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Acne vulgaris

Last updated: January 3, 2021

Summary

Acne vulgaris is a common skin disease that affects most individuals at some point in their lives. It is classified into different forms which vary in severity, lesion type, and localization, with the face commonly involved. The hallmark of acne are comedones, which can develop further into inflammatory papules, pustules, or even abscesses and nodules. Symptoms typically begin in early puberty and cease spontaneously during the third decade of life. There are multiple etiological factors: genetic predisposition, seborrhea, and hyperkeratosis are known to promote the development of acne. Topical and systemic treatment options are available to counteract inflammation and hyperkeratosis, as well as to help purify the skin.

Epidemiology

  • Prevalence: the most prevalent chronic skin condition in the US [1]
  • Age of onset: typically by 11–12 years, with symptoms usually disappearing around 20–30 years of age [2]
  • Sex: more common in males during adolescence, but more common in women during adulthood

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Clinical features

  • Localization: common in areas with sebaceous glands (predilection sites: face, shoulders, upper chest, and back)
  • Primary lesions
    • Non-inflammatory: comedonal acne
      • Closed comedones (“whiteheads”): closed small round lesions that contain whitish material (sebum and shed keratin)
      • Open comedones (“blackheads”): dark, open portion of sebaceous material
    • Inflammatory: affected areas are red and can be painful
  • Secondary lesions: : postinflammatory erythema, hyperpigmentation, and scarring

References:[5]

Subtypes and variants

Hidradenitis suppurativa

Neonatal acne

  • Age of onset: : first few weeks of life
  • Clinical presentation: : papulopustular rash
  • Treatment: self-limiting disease ; no specific treatment

Infantile acne

  • Age of onset: ≥ 3 months
  • Clinical presentation: papulopustular rash, closed comedones, and sometimes formation of nodules (more common in boys)
  • Treatment: benzoyl peroxide, possibly in combination with erythromycin; in contrast to neonatal acne, treatment is indicated to avoid scarring

References:[5][6]

Treatment

Acne treatment [7]

Severity Treatment
Mild (e.g., comedonal)
Moderate (e.g., papular/pustular)
Severe (e.g., conglobata)

Therapy is particularly important for patients with inflammatory acne to prevent complications such as scarring.

Retinoids [5][7]

Retinoid therapy should be discontinued at the latest one month before planned conception.

References

  1. Oge' LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment.. Am Fam Physician. 2019; 100 (8): p.475-484.
  2. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013; 168 (3): p.474-485. doi: 10.1111/bjd.12149 . | Open in Read by QxMD
  3. Tuchayi SM, Makrantonaki E, Ganceviciene R, Dessinioti C, Feldman SR, Zouboulis CC. Acne vulgaris. Nature Reviews Disease Primers. 2015; 1 (1). doi: 10.1038/nrdp.2015.29 . | Open in Read by QxMD
  4. Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults.. Nutrients. 2018; 10 (8). doi: 10.3390/nu10081049 . | Open in Read by QxMD
  5. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  6. Neonatal and infantile acne. https://www.dermcoll.edu.au/atoz/neonatal-infantile-acne/. Updated: August 10, 2015. Accessed: March 10, 2017.
  7. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74 (5): p.945-973. doi: 10.1016/ j.jaad.2015.12.037 . | Open in Read by QxMD
  8. Browne H, Mason G, Tang T. Retinoids and pregnancy: an update. The Obstetrician & Gynaecologist . 2014; 16 : p.7–11. doi: 10.1111/tog.12075 . | Open in Read by QxMD
  9. Le T, Bhushan V, Tolles J. First Aid for the USMLE Step 1 2011. Mcgraw-Hill Professional ; 2011
  10. Jovanovic M. Hidradenitis Suppurativa. Hidradenitis Suppurativa. New York, NY: WebMD. http://emedicine.medscape.com/article/1073117. Updated: May 19, 2016. Accessed: February 17, 2017.
  11. Infantile acne. http://www.dermnetnz.org/topics/infantile-acne/. Updated: February 1, 2014. Accessed: February 17, 2017.
  12. ACCUTANE® (isotretinoin capsules).
  13. Rao J. Acne Vulgaris. Acne Vulgaris. New York, NY: WebMD. http://emedicine.medscape.com/article/1069804-overview. Updated: May 20, 2016. Accessed: March 10, 2017.