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.
People experiencing symptoms of acne can use the free Ada app to carry out a symptom assessment.
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. If you are experiencing possible symptoms of acne, use the free Ada app to carry out a symptom assessment.
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 a group of hormones known as 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:
- 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.
Types of pimples
There are six main types of pimples:
- 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 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:
- 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.
- 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, which contains estrogen and progesterone, or substitutes, may be effective at treating acne in women whose acne seems to be 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 risk of disturbing embryo development in pregnancy and other 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 treatments 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 prevention
There are several ways to help prevent the development of acne. Not all preventive measures will work for all people, however, and no technique is guaranteed to be effective.
- Keeping the face clean: The face should be cleaned roughly twice daily using warm water and a mild soap in order to remove impurities and dead skin cells form the surface. Avoid washing the face too often, however, and do not use a harsh soap or cleanser.
- Moisturize: Moisturizing can help to keep the skin moist and prevent it from peeling. Products with “non-comedogenic” on the label should not block the pores and thus also not contribute to acne.
- Diet and exercise: Eating a diet rich in fruits and vegetables, and low in fats and sugars may help to control acne. Similarly, getting plenty of exercise may also help to prevent acne outbreaks, as well as promoting general good health. After exercising, be sure to wash away any residual sweat, as this can contribute to acne.
- Avoid makeup: Limiting makeup use may help to prevent an acne outbreak. Any makeup that is used should be oil-free and non-comedogenic.
- Shampoo often: Wash the hair regularly with shampoo. If the hair is particularly oily, use shampoo daily.
- Don’t touch: Avoid the temptation to touch the face throughout the day and be sure not to squeeze, pick or pop pimples; this will allow the acne to heal naturally.
- Avoid excessive sunlight and tanning beds: Too much exposure to the sun and the use of tanning beds may damage the skin and is therefore not recommended.
- Over-the-counter medication: Many anti-acne products are available over the counter from pharmacists and general stores. As well as controlling outbreaks after they have occurred, these products may help to prevent an outbreak from happening in the first place.
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.
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.
Q: Are acne scars permanent?
A: Scarring can result from any type of acne, though is most commonly associated with severe forms of the condition. If left untreated, acne scars are likely to be present for life. Treatment options, however, are available and include cosmetic surgery, laser treatment and dermabrasion. A doctor, specifically a skin specialist or dermatologist, will be able to help outline treatment options and advise on the most appropriate method for each individual.
Q: What is cystic acne vulgaris?
A: Cystic acne vulgaris is a severe type of acne that involves the development of cysts: red, large and often painful lumps that form deep within the skin’s pores. Cystic acne is a severe form of acne that can, in some cases, lead to scarring. For this reason, it is important to visit a doctor or specifically a dermatologist if cystic acne occurs; they will be able to properly diagnose the condition and recommend treatment options.
Q: What is the difference between acne and rosacea?
A: Acne and rosacea are commonly confused conditions. Both can result in pimples, redness and swelling, and both tend to affect the face. They are, however, separate conditions that require different approaches to management and treatment. For more information on rosacea, take a look at this specialist resource from Ada.
Q: Can pregnancy make acne worse?
A: Pregnancy can trigger an acne outbreak or make existing acne worse. This is thought to be due to an increase in androgen hormones, which can make the skin oilier and lead to an increase in the size of the skin’s pores. This may not be the case for all pregnant women, however.
Other names for acne vulgaris