acne%20vulgaris
ACNE VULGARIS
Acne vulgaris is a chronic inflammatory dermatosis which is notable for open and/or closed comedones (blackheads and whiteheads) and inflammatory lesions including papules, pustules or nodules.
Mild acne has <20 comedones or <15 inflammatory lesions or <30 total lesion count.
Moderate acne has 20-100 comedones or 15-20 inflammatory lesions or 30-125 total lesion count.
Severe papules/pustules or nodulocystic acne is the acne resistant to topical treatment or if scarring/nodular lesions are present.

Classification

Classification by Severity

  • Usually overestimated by patient and underestimated by physician
Mild* Moderate** Severe***
Comedones <20 20-100 >100
Papules/Pustules <15 15-50 >50
Nodules/Cysts 0 <5 >5
Total Lesion Count <30 30-125 >125
*Includes comedonal and mild papulopustular acne
**Further subdivided into moderate papulopustular acne and moderate nodular acne
***Further divided into severe papulopustular acne, severe nodular acne, and conglobate acne


Other Considerations

  • Grading schemes that rely on the above lesion counts are usually of greater use in clinical studies rather than clinical practice
  • May be better to focus on the most severe lesions present
    • Proper treatment of the most severe lesions usually covers all lesser lesions

History

  • History of past treatments
  • In most cases, there is no need to look for underlying cause, which may be found in patients >20 years old and in resistant acne cases

Physical Examination

  • Diagnosis is usually confirmed based on the morphology of the lesions and their site of distribution

Types of Acne Lesions

  • Comedonal (non-inflammatory)
    • Closed (whitehead) or open (blackhead) lesions
  • Papulopustular (inflammatory)
    • Papule: Small bump <5 mm in diameter
    • Pustule: Smaller bump with core of purulent material
  • Nodular (inflammatory)
    • Represents severe acne, manifested as nodules and deep pustules of >5 mm diameter
    • Conglobate acne is a severe form of nodular acne where the lesions are firm, inflamed and painful measuring >10 mm

Site of Distribution

  • Lesions typically concentrate in the centrofacial areas
    • Forehead, nose, chin
  • May eventually involve other areas containing sebaceous glands
    • Face, ears, neck, chest, shoulders, back, scalp

Evaluation

Acne Grading Systems
  • Currently there is no recommended universal grading/classifying system for acne
  • Several scoring methods are being used by different associations, grading and lesion counting being the most commonly used methods
    • Number of lesions, type of acne, disease severity, anatomical site/s, and propensity for scarring should be considered when determining acne score for management purposes
    • Some scoring methods being used include the Echelle de Cotation des Lesions d’Acne (ECLA) or Acne Lesion Score Scale, Leeds technique, post acne hyperpigmentation index (PAHPI), Comprehensive Acne Severity System (CASS), and the Acne Quality of Life Scale (AQOL) among others
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