade 4: Severe acne, with a large number of painful papules, pustules and nodules.

Acne vulgaris treatment

The treatment of acne depends on the severity of the condition. To treat very mild acne, simple steps such as washing the face and hair regularly, but not excessively, to remove excess oil, avoiding heavy, oily creams and cosmetics and maintaining a healthy diet may suffice.

If, however, the acne is severe, or mild acne does not improve after following the steps outlined above, a number of different topical and/or oral medications are available. Some are available over the counter whereas others may require a prescription.

Some of the most common topical acne medications include:[1][3]

  • Retinoids: These medications are effective at unblocking pores and can help to reduce inflammation. They are often used early on in the treatment process and generally require a prescription. Types include adapalene, tretinoin and isotretinoin, which all come with various brand names.
  • Benzoyl peroxide: This is a topical treatment option which can be bought from pharmacies without a prescription. It is effective at clearing the skin of bacteria, unblocking pores and reducing inflammation. In some instances, this type of medication may be used in combination with antibiotics, which will typically require a prescription. Always read the enclosed information leaflet carefully before beginning treatment.
  • Topical antibiotics: These medications work by killing the bacteria growing inside the pores. They are therefore effective at reducing inflammation, but have limited effectiveness at unblocking pores, meaning they are generally ineffective at tackling blackheads or whiteheads. A prescription is necessary.
  • Selective aldosterone antagonists: Can be taken orally or applied topically. Examples include spironolactone.

Some of the most common oral acne medications include:

  • Antibiotics are effective at reducing inflammation and killing the bacteria that can contribute to acne. Tetracycline-based antibiotics are the most commonly prescribed for treating acne.
  • The combined pill (estrogen and progesterone, or substitutes) may be effective at treating acne in women whose acne seems to caused by abrupt hormonal changes.
  • Isotretinoin, part of the retinoids group, can be very effective at treating even severe acne, though is generally only used once all other treatment options have been explored. This is due to the teratogen risk and possible side-effects that isotretinoin may cause, which include headaches, joint and muscle pain.

Acne treatment can take a number of weeks to show results, with most showing good results by roughly week six. It is therefore important to continue treatment, even if the acne is showing no signs of improvement.

Acne vulgaris FAQs

Q: Will acne return after treatment?
A: Once treatment has been stopped, it is normal for acne to return. For this reason, many people choose to carry on with maintenance treatment, sometimes for as long as four or five years. This is usually done using a topical retinoid or benzoyl peroxide.[1]

Q: Can acne ever pose a serious risk to your health?
A: Acne does not pose a direct health risk, but can, in some cases, cause permanent scarring of the skin. If your acne does not respond to treatment, you may be referred to a hospital specialist to explore further options. If scarring has already occurred, laser treatment or a chemical peel, among other options, may be recommended.[1]

Other names for acne vulgaris

  • acne

  1. Patient. “Acne.” May 11, 2015. Accessed May 11, 2018.

  2. NHS Choices. “Acne - Diagnosis.” April 28, 2016. Accessed May 11, 2018.

  3. UpToDate. “Patient education: Acne (Beyond the Basics).” October 12, 2017. Accessed May 14, 2018.