Acne or Acne Vulgaris

Acne or Acne vulgaris is the most common skin disease. Normally, acne develops between the age of 12-25 years. However, acne is not limited to any particular age group. As people grow and become older or in younger people, acne is becoming a point of concern.

Acne is known as the disease of the pilosebaceous units (PSUs). PSUs are found underneath the skin surface but are more in number on the face, back, and chest. PSUs consist of oil glands (sebaceous gland). These oil glands secrete oil to the skin which makes skin moisturized and soft. But in case of any pathophysiological changes in these glands due to external or internal factors can lead to acne this can be either be blackheads or whiteheads.

The acne triggering factors are listed below

  • Oil glands are over stimulated by increase secretion of sex hormones called androgens that release in both boys and girls during adolescence.
  • Diseases like polycystic ovary syndrome and cushing's syndrome
  • Hormonal changes due to menstruation, pregnancy or hormonal therapy like birth control pills
  • Cosmetic mostly moisturizers and oily preparations 
  • Genetics
  • Pathogenic invasion like Propionibacterium acnes and Staphylococcus epidermidis 
  • Secondary physical factors such as diet, personal hygiene (dirt, sweat) and stress

Incidence of Acne 

On the basis of age: Acne affects 90% teenagers. Acne generally begins with the onset of adolescence, when androgen concentration begins to increase in the body.

On the basis of gender: Acne is more common in males than females during puberty. However during adulthood due to hormonal changes women become prone to acne.

Symptoms & Types of Acne

Acne can of various types which are as follows:

Types of acne  Characteristics/ intensity of acne
Open comedo (blackhead) Very small/mild form of acne
Closed comedo (whitehead) Black spots visible on skin like pin heads/moderate form of acne
Papule Small bumps/moderate form of acne
Pustule  Clearly visible on skin and filled with pus/moderate to severe
Nobules Large and dense acne, clearly visible on skin, painful and filled with pus/ severe form of acne
Cysts Large, dense, filled with pus, clearly visible on skin, painful, scaring in nature/severe form of acne

Acne can be inflammatory and non-inflammatory in nature. It mainly occurs on that area of skin which has the densest presence of oil glands such as face, upper back, chest etc. Symptoms of acne include pain, irritation and tenderness.

People suffering from moderate-to-severe acne or acne scars can experience physiological problems and low self-esteem. Large, solid and clearly visible acne can be very distressing. Since acne is more prevalent among adolescents it can be very challenging for young people to struggle with acne. Studies have shown that adolescents with acne or acne scars choose frequent absenteeism from school and social gathering, thus resulting in depression and isolation.

Acne Treatment

The Treatment of Acne Depends Upon The Severity of Acne Flare.

  • In case of mild acne over the counter drugs can be used for the treatment purpose. However moderate to severe acne treatment may require consultation by dermatologist and use of prescribed medications. 
  • Treatment decision also depends upon the reason responsible for acne outbreak.

Diet & Personal Hygiene

  • Cut down the glycemic level by avoiding sweets, oily preparations, refined flour (maida), and food having high carbohydrate level.
  • Try to include lots of whole grains, fiber fresh fruits and vegetables, food rich in antioxidants such as green tea and omega 3 fatty acids in diet.
  • Good self hygiene is very important in treating acne. Wash face twice a day with good, non-irritant and mild face wash. 
  • Avoid using strong and fragnated soaps.
  • If your skin is dry use gel base, non oily emollient. 
  • Do not use excessive scrub as it can make your skin dry.
  • Try applying non-greasy sunscreen. Prolonged exposure to sun can also lead to acne out-break.
  • Use non-irritating, mild, non-fragnated, gel based cosmetics.
  • Do not touch your skin repeatedly.

Topical Medications

  • These are applied superficially on the surface of the skin. In topical preparations medication is dispensed in lotion, cream, gel base formulation. 
  • They are easy to apply, non-oily preparations that form thin protective layer over the acne. They are generally use in spot treatment. Topical medications are better tolerated and have fewer side-effects. 
  • Antibiotics (e.g., erythromycin, daptomycin, clindamycin), retinoid (e.g., tretinoin, adapalene, tazarotene, isotretinoin) and many other medications such as benzoyl peroxide, resorcinol, salicylic acid, sulfur, azelaic acid are the agents of interest for treatment of mild to moderate acne. 
  • With topical medications redness, dryness, itching, hyperpigmentation, blisters formation, scaling, mild burning sensation, photosensitivity, tenderness of skin may be experienced. But on continuous use these side-effects gradually subside.

Oral Medications

Oral medications are paramount in treatment of moderate to severe acne.


  • Tetracycline, Minocycline, Doxycycline, Trimethoprim/sulfamethoxazole, Clindamycin, Erythromycin, Daptomycin inhibit the growth of P. acnes and S. Epidermidis bacteria.
  • However indiscriminate use of antibiotics can lead to development of bacterial resistance.

Retinoid and its analogs

  • They are highly effective in treatment of moderate to severe acne. These agents have anti-inflammatory and anti-bacterial properties. 
  • Oral retinoids usually cause dryness of lips and occasionally nose bleeding and muscular pain. They are associated with a number of possible side-effects including mild depression.

Hormonal therapy

  • As hormonal therapy oral contraceptives with less androgenic activity are recommended to women. Hormonal therapy limits the oil (sebum) production. 
  • Another hormone, spironolactone reduces the androgen secretion in the body. Combination of spironolactone and oral contraceptive can also be used because of their better safety and tolerability profile.
  • Hormonal therapy can cause menstrual irregularities, mood swings, and gastrointestinal related side-effects like nausea and vomiting .

Minimal Invasive Techniques

  • Manual extraction of closed and open comedones 
  • Intralesional steroid injections


Using Red Light or Blue Light and Photodynamic Therapy

Myths About Acne: Busted

There are several myths about occurrence, prevention and treatment of acne that need to be busted.

  • There is no exact known way to prevent or manage acne. 
  • Poor hygiene, sweating, pollution are not the primary factors for the acne outbreak. These factors do not clog the pores; they rather contribute in the worsening of already existing acne.
  • Frequent washing your face with water or applying non-medicated soaps and face wash are not the standard treatment for acne management. These agents will only help in maintaining good hygiene.
  • Even simple and readily available over the counter medication can also treat acne. You do not always require high end, expensive products to treat acne.
  • Excessive scrubbing and exfoliating leads to worsening of acne.
  • Tanning does not help in treating acne actually it worsen the situation by making skin for sensitive and causing premature ageing.