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INTRODUCTION  

Acne vulgaris is one of the most common skin conditions, affecting an estimated 50 million people in the United States each year. Typical acne develops when hair follicles become clogged with excess oil, dead skin cells, and sometimes bacteria, leading to inflammation. It is most common during adolescence and young adulthood due to hormonal changes, but it can also affect adults.1,2 

SYMPTOMS  

Recognizing the following symptoms of acne vulgaris can help in seeking timely treatment and preventing complications. 

  • Comedones: Non-inflammatory lesions that can be open (blackheads) or closed (whiteheads).3 
  • Pustules and Papules: Superficial and deep inflammatory lesions.3 
  • Nodules: Large, firm, often painful lesions beneath the surface of the skin.3 
  • Cysts: Deep, painful, pus-filled lesions that can lead to significant scarring.3 

 Acne vulgaris primarily affects areas with a high density of oil glands, such as the face, neck, chest, upper arms, and back.3,4 

DIAGNOSIS  

Diagnosing acne vulgaris involves a thorough medical history and physical exam. Physicians will review the patient’s symptoms, risk factors, and underlying health conditions. Factors such as age, family history, hormonal changes, and dietary habits can play a role in acne and are important to share.5 A physical exam will then be performed, assessing for the symptoms described above and possible scarring, as well as severity of the condition. 

TREATMENT  

Effective management of acne vulgaris can range from topical agents to oral medications, depending on the severity and responsiveness of the condition. 

Topical Agents 

Creams and gels applied to the skin are often used for the initial treatment of acne.5   

Topical Retinoids: These include tretinoin, adapalene, and tazarotene. They work by gently clearing clogged hair follicles.5   

Benzoyl Peroxide: A topical that has antibacterial and anti-inflammatory properties.5   

Topical Antibiotics: These include clindamycin and erythromycin. They work by reducing acne-causing bacteria and are used in combination with benzoyl peroxide.5    

Oral Medications 

In moderate to severe acne or no improvement with topical therapy, an oral medication may be indicated.5 

  • Systemic Antibiotics: Doxycycline and minocycline are commonly used. It is recommended they be paired with a topical agent.5  
  • Hormonal Agents: Combined oral contraceptives and spironolactone may be useful in correcting hormonal acne depending on patient sex, age, and past medical history.5   
  • Isotretinoin: This medication works by reducing the size and secretion of oil glands. It is reserved for severe acne, failure to improve with the options outlined above, or those experiencing scarring.5   

COMPLICATIONS  

If acne vulgaris goes untreated, it can result in long-term complications that significantly impact skin health and quality of life. Early diagnosis and treatment can reduce the following complications: 

  • Scarring: Permanent scarring is often associated with more severe breakouts.3 
  • Emotional Distress: Acne is associated with increased rates of anxiety, depression, and suicidal ideation.1 

SOURCES 

  1. Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: A review. JAMA. 2021;326(20):2055-2067. doi:10.1001/jama.2021.17633 
  2. Oge' LK, Broussard A, Marshall MD. Acne vulgaris: Diagnosis and treatment. Am Fam Physician. 2019;100(8):475-484. 
  3. Geng R, Sibbald RG. Acne vulgaris: Clinical aspects and treatments. Adv Skin Wound Care. 2024;37(2):67-75. doi:10.1097/ASW.0000000000000089 
  4. Feldman S, Careccia RE, Barham KL, Hancox J. Diagnosis and treatment of acne. Am Fam Physician. 2004;69(9):2123-2130. 
  5. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017