Acne Vulgaris

Acne vulgaris, commonly known simply as acne, is a skin condition that occurs when hair follicles become clogged with oil and dead skin cells, leading to the formation of pimples, blackheads, whiteheads, and in more severe cases, nodules and cysts. It most commonly affects teenagers due to hormonal changes during puberty, but can occur at any age. Acne typically appears on the face, forehead, chest, upper back, and shoulders, which are areas with the most oil (sebaceous) glands. While not a life-threatening condition, acne can cause significant emotional distress and, in severe cases, permanent scarring. With proper treatment and management, most cases of acne can be controlled effectively.

Causes

Excess oil (sebum) production - Overactive sebaceous glands produce too much oil, contributing to clogged pores.
Hair follicles clogged by oil and dead skin cells - When these combine, they form a plug in the follicle.
Bacteria (Cutibacterium acnes, formerly Propionibacterium acnes) - These normally harmless bacteria can multiply rapidly in clogged pores, causing inflammation.
Inflammation - The body's response to bacterial overgrowth can cause redness, swelling, and pus formation.
Hormonal changes - Androgens (hormones that increase during puberty) cause the sebaceous glands to enlarge and produce more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives can also affect acne.
Genetic factors - Acne tends to run in families, suggesting a genetic component to susceptibility.
Certain medications - Drugs containing corticosteroids, testosterone, or lithium can worsen acne.
Diet - Some research suggests that certain dietary factors, including dairy products and carbohydrate-rich foods, may trigger or worsen acne in some people.
Stress - While stress doesn't cause acne, it can exacerbate it by increasing cortisol production, which can stimulate the oil glands and worsen inflammation.
Friction or pressure on the skin - From items like helmets, tight collars, or cell phones (acne mechanica).

Signs and Symptoms

Whiteheads (closed plugged pores)
Blackheads (open plugged pores where the oil oxidizes, turning black)
Papules (small, tender, red bumps)
Pustules (papules with pus at their tips)
Nodules (large, solid, painful lumps beneath the skin's surface)
Cystic lesions (painful, pus-filled lumps beneath the skin's surface)
Redness and inflammation of surrounding skin
Potential scarring, particularly from severe nodular or cystic acne
Post-inflammatory hyperpigmentation (darkening of the skin after an acne lesion heals)
Post-inflammatory erythema (persistent redness after an acne lesion heals)
Psychological impacts including decreased self-esteem, social withdrawal, and in some cases, depression or anxiety

Diagnosis

Visual Examination

A dermatologist can typically diagnose acne through a visual inspection of the affected areas, identifying the types of lesions present (comedones, papules, pustules, nodules, or cysts) and assessing the severity and distribution of the acne.

Medical History

Your doctor will ask about your symptoms, when they began, what treatments you've tried, any medications you're taking, family history of acne, and for women, information about menstrual cycles and possible hormonal factors.

Grading and Classification

Acne is often classified as mild (primarily comedones), moderate (inflammatory papules and pustules), or severe (nodules and cysts, with potential scarring). This classification helps determine the appropriate treatment approach.

Differential Diagnosis

In some cases, your doctor may need to rule out other conditions that can resemble acne, such as rosacea, folliculitis, keratosis pilaris, or perioral dermatitis, each of which requires different treatment approaches.

Hormonal Evaluation

For women with signs of hormonal acne (such as flares related to menstrual cycles or acne primarily on the lower face and jawline), blood tests may be performed to check hormone levels, particularly if there are other signs of hormonal imbalance.

Treatment Options

Topical Treatments

Applied directly to the skin, these are often the first line of treatment. Options include benzoyl peroxide (kills bacteria and removes excess oil and dead skin cells), retinoids (derived from vitamin A, they prevent clogging of hair follicles), salicylic acid (helps remove dead skin cells and reduce inflammation), azelaic acid (has antibacterial properties and reduces inflammation), and topical antibiotics (reduce bacteria and inflammation).

Oral Medications

For moderate to severe acne, oral medications may be prescribed. These include antibiotics (such as doxycycline or minocycline) to reduce bacteria and inflammation, combined oral contraceptives (for women, to regulate hormones), anti-androgen agents (such as spironolactone, which blocks the effect of androgen hormones), and isotretinoin (a powerful retinoid for severe, resistant acne that works on all contributing factors).

Procedures

Various procedures can help treat acne and improve the appearance of skin. These include extraction of large cysts by a dermatologist, steroid injections into nodules to reduce inflammation and pain, chemical peels to remove the top layer of skin and unclog pores, and light therapies that target bacteria or reduce oil production.

Lifestyle and Skincare Management

Proper skincare is essential for managing acne. This includes gentle cleansing twice daily with a mild, non-soap cleanser, avoiding scrubbing or frequent washing, using oil-free, non-comedogenic moisturizers and makeup, and never picking or squeezing pimples, which can lead to infection and scarring.

Home Remedies

Proper Cleansing

Wash affected areas twice daily with a gentle, pH-balanced cleanser. Avoid harsh soaps or scrubbing, which can irritate the skin and worsen acne. Use lukewarm water and pat dry with a clean towel rather than rubbing.

Tea Tree Oil

When diluted properly, tea tree oil has antimicrobial properties that may help reduce acne-causing bacteria. Apply a small amount with a cotton swab directly to pimples after performing a patch test to ensure you don't have a sensitivity to it.

Dietary Adjustments

Some people find that reducing high-glycemic foods (like refined carbohydrates) and dairy products helps improve their acne. Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Stay well-hydrated by drinking plenty of water.

Stress Management

Since stress can worsen acne, practices like deep breathing, meditation, yoga, or regular exercise may help reduce stress levels and potentially improve skin condition. Ensuring adequate sleep is also important for skin health.

Natural Spot Treatments

Ingredients like honey (antimicrobial), aloe vera (anti-inflammatory), or a diluted solution of apple cider vinegar (antibacterial) can be applied directly to pimples. However, discontinue use if any irritation occurs, and always patch test new treatments first.

Preventive Care

Establish a consistent skincare routine with gentle cleansing and appropriate products for your skin type.
Use non-comedogenic (won't clog pores) moisturizers, sunscreens, and makeup products.
Remove makeup completely before sleeping to allow skin to breathe and prevent pore clogging.
Avoid touching your face, which can transfer bacteria and irritate the skin.
Clean items that regularly contact your face, such as cell phones, pillowcases, and makeup brushes.
Shower after exercising or sweating heavily to remove excess oil and bacteria from the skin.
Consider using oil-absorbing products if you have particularly oily skin.
Avoid harsh skincare products containing alcohol, fragrances, or abrasives that can irritate the skin.
Be consistent with prescribed treatments, as acne management requires regular, ongoing care rather than spot treatment.
Protect your skin from excessive sun exposure, as some acne medications increase sun sensitivity, and sunburn can worsen acne.
Maintain a balanced diet rich in fruits, vegetables, lean proteins, and whole grains, while limiting foods that seem to trigger your acne.

Surgical Options

Chemical Peels

While not traditional surgery, professional-strength chemical peels involve applying an acid solution to remove the outer layer of skin, unclog pores, and stimulate new skin growth. Glycolic acid, salicylic acid, or trichloroacetic acid peels of varying strengths may be used, depending on acne severity and skin type.

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Microdermabrasion

This minimally invasive procedure uses tiny crystals or a diamond-tipped handpiece to gently sand the skin, removing the outer layer and stimulating new skin growth. It can help with mild acne, blackheads, and some superficial acne scars, though multiple sessions are typically needed for best results.

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Laser and Light Therapies

Various laser and light treatments can target the bacteria that cause acne, reduce oil production, or improve acne scars. Options include blue light therapy, pulsed dye lasers, and fractional laser resurfacing. These treatments may be particularly useful for people who cannot use certain medications or have not responded to other treatments.

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Drainage and Extraction

For large, painful cysts that don't respond to medication, a dermatologist can drain and extract the contents using specialized tools in a sterile environment. This can provide immediate relief and reduce the risk of scarring, though it is not a cure for acne itself.

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Acne Scar Treatments

For those with significant scarring from previous acne, procedures such as subcision (breaking up scar tissue beneath the skin), dermal fillers (temporarily filling in depressed scars), or punch excision (cutting out deep scars and repairing with stitches or skin grafts) may be recommended after the active acne is controlled.

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Schedule a Consultation

If you're experiencing symptoms of acne vulgaris, our expert team is here to help you find the right treatment approach for your specific needs.

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