Acne Vulgaris

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Images of Acne Vulgaris

Overview

Acne vulgaris is the medical term for the very common skin condition known as blemishes, pimples, zits, and spots. Acne is "multifactorial," meaning that many different factors contribute to the problem. These factors include overgrowth of normal skin bacteria (so some acne is treated with antibacterial creams or pills), plugging of follicles (so some acne is treated with creams to promote clearing of follicles), and overproduction of natural oils (again, there are creams to treat this cause). These coupled with the normal hormonal changes of adolescence are the major causes of acne. Other factors include medications such as lithium, cortisone, and seizure medications; stress; and an unhealthy diet. Acne is often hereditary, meaning it runs in families. Acne is not caused by dirt, though skin that is irritated by environmental exposures may be more inflamed in general. Almost all acne can be improved by simple measures and treatments that your doctor can advise. Many people are bothered by their acne and embarrassed to talk about it, but it is very important to discuss it with your doctor because he/she will be able to give you tips and prescribe products that can make a big difference.

Who's at risk?

It is important to remember that every almost single person has acne at some point in their lives; the vast majority of people have acne in their teen years that goes away by adulthood, but some people have acne that persists into adulthood, and some adults develop acne for the first time.

Signs and Symptoms

Acne results in a variety of lesions. The most common acne locations include the face, neck, chest, and back, where the most sebaceous glands are located. Along the jaw line is a common location in adults. "Blackheads" (open comedones) and "whiteheads" (closed comedones) are follicular plugs that are either sitting below the skin surface (whitehead) or oxidized from being exposed to the air (blackhead). Papules are small pink to reddish-brown bumps, pustules are pus-filled lesions, and nodules or cysts are deeper pus-filled lesions.

Mild acne consists of a few papules/pustules and/or comedones. Moderate acne has an increased number of lesions. Severe acne has numerous comedones, papules, and pustules and may have painful nodules.

Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were.

Self-Care Guidelines

  • Gently cleanse with mild soap or cleansers. (But don't scrub!)
  • Resist picking at lesions.
  • Avoid irritants (rubbing and other alcohols, abrasive scrubs) and oily creams, cosmetics, hair products, and sunscreens.
  • Use products labeled "water-based" or "noncomedogenic."
  • Keep hair, hands, and devices such as cell phones off the face.
  • Avoid greasy products on the skin and scalp.
Over-the-counter medications:
All over-the-counter therapies listed below should be used as a preventive therapy, applied in a thin to moderate quantity to entire regions. Acne treatment is not intended for existing individual lesions but is applied consistently over months to prevent new lesions. Expect slow improvement. Develop a skin care regimen that is modified slowly over time, not week to week.
  • Benzoyl peroxide (most effective), available in a variety of forms and strengths. Benzoyl peroxides tend to dry the skin. If you have dry skin, use a weaker concentration product; for oily skin, consider higher strengths.
  • A combination of a vitamin (nicotinamide) and zinc is available in cream and gel form.
  • Exfoliants (or peeling agents) such as salicylic acid, sulfur, resorcinol, alpha-hydroxy acids (glycolic, lactic, pyruvic, and citric acid).
  • Aluminum chloride hexahydrate (an antiperspirant available as Xerac-AC™) may be useful but can also be irritating.
  • Clinac OC is a copolymer that absorbs oil, helping reduce the look of "greasy skin." It also is produced combined with benzoyl peroxide.
Salon or office treatments:
Microdermabrasion performed every 7–10 days ("lunchtime peel") has been a popular (but costly) way to control mild acne. The same type of peeling agents (exfoliants) are available in over-the-counter products, which can be used at home at much less cost.

Of Note:

  • Acne can have significant psychological effects. Talk to your doctor about any feelings of depression.
  • Changes in diet have no proven effect.

When to Seek Medical Care

If you have moderate or severe acne that has not improved enough with self-care, seek medical help.

Treatments Your Physician May Prescribe

Topical (or external) treatments include one or more creams, washes, or gels that include:

  • Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
  • Retinoids – vitamin A-derived products such as tretinoin, tazarotene, and adapalene.
Oral treatments may include the following:
  • Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
  • Hormone therapy with oral contraceptives or spironolactone.
  • Isotretinoin, a strong drug with many side effects, for severe acne unresponsive to the above treatments.
Procedures:
  • Special "blue light" treatments are being investigated to treat acne but are usually not covered by insurance.
  • Several types of laser treatment also help acne and are often used with other treatment methods; however, treatments are expensive, must be repeated for several months, and have variable efficacy. Insurance may not cover laser therapy.
  • Laser resurfacing, plastic surgery, and/or dermabrasion may help reduce the prominence of old acne scars.

References

Bolognia, Jean L., ed. Dermatology, pp.531-543. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 672-684. New York: McGraw-Hill, 2003.