Acne Vulgaris
Description of the Disease
Acne vulgaris is a chronic, multifactorial skin disease that affects the hair follicle-sebaceous gland unit. It typically begins during adolescence but may persist into adulthood. Acne affects up to 85% of adolescents and is more common in males.
Causes and Risk Factors
Several factors contribute to the development of acne. One of the primary factors is the overgrowth of Cutibacterium acnes (formerly Propionibacterium acnes), a bacterium that normally lives on the skin. Hormonal influences, particularly increased androgen levels, also play an important role. In women, elevated levels of male sex hormones may contribute to acne development.
Genetic predisposition is significant, with up to 60% of patients reporting a family history of acne. Certain medications, including lithium, corticosteroids, and vitamin B preparations, may trigger or worsen acne. Hormonal changes related to the menstrual cycle, pregnancy, oral contraceptive use, and some endocrine disorders can also influence disease activity.
Seasonal variation has been observed, with many people experiencing fewer breakouts during the summer months. Psychological stress may also worsen acne in susceptible individuals.
Other contributing factors include the use of inappropriate cosmetic products, frequent touching or irritation of the skin, high humidity, air pollution, exposure to mineral oils, and contact with certain metals.
Current scientific evidence does not conclusively support a direct relationship between diet and acne.
Symptoms
The primary concern for most patients is the appearance of skin lesions, which typically develop in areas with a high concentration of sebaceous glands, most commonly the face, upper back, and, less frequently, the chest. On the face, the T-zone is most commonly affected.
Acne is characterized by lesions at different stages of development occurring simultaneously. These may include:
- Comedones (blackheads and whiteheads).
- Papules.
- Pustules.
- Nodules.
- In severe cases, cysts, which are large, painful, pus-filled lesions that may heal with permanent scarring.
Diagnosis
Acne is diagnosed based on its characteristic clinical appearance. Laboratory or specialized diagnostic tests are generally not required.
Treatment
Successful acne management usually requires a combination of treatment approaches.
Topical treatment is recommended for mild acne, as an adjunct to oral therapy in moderate to severe acne, and for maintenance after systemic treatment. Proper skin hygiene and adherence to treatment are essential.
Common topical treatments include:
- Topical retinoids.
- Benzoyl peroxide.
- Topical antibiotics.
- Azelaic acid.
Systemic treatment is recommended for moderate to severe acne or for patients whose quality of life is significantly affected, even when skin lesions are relatively mild.
Common systemic treatments include:
- Oral antibiotics.
- Oral retinoids.
- Hormonal therapy, including combined oral contraceptives for women.
Acne treatment requires patience, as noticeable improvement usually takes several weeks. Treatment effectiveness should generally be evaluated after 6–8 weeks. Long-term adherence to the prescribed treatment regimen is essential, as inconsistent use of medications is a common cause of treatment failure.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology