Acne

Common skin condition characterized by pimples, blackheads, and cysts

Acne
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Synonyms	Acne vulgaris
Pronounce	N/A
Field	Dermatology
Symptoms	Pimples, blackheads, whiteheads, cysts, oily skin, scarring
Complications	Scarring, anxiety, depression
Onset	Puberty
Duration	Long-term
Types	N/A
Causes	Hormonal changes, genetics, bacteria, excess oil production
Risks	Adolescence, family history, hormonal changes
Diagnosis	Based on appearance
Differential diagnosis	Folliculitis, rosacea, keratosis pilaris
Prevention	Proper skin care, avoiding triggers
Treatment	Topical treatments, oral medications, laser therapy, chemical peels
Medication	Benzoyl peroxide, salicylic acid, retinoids, antibiotics, hormonal treatments
Prognosis	N/A
Frequency	Common
Deaths	N/A

Acne, also known as acne vulgaris, is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It often causes pimples, blackheads, whiteheads, and sometimes cysts or nodules. Acne typically appears on the face, forehead, chest, upper back, and shoulders. It is most common among teenagers, though it affects people of all ages.

Pathophysiology and Causes

Pathophysiology

Acne occurs when hair follicles become clogged with a combination of sebum (skin oil), dead skin cells, and bacteria. The four primary factors contributing to acne development include:

• 1. Increased sebum production – Overactive sebaceous glands produce excess oil.
• 2. Follicular hyperkeratinization – The normal shedding of keratinocytes (skin cells) is disrupted, leading to clogged pores.
• 3. Bacterial colonization – The bacterium Cutibacterium acnes thrives in clogged pores, leading to inflammation.
• 4. Inflammatory response – The immune system reacts to bacterial overgrowth, causing redness, swelling, and pus formation.

Causes of Acne

Acne is a multifactorial condition with various contributing causes:

1. Hormonal changes

Hormonal fluctuations play a significant role in acne development:

• Increased androgens during puberty cause sebaceous glands to enlarge and produce more sebum.
• Menstrual cycles, pregnancy, and birth control use can influence acne flare-ups.
• Polycystic ovary syndrome (PCOS) is associated with persistent hormonal acne.

2. Genetics

A family history of acne increases the likelihood of developing the condition. Studies suggest that genetic factors affect:

• Sebum production rates
• Skin's inflammatory response to bacteria
• Pore structure and susceptibility to clogging

3. Bacterial infections

Cutibacterium acnes, a commensal bacteria of the skin, can proliferate in clogged hair follicles, causing inflammation.

4. Excess oil production

The overproduction of sebum by sebaceous glands leads to clogged pores.

5. Diet and lifestyle factors

Certain dietary and lifestyle factors may exacerbate acne, including:

• High-glycemic diets – Foods that spike blood sugar levels can increase insulin, which triggers sebum production.
• Dairy consumption – Some studies link dairy intake to acne due to hormonal effects.
• Stress – Elevated levels of cortisol can worsen acne.
• Cosmetics and skincare products – Oil-based or comedogenic products can clog pores.

Symptoms, Risk Factors, and Diagnosis

Symptoms of Acne

Acne presents with various lesions, which can be classified into non-inflammatory and inflammatory types:

Non-inflammatory lesions

• Blackheads (open comedones) – Pores clogged with sebum and dead skin cells that remain open.
• Whiteheads (closed comedones) – Clogged pores covered by skin, preventing oxidation.

Inflammatory lesions

• Papules – Small, raised, red bumps caused by inflammation.
• Pustules (pimples) – Papules filled with pus.
• Nodules – Large, painful, solid lumps under the skin.
• Cysts – Deep, pus-filled lumps that can cause scarring.

Risk Factors for Acne

Several factors can increase the risk of developing acne:

• Adolescence – Hormonal changes during puberty are a major trigger.
• Family history – Genetic predisposition influences the likelihood of acne.
• Hormonal changes – Related to menstruation, pregnancy, or polycystic ovary syndrome.
• Stress – Can trigger hormonal imbalances leading to breakouts.
• Certain medications – Such as corticosteroids, anticonvulsants, and oral contraceptives.

Diagnosis of Acne

Acne is typically diagnosed based on clinical presentation. A dermatologist may:

• Examine the skin – Assess lesion type, location, and severity.
• Consider hormonal evaluations – For patients with persistent or severe acne.
• Perform a bacterial culture – In cases of suspected antibiotic-resistant acne.

Differential Diagnosis

Conditions that may resemble acne include:

• Rosacea – Characterized by facial redness and inflammatory papules.
• Folliculitis – Infected hair follicles mimicking acne.
• Keratosis pilaris – Small rough bumps caused by keratin buildup.

Treatment and Management

Prevention and Skincare Routine

Preventive measures for acne include:

• Gentle skin cleansing – Using a mild cleanser twice daily.
• Non-comedogenic skincare – Avoiding oil-based products.
• Avoiding excessive touching – Picking at acne can cause scarring and hyperpigmentation.

Medical Treatments

Treatment varies based on severity:

1. Topical treatments

• Benzoyl peroxide – Kills Cutibacterium acnes and reduces inflammation.
• Salicylic acid – Exfoliates dead skin cells and unclogs pores.
• Retinoids (e.g., tretinoin) – Promote skin cell turnover and prevent comedone formation.
• Topical antibiotics – Such as clindamycin and erythromycin.

2. Oral medications

• Oral antibiotics – Used for moderate to severe inflammatory acne.
• Hormonal treatments – Oral contraceptives and spironolactone for hormonal acne.
• Isotretinoin – A powerful retinoid for severe, cystic acne.

3. Procedural treatments

• Laser therapy – Reduces bacteria and inflammation.
• Chemical peels – Helps with exfoliation and unclogging pores.
• Drainage and extraction – Removes large cysts or nodules.

Complications and Psychological Impact

Complications of Acne

Acne can lead to long-term complications, including:

• Scarring – From severe nodular or cystic acne.
• Post-inflammatory hyperpigmentation – Dark spots that remain after lesions heal.
• Skin infections – Secondary infections may occur if lesions are picked.

Psychological and Social Effects

Acne can significantly impact mental health:

• Anxiety and depression – Studies link acne to increased psychological distress.
• Social withdrawal – Patients may experience self-esteem issues.

Prognosis and Long-Term Outlook

• Mild acne often improves with consistent skincare.
• Severe acne may require aggressive treatment to prevent scarring.

See also

• Dermatology
• Skin care
• Hormonal acne
• Cystic acne

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