acne%20vulgaris
ACNE VULGARIS
Treatment Guideline Chart
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 15-50 inflammatory lesions or 30-125 total lesion count.
Severe papules/pustules or nodulocystic acne is the acne resistant to topical treatment or with scarring/nodular lesions present.

Acne%20vulgaris Signs and Symptoms

Definition

  • 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
  • Occurs most commonly in adolescents and young adults, though is not limited to these age groups 
    • Adolescent acne is due to the hormonal surges as a child transitions into adulthood while post-adolescent acne is due to many contributing factors

Risk Factors

Contributing Factors

  • Medications
    • Corticosteroids, anabolic steroids, Lithium, some oral contraceptives (OC), retinoids, etc
  • Androgen excess
    • Signs of androgen excess: Precocious puberty, hirsutism, irregular menstruation, androgenetic alopecia
    • Causes of androgen excess: Polycystic ovary disease or adrenal, ovarian, or pituitary tumor
    • Pathogenesis: Androgen excess causes abnormal epithelial desquamation and obstruction of follicles, the latter secondary to sebum production forming open and closed comedones. Cutibacterium acnes (previously known as Propionibacterium acnes) proliferates due to sebum and causes inflammation manifested as papules, pustules, nodules, and cysts
  • Mechanical
    • Physical occlusion: Eg cosmetics (comedogenic), hats, head bands, mask-related acne (maskne), etc
  • Other factors 
    • Resistant Cutibacterium sp and dysbiosis within the microbiome of the pilosebaceous follicle 
    • Innate and cellular immune responses, genetic predisposition, endocrine disorders (eg Cushing syndrome, androgen-secreting tumors, obesity) 
    • Consumption of westernized diet, intake of skim milk, stress, smoking, poor quality of sleep, air pollution
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