Acne Vulgaris Overview

A common skin condition that affects the oil glands and hair follicles, causing pimples, whiteheads, blackheads, and other blemishes.

The process by which acne develops, involving four main factors: abnormal keratinization, increased sebum production, Propionibacterium acnes overgrowth, and inflammation.

The skin cells in hair follicles are overproducing and clumping together, blocking the follicle.

Hormonal changes, particularly increased androgens, lead to excess oil production in the skin.

The bacteria, Propionibacterium acnes, thrives in the oily environment of clogged follicles, contributing to inflammation.

The bacteria P. acnes triggers inflammation by activating an immune response, resulting in redness, swelling, and pus formation.

Acne severity ranges from mild to severe, with varying degrees of blemishes and inflammatory responses.

In addition to the four primary factors, stress, personal care products, mechanical pressure, and certain medications can contribute to acne.

A healthy diet with less sugar and a skincare routine that uses non-comedogenic products can help prevent acne.

The assessment and treatment of acne include counseling, evaluation of skincare routine, and customized treatment plans.

Acne vulgaris, commonly referred to as acne, is a chronic inflammatory skin condition characterized by the presence of comedones (blackheads and whiteheads), papules, pustules, nodules, and cysts. It often appears on the face, neck, chest, back, and shoulders.

Factors that contribute to acne development include excessive sebum (oil) production, abnormal follicular keratinization (the lining of hair follicles), bacterial overgrowth (Propionibacterium acnes), inflammation, and hormonal fluctuations, particularly those associated with puberty.

The distribution of acne lesions provides valuable information about the severity and location of the condition. Doctors may observe the T-zone of the face (forehead, nose, and chin), cheeks, jawline, neck, chest, back, and upper arms.

The severity of acne can be classified into mild, moderate, or severe categories. Mild acne is characterized by minimal inflammatory lesions, moderate acne has more inflamed lesions, and severe acne involves large, inflamed nodules and cysts with potential scarring.

Comedones are non-inflammatory lesions that are the primary characteristic of acne. Comedones can be open (blackheads) or closed (whiteheads). Inflammatory lesions like papules, pustules, nodules, and cysts are caused by inflammation and bacterial infection.

Topical retinoids are often the mainstay treatment for acne due to their comedolytic (reduce comedones), anti-inflammatory, and hyperproliferation-reducing effects. They work by regulating the shedding of skin cells and reducing oil production.

Topical retinoids are generally recommended for patients with comedonal acne to moderate-severe inflammatory acne. They are typically applied once every other night, gradually increasing to nightly use.

Topical antimicrobials, such as benzoyl peroxide (BPO), are used to combat the bacteria Propionibacterium acnes, which contributes to acne inflammation. They are available in various forms, including washes and topical creams or gels.

Benzoyl peroxide (BPO) is a common topical antimicrobial agent that is effective against P. acnes. It acts as an oxidant, killing bacteria and reducing inflammation. It is typically applied once to twice daily, depending on the formulation and severity of acne.

Topical treatments for acne often require consistency and patience to see noticeable improvement. It's essential to remember that results vary depending on the individual, severity of acne, and adherence to the treatment regimen.

A type of oral acne treatment that works by reducing inflammation and killing bacteria. It's often used for moderate to severe acne, especially on the back, chest, and arms.

A common side effect of Doxycycline, which is an oral antibiotic for acne. It can make your skin more sensitive to sunlight.

Oral antibiotics can be used for acne in patients 8 years or older, especially when the acne is moderate to severe, and involves the back, chest, and arms.

Common side effects of Minocycline, an oral antibiotic for acne. They can include stomach upset, darkening of scars, and discoloration of teeth.

Oral medications that work by lowering the production of hormones that contribute to sebum (oil) production.

Oral contraceptives (OCPs) are a type of hormonal medication FDA-approved for acne. Some examples of OCPs for acne include Ortho Tri-Cyclen, Yaz, and Estrostep.

Spironolactone is an antiandrogen medication taken by mouth to decrease sebum production. It's often used for hormonal acne.

A common side effect of Spironolactone, an oral antiandrogen medication, that can cause frequent urination.

Spironolactone can cause a decrease in blood pressure when standing up quickly. It is important to be careful and avoid standing up suddenly to prevent dizziness.

Spironolactone can increase potassium levels in the blood. Regular blood tests are necessary for individuals at risk, such as those with kidney problems or a history of high potassium levels.

Oral retinoids are a type of medication often used to treat moderate to severe acne, or acne that hasn't responded to other treatments. They work by reducing the size of oil glands and affecting all aspects of acne development.

Oral retinoids are usually taken daily for about 6 months, with the dosage adjusted based on the patient's weight. The total amount of medication a person takes over the course of treatment is also important.

Common side effects of oral retinoids include dry lips, nose, and eyes, as well as dry skin, headaches, and slower healing.

Women who are pregnant or planning to become pregnant should avoid oral retinoids due to their potential harm to the developing fetus.

Oral isotretinoin is a powerful and effective medication for severe acne that hasn't responded to other treatments. It can cause serious birth defects, so strict precautions are taken with female patients.

Oral isotretinoin is known to be a teratogen, meaning it can cause birth defects. To prevent this, women taking this medication must use two forms of birth control and have regular pregnancy tests.

All patients taking oral isotretinoin must register with a program called iPledge, a system designed to minimize the risk of birth defects.

Aside from medication, a healthy diet and lifestyle changes, such as avoiding excess alcohol, can be helpful in managing acne.

Oral antibiotics are commonly used to treat moderate acne. These medications fight bacteria that contribute to inflammation, along with topical retinoids and benzoyl peroxide.

Severe acne is often treated with a combination of medications, including topical benzoyl peroxide and oral antibiotics, and may include topical retinoids and oral isotretinoin.