Acne vulgaris
ICD-10 L70.0
- ~0%
- of teens experience acne
- ~0%
- of adult women have persistent acne
- 0-12 wk
- typical response to topical retinoid
- 01
- FDA approval of tretinoin (first topical retinoid)
What is acne vulgaris?
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, characterized by comedones, papules, pustules, and (in severe cases) nodules and cysts. Most prevalent in adolescence but ~40% of adult women experience persistent or adult-onset acne. Drivers: androgen-mediated sebum production, follicular hyperkeratinization, Cutibacterium acnes proliferation, and inflammation.
What are the symptoms of acne vulgaris?
- Comedones (closed/whiteheads and open/blackheads)
- Inflammatory papules and pustules
- Nodules and cysts (severe / nodulocystic acne)
- Distribution on face, chest, upper back, shoulders
- Post-inflammatory hyperpigmentation in patients with darker skin tones
Who is at risk for acne vulgaris?
- Adolescent age (hormonal surge during puberty)
- Family history of acne
- Hormonal fluctuation (menstrual cycle, pregnancy, PCOS)
- Certain medications: corticosteroids, lithium, some progestins
- High-glycemic-load diet and dairy (effect modest but real in studies)
- Occlusive cosmetics, helmets, masks (acne mechanica)
How is acne vulgaris diagnosed?
Clinical, by lesion type and distribution. Severity graded as mild (comedonal), moderate (inflammatory papules/pustules), or severe (nodulocystic). Hormonal evaluation (testosterone, DHEAS) in women with new-onset adult acne, irregular menses, or hirsutism (rule out PCOS).
How is acne vulgaris treated?
Step-wise approach. Mild: topical retinoid (adapalene, tretinoin) + topical benzoyl peroxide. Moderate: add oral antibiotic (doxycycline) limited to 3 months. Severe: oral isotretinoin (Accutane) under iPLEDGE program. Hormonal acne in women: combined oral contraceptives or spironolactone. Lifestyle and diet adjustments are adjunctive, not curative.
Medications used for acne vulgaris
Authority reference: www.aad.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Guidelines of Care for the Management of Acne Vulgaris · Journal of the American Academy of Dermatology, 2024
- Spironolactone for Adult Female Acne · British Journal of Dermatology, 2017 · PMID 27734129
People also ask
Does diet really cause acne?
High-glycemic-load diets and dairy intake are associated with worse acne in observational and small interventional studies. The effect is modest compared to medication and not consistent across all patients. Don't make dietary changes a substitute for evidence-based topical or systemic therapy.
How long until tretinoin works?
Visible improvement at 8-12 weeks of consistent use. The first 2-4 weeks often include a 'purge' (worse before better) as deep-seated comedones come to the surface. Full effect on texture and post-inflammatory marks takes 6 months. Discontinuing prematurely (before 8 weeks) is the most common reason 'tretinoin didn't work' actually means 'wasn't given time'.
Will isotretinoin (Accutane) cure acne?
Isotretinoin produces lasting remission in ~60-80% of patients who complete a 6-month course at cumulative dose ~120-150 mg/kg. The mechanism (long-term shrinkage of sebaceous glands) is unique. Side-effect profile (dryness, lipid changes, mood effects, teratogenicity) requires monitored prescribing through iPLEDGE.
Can adults get acne for the first time?
Yes. Adult-onset acne, particularly in women, often appears in the late 20s through 40s and is frequently hormonal — worse before menses, often on the jawline and lower face. Spironolactone (off-label) and combined oral contraceptives are first-line for hormonal pattern. Workup for PCOS if accompanied by other androgen-excess symptoms.