• 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

Contributing Factors

• Medications
  
  • Corticosteroids, anabolic steroids, Lithium, some oral contraceptives (OC), 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. Propionibacterium acnes (also known as Cutibacterium acnes) proliferates due to sebum and causes inflammation manifested as papules, pustules, nodules, and cysts

• Mechanical
  
  • Physical occlusion: Eg cosmetics, hats, head bands, etc

• Other factors for which evidence is limited
  
  • Consumption of westernized diet, intake of skim milk, stress