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Acne vulgaris

Author: Reviewed and updated by Dr Amanda Oakley Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer; and Clare Morrison, Copy Writer; June 2014. Skin of colour update: Dr Chelsea Jones, Dermatology Research Fellow, The Skin Hospital Westmead NSW, Australia; Dr Monisha Gupta, Dermatologist, Conjoint University of NSW and Western Sydney University, Sydney, NSW, Australia. July 2021


Acne vulgaris — codes and concepts
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Acne vulgaris is the common form of acne, characterised by a mixed eruption of inflammatory and non-inflammatory skin lesions (see all the acne types).

You may prefer to call acne "pimples", "spots" or "zits".

Who gets acne vulgaris?

Nearly all of us have acne at some time or another. Acne affects both sexes and all races. Although acne mainly affects adolescents, it can affect a wide age range.

Find out more about the causes of acne...

What are the clinical features of acne vulgaris?

Acne most often affects the face, but it may spread to involve the neck, chest and back, and sometimes even more extensively over the body.

Individual lesions are centred on the pilosebaceous unit, ie the hair follicle and its associated oil gland. Several types of acne spots occur, often at the same time. They may be inflammatory papules, pustules and nodules; or non-inflamed comedones and pseudocysts.

Superficial lesions

  • Open and closed comedones (blackheads and whiteheads)
  • Papules (small, tender red bumps)
  • Pustules (white or yellow "squeezable" spots)

Deeper lesions

  • Nodules (large painful red lumps)
  • Pseudocysts (cyst-like fluctuant swellings)

Secondary lesions

  • Excoriations (picked or scratched spots)
  • Erythematous macules (red marks from recently healed spots, best seen in in fair skin)
  • Pigmented macules (dark marks from old spots, mostly affecting those with dark skin)
  • Scars of various types

Individual acne lesions usually last less than 2 weeks but the deeper papules and nodules may persist for months. Many acne patients also have oily skin (seborrhoea).

Acne vulgaris

More images of acne ...

How do clinical features vary in differing types of skin?

All characteristic lesions of acne vulgaris can occur in skin of colour, but it usually presents with less discernible redness and more postinflammatory hyperpigmentation (pigmented macules) which persists long after the acne lesion has gone. Post-inflammatory hyperpigmentation is often the major reason for seeking medical attention, causing significant psychological effects.

Pomade acne occurs more commonly in people with skin of colour due to cultural practices with hair styling products in African American and Hispanic populations. The use of greasy hair products leads to follicular plugging and comedones along the hairline.

Keloid scarring is more common in skin of colour following acne lesions, particularly along the jawline, chest, and upper back.

Acne in skin of colour

Acne grading

Acne may be classified as mild, moderate or severe. Comedones and inflammatory lesions are usually considered separately.

Mild acne

  • <20 comedones
  • <15 inflammatory lesions
  • Or, total lesion count <30

Moderate acne

  • 20–100 comedones
  • 15–50 inflammatory lesions
  • Or, total lesion count 30–125

Severe acne

  • >5 pseudocysts
  • Total comedo count >100
  • Total inflammatory count >50
  • Or, total lesion count >125

Classification of acne

Some dermatologists assess the severity of a patient's acne more precisely by using a grading scale. The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be 1 (very mild) to 12 (exceptionally severe) for example.

In clinical trials evaluating acne treatment, the numbers of non-inflamed and inflamed lesions are carefully counted at regular intervals. It is remarkably difficult to count consistently.

What are the complications of acne vulgaris?

What is the treatment for acne vulgaris?

Treatment for acne depends on the patient's age and sex, the extent and the severity of the acne, how long it has been present, and response to previous treatments.

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References

  • Lehmann HP, Robinson KA, Andrews JS, Holloway V, Goodman SN. Acne therapy: a methodologic review. J Am Acad Dermatol. 2002;47(2):231-40. doi:10.1067/mjd.2002.120912
  • Tan JKL, Jones E, Allen E, Pripotnev S, Raza A, Wolfe B. Evaluation of essential clinical components and features of current acne global grading scales. J Am Acad Dermatol. 2013;69(5):754-61. doi:10.1016/j.jaad.2013.07.029 PubMed 
  • Yin NC, McMichael AJ. Acne in patients with skin of color: practical management. Am J Clin Dermatol. 2014;15(1):7-16. doi:10.1007/s40257-013-0049-1 PubMed 

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