01/01/2026
🔴Acne Vulgaris
👉A chronic inflammatory disease of the pilosebaceous unit (hair follicle and its attached oil gland).
👉It is the most common skin condition in the world, affecting over 85% of adolescents and often persisting into adulthood.
👉It primarily affects areas with a high density of sebaceous glands: the face, chest, and back.
❇️Key Pathogenic Factors (The "Perfect Storm")
👉Acne develops from the interplay of four main factors:
1. Excess Sebum (Oil) Production:
✅Stimulated primarily by androgens (hormones) during puberty.
✅Oily skin (seborrhea) is a key feature.
2. Follicular
Hyperkeratinization:
✅The lining of the hair follicle sheds abnormally, sticking together and forming a microcomedone (the precursor to all acne lesions).
3. Colonization by Cutibacterium acnes (C. acnes):
✅This bacteria thrives in the clogged, oily follicle.
✅It breaks down sebum into inflammatory fatty acids and triggers an immune response.
4. Inflammation:
✅Present from the earliest stages.
✅The body's immune response to C. acnes and the trapped materials causes redness, swelling, and pus.
🔴Types of Acne Lesions (Clinical Presentation)
Acne is classified as non-inflammatory and inflammatory
🔎A. Non-Inflammatory (Comedonal) Acne:
✅Open Comedone (Blackhead):
👉A plugged follicle with a wide opening. The dark color is not dirt but oxidized melanin.
✅Closed Comedone (Whitehead):
👉A plugged follicle with a very small opening, forming a small, flesh-colored bump.
🔎B. Inflammatory Acne:
👉Papules: Small, red, tender bumps.
👉Pustules ("Pimples"): Papules with a visible center of pus.
👉Nodules: Large, solid, painful lumps deep under the skin.
👉Cysts: Deep, pus-filled, painful lesions.
💠Nodules and cysts are the most severe forms and carry the highest risk of permanent scarring.
🔴Common Triggers & Exacerbating Factors
✅Hormonal Fluctuations:
Puberty, menstrual cycles, pregnancy, PCOS, and certain endocrine disorders.
✅Genetics: Family history is a strong predictor.
✅Skincare/Cosmetics:Comedogenic (pore-clogging) oils, heavy moisturizers, or makeup.
✅Medications: Steroids, lithium, some anticonvulsants, and hormonal contraceptives (some help, some worsen).
✅Diet: High glycemic index foods (sugary drinks, white bread) and, for some individuals, dairy (particularly skim milk) may play a role.
✅Stress:Can increase cortisol and exacerbate acne.
✅Friction/Pressure: "Acne mechanica" from helmets, tight clothing, or frequent touching of the face.
🔴Treatment Principles
Treatment is chosen based on severity and type of lesions.
💠A combination approach is standard.
1. Topical Treatments (First-Line for Mild-Moderate Acne):
✅Retinoids (Vitamin A derivatives): Adapalene, Tretinoin, Tazarotene.
👉They normalize follicular keratinization, prevent comedones, and have anti-inflammatory effects.
✅Benzoyl Peroxide:
👉Kills *C. acnes*, reduces inflammation, and has mild comedolytic effects.
👉Helps prevent antibiotic resistance.
✅Topical Antibiotics:** Clindamycin, Erythromycin. Reduce *C. acnes* and inflammation.
👉Always combined with Benzoyl Peroxide to prevent resistance.
✅Azelaic Acid:
👉Antibacterial, anti-inflammatory, and helps with post-inflammatory hyperpigmentation.
✅Salicylic Acid:
👉A beta-hydroxy acid that helps exfoliate inside the pore.
2. Systemic (Oral) Treatments (For Moderate-Severe Acne):
✅Oral Antibiotics:
👉Doxycycline, Minocycline. Used for their anti-inflammatory (low-dose) and antibacterial effects for a **limited duration** (3-6 months).
✅Hormonal Therapies:
👉Combined oral contraceptives and anti-androgens like Spironolactone (for females) block the hormonal drive for sebum production.
✅Isotretinoin (Accutane):
👉A powerful oral retinoid used for severe, nodulocystic, or treatment-resistant acne.
👉It targets all four pathogenic factors.
👉Requires strict monitoring due to potential side effects (e.g., dry skin, elevated lipids, teratogenicity).
3. Procedures (In-Office):
✅Comedone Extraction:
👉Manual removal of blackheads/whiteheads.
✅Corticosteroid Injections:
👉For rapid reduction of large, painful nodules/cysts.
✅Chemical Peels:
👉Using salicylic or glycolic acid.
✅Light/Laser Therapies:
👉Target *C. acnes* and reduce sebum production/inflammation.
🔍🔍🔍Important Considerations & Myths
💠Myth: Acne is caused by poor hygiene.
💠Fact:Over-washing or scrubbing can worsen inflammation.
❇️Myth:Popping pimples helps.
❇️Fact:It increases inflammation, risk of infection, and scarring.
🔎Time to Effect: Most treatments require 6-12 weeks to show significant improvement.
⏰Patience and consistency are crucial.
❌Scarring: The best treatment for acne scarring is preventing it by controlling active inflammation.
✅Existing scars can be treated with lasers, microneedling, or chemical peels.
🔴Psychological Impact:
👉Acne can severely affect self-esteem, body image, and cause anxiety/depression. It is a legitimate medical condition, not a cosmetic vanity.
🔴When to See a Doctor
Consult a dermatologist if:
1-Over-the-counter products fail after 2-3 months.
2-Acne is moderate to severe (many papules/pustules, or any nodules/cysts).
3-It is causing scarring or dark spots.
4-It is causing significant emotional distress.