Acne vulgaris

Acne vulgaris is a common inflammatory skin condition that presents as spots, pimples or nodules. It generally affects the facial area, also may spread to involve neck, chest, back. It generally presents in teenager years during puberty due to a surge in testosterone levels.

Testosterone stimulates sebaceous glands at the base of hair follicles to produce excess oil/ sebum as well as pro-inflammatory factors. Inflammation and dead skin cell debris can lead to blockage of the skin pores forming comedones (open or closed). The follicle wall may eventually rupture, increasing the inflammatory response (papules and nodules), and proliferating bacteria within the hair follicle creates pustular reaction (inflamed pustules).

Grading acne based on severity

  • Mild – <20 comedones, <15 inflammatory lesions, or total lesion count <30
  • Moderate – 20-100 comedones, 15-50 inflammatory lesions, or total lesion count 30-125
  • Severe – >5 psudocysts, >100 comedones, >50 inflammatory lesions, or total lesion count >125

Management of acne 

  • General cares
  • Good skin hygiene – wash face with gentle face wash and warm water, reduce makeup every night
  • Avoid excessively humid conditions (ie sauna, working in unventilated kitchen)
  • Don’t pick, squeeze, pop or scratch your lesions
  • Avoid smoking
  • Mild acne – topical treatments
  • Examples include – antiseptic washes (eg benzoyl peroxide), mild salicylic preparations for exfoliation and unplugging of follicles, azelaic acid, hydrogen peroxide in stabilised cream, antibiotic solutions (eg clindamycin or erythromycin)
  • Moderate acne – similar topical agents as above, +/- oral medications
  • Examples include – oral antibiotics (eg tetracycline, doxycycline), COCP, oral anti-androgens (low dose cyproterone in combination with oestrogen), short term use of NSAID
  • Oral isotretinoin for resistant or persistent acne
  • Severe acne
  • Examples include – high dose oral antibiotics (>6mth duration), oral anti-androgens (females, especially PCOS), systemic corticosteroids
  • Lasers, cryotherapy, intralesional steroid injections etc