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Acne Vulgaris

By Sasha de Beausset Aparicio, MSc

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Acne Vulgaris
Acne Vulgaris

What Is Acne Vulgaris

Acne Vulgaris is a skin disease found rather commonly in teenagers but with numerous cases still manifested into adulthood. The disease is characterized by areas of the skin being affected in different ways, including comedones (blackheads or whiteheads), papules, nodules, pimples, potential scared areas and seborrhea (red, inflamed skin areas). These infections situated at skin level will most likely raise to pustules (pimples filled with pus) at skin surface and can discharge the pus when squeezed.

The disease will most likely affect skin areas that are dense in sebaceous follicles, the organ which makes the hair grow. An infection in these follicles will most likely set off acne at face level, and body level (particularly the upper chest area and the back).

Acne is one of the most common diseases in the United States today. The condition may be the result of numerous factors, including genetics as one determinant element for the on-setting of the disease. There are several types of Acne known today, of which the “common acne” or Acne vulgaris which presumes the presence of comedones and “acne rosacea,” which is not associated with the existence of comedones. Chloracne is an eruption of blackheads, cysts, and pustules similar to those exhibited by patients that suffer from acne, and are associated with the toxic exposure to certain dioxins and halogenated compounds.


Acne vulgaris may develop as a result of one or a combination of factors, including an excess production of sebum at shin level, the presence of bacteria called Propionibacterium acnes, inflammation of the follicles, and other factors.

The sebaceous glands are often enlarged in case of patients suffering from acne while sebum production is enhanced as a result of increased androgen production. The sebaceous glands become, as a result, clogged with sebum. Inflammation and infections (in the form of pustules) are often the next stage, usually followed by an appearance of comedones (open-blackheads, or closed-whiteheads), redness and scars, and hyperpigmentation.

Hormonal problems may also be at the root of an acne eruption. This frequently occurs during menstrual cycles in women and puberty in teenagers, when hormonal imbalances usually occur. Particularly, acne has been linked to an excess activity of sexual hormones, called androgens. Androgens determine a growth in the follicular glands and hence and increase in the production of sebum. This is why acne vulgaris, the common acne is most present during puberty, while other forms of acne may be common to older age groups.

When acne vulgaris is present in older individuals, it may be an indicator that the patients suffer from an underlying condition. Adult women who experience the condition, for instance, may in fact suffer from certain ovary conditions and other diseases.

Genetics may also greatly influence the on-setting of this condition. People who have cases of acne in their family are more likely to develop themselves this condition. Various genes have been discovered to potentially cause the transfer of this disease among family members, including IL-1 alpha and CYP1A1.

Some people have supported the theory according to which acne may have psychological causes as well. It may be set off by high levels of stress or emotional pressure. Several studies conducted on adolescents seem to indicate that the severity of the acneic episodes is emphasized by elevated stress levels. Still, the degree of correlation between these two phenomena needs further investigation.

The presence of the Propionibacterium acnes (P. acnes) bacterium has been determined to be a clear causing factor of acne. It is still uncertain which strain of the bacterium is more likely to cause the condition, as there are certain strains associated to normal, healthy skin. Other strains of P. acnes may however evolve or be acquired, however further studies need to be conducted to determine in which conditions the bacterium is likely to aggravate or foster perpetuation of the disease. Unfortunately, the bacterium is becoming more and more resistant to antibiotic medication, making treatment increasingly hard. Infectious causality of this condition is one of the most frequent determinants of the disease, and many treatments aim to destroy the bacteria in order to achieve normal and healthy skin. We will further address this issue in the Diagnosis section of this review.

The exact nature and intensity of the relation between acne and diet is still unclear at this point, however numerous hypotheses have been enunciated so far. A diet loaded with glycosides is known to worsen acne in patients suffering from this condition. Also, consumption of certain foods while an acne eruption may make things worse for the patient. Such foods include milk, fat rich foods, salt and processed foods among others. A full acne treatment will also include some dieting measures as well, in an attempt to minimize harmful effect of diets on the condition.

Signs & Symptoms

Acne vulgaris is most likely to be associated with comedones (open or closed, as stated previously), papules, nodules, and pustules filled with puss. Redness and inflammation of the skin is also a common symptom, while the acne itself may be found particularly on the face, back and upper chest. Pain or tenderness of skin areas may also be a local symptom of the disease, particularly prior to an acneic eruption. Severe acne, or acne fulminans, may also be associated with fever episodes, as cause of the infection present in the body.

Severe forms of acne may also leave significantly visible scars, as the skin tissue is affected to its core layers. Perhaps one extremely important aspect of the disease, which should be treated with increased attention during the treatment phase, is the psychological impact that the disease has on a patient.

Acne, as any skin disease, may have serious implications to the person’s body and self image, consequently to his or her self-esteem. Particularly vulnerable are the teenagers who are often stigmatized if their acne is severe.

Symptoms such as anxiety, depressed feelings and mood changes may often be present during the long process of treatment of the disease. The full support of the family and a specialist where needed should be ensured to the patient.

Diagnosing Acne Vulgaris

A specialized examination of the patient should be able to reveal the severity degree of the condition (mild, moderate, severe, etc.) in order to lead the way to the most appropriate treatment plan. Laboratory tests may also be conducted, as acne is a clinical diagnosis and should be determined after thorough examinations. Hormonal evaluations and skin analysis will most often be included on the list of tests to be conducted prior to establishing a diagnosis and treatment.

Treatment for Acne Vulgaris

Numerous over-the-counter treatment options are available. Most people will often recur to these treatments before attempting a serious and specialized approach to curing the condition. Oral antibiotics are frequently prescribed as part of the treatment plan. The downside here is that many of the P. acnes strains are resistant to the medicines and long term use may seriously damage your immune system and expose you to a whole variety of risks.

Various procedural treatments are also available, including the extraction of the comedones and steroid injections. A healthcare specialist should always be consulted prior to applying any treatment.