Acne Vulgaris

Aka: Acne Vulgaris, Acne

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II. Epidemiology

  1. Prevalence: 75% of teenagers and young adults
  2. Acne Vulgaris may persist in some 30-40 year olds

III. Pathophysiology

  1. See Acne Vulgaris Pathophysiology
  2. See secondary acne causes below

IV. Risk Factors: Exacerbating Factors

  1. See Acne Vulgaris Exacerbating Factors

V. Signs: Lesion Types

  1. Obstructive Acne (Papules and Pustules)
    1. Closed Comedones (White heads)
      1. Papules resulting from sebum and keratin accumulation within the Hair Follicle
    2. Open Comedones (Black heads)
      1. Closed comedones distend with trapped sebum and keratin and ultimately open
      2. Exposed lipids oxidize and Melanin is deposited
  2. Inflammatory Acne resulting from Hair Follicle rupture (in order of lesion formation)
    1. Papules
    2. Pustules
    3. Nodules
    4. Cysts
    5. Scars

VI. Signs: Distribution

  1. Face
  2. Neck
  3. Chest
  4. Upper Back

VII. Types: Severe subtypes

  1. Consider in refractory cases
  2. Referral usually indicated
  3. Conditions
    1. Gram NegativeFolliculitis
      1. Severe, inflammatory acne
      2. Onset months after starting oral Antibiotics
    2. Acne Fulminans
      1. Rapidly progressive, severe inflammatory acne
      2. Associated findings
        1. Fever
        2. Arthralgia
        3. Bone diathesis
    3. Acne conglobata
      1. Severe Cystic Acne
      2. Associated with dissecting scalp Cellulitis
      3. Associated with Hydradenitis suppurativa
      4. Aggressive treatment required
    4. Pyoderma faciale
      1. Rapidly progressive facial Cystic Acne (esp cheeks)
      2. May be a variant of Acne Rosacea
      3. Affects adult women

VIII. Differential Diagnosis: Dermatologic Conditions

  1. See Medication Causes of Acne Vulgaris
  2. Acne Rosacea
  3. Hidradenitis Suppurativa
  4. Miliaria
  5. Perioral Dermatitis
  6. Pseudofolliculitis Barbae
  7. Seborrheic Dermatitis
  8. Superficial Folliculitis
  9. Acne Cosmetica
    1. Oil-based hair products and cosmetics plug Hair Follicles and result in Acne Vulgaris

IX. Differential Diagnosis: Systemic Conditions (secondary acne)

  1. See Medication Causes of Acne Vulgaris
  2. See Hyperandrogenism
  3. Cushing's Disease
  4. Polycystic Ovary Syndrome
  5. Congenital Adrenal Hyperplasia

X. Management

  1. See Acne Vulgaris Management
  2. Adjunctive Acne Vulgaris Management
  3. Moderate Acne Vulgaris Management
  4. Severe Acne Vulgaris Management (includes Cystic Acne)

XI. Resources: Patient Education

  1. Information from your Family Doctor: Acne in Teens
    1. http://www.familydoctor.org/healthfacts/001/

XII. References

  1. Habif (2004) Dermatology, Mosby, p. 162-94
  2. Parker in Noble (2001) Primary Care p. 758-60
  3. Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]
  4. Oge (2019) Am Fam Physician 100(8): 475-84 [PubMed]

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