What Is Acne (Acne Vulgaris)?

Acne, or acne vulgaris, is a common skin condition that develops when dead skin cells, sebum (skin oil), and bacteria plug the pores, leading to skin lesions commonly known as pimples or zits. Acne outbreaks can develop on the face, back, shoulders, and chest.

A range of acne treatments—from over-the-counter products to prescription medications to specialist procedures—can help clear the skin and prevent scarring. The specific treatment depends on the type and severity of acne.

An estimated 85% of people ages 12-24 experience acne. But while acne is most common during adolescence and early adulthood, it can occur at any age. In fact, acne among adults is increasing.

Types of Acne Vulgaris

There are several types of acne. They have similar causes but vary in appearance and severity. The different types of acne include:

• Whiteheads: Closed comedones, or whiteheads, are small, white bumps that develop when oil and skin cells block a pore but remain under the skin.
• Blackheads: Open comedones, or blackheads, develop when a plugged pore builds up with oils and skin cells, widening the pore’s opening. Blackheads appear dark not due to dirt but because of oxygenation—a chemical reaction when a blocked pore’s contents are exposed to oxygen. 
• Pustules and papules: These inflamed acne lesions develop when pores fill with excess oil, bacteria, and skin cells. Papules are red bumps, and pustules are pus-filled. 
• Nodules and cysts: These are more severe than other types of acne. They are large, painful acne lesions that develop deep within the skin. Cysts are pus-filled, and nodules do not contain pus. 
  

Acne Vulgaris Symptoms

Acne symptoms may be mild, moderate, or severe. It commonly develops on areas of the skin with many sebaceous (oil) glands, including the face, shoulders, back, and chest. It may also appear on the buttocks, legs, and arms. 

With acne, you may notice skin changes that include:

• Small, red bumps 
• Small, red bumps containing yellow or white pus 
• Whiteheads
• Blackheads
• Crusting over the bumps 
• Redness and swelling on the skin surrounding the blemishes
• Pain or tenderness, especially with cysts and nodules
  

After an acne breakout clears, you may notice dark spots where the blemishes once were. These spots are usually temporary and may appear red, black, purple, pink, or brown. Sometimes, acne breakouts can leave scars. This is more likely if you have acne for an extended period or have family members who developed acne scars.

What Causes Acne Vulgaris? 

Acne develops when hair follicles (pores) become clogged with excess sebum. Sebum is a natural oil produced by sebaceous glands in the skin. When these glands become overactive, they make more sebum than the skin needs, leading to clogged pores. The pores can also become clogged with dead skin cells and, in some cases, bacteria. This, too, can lead to acne. 

Risk Factors

Several factors can increase your risk of developing acne, including:

• Age: Acne can occur at any age but is most common among adolescents and young adults. This is partly because the body produces more androgens during puberty. Androgens are sex hormones that stimulate sebum production and enlarge sebaceous glands. 
• Hormonal fluctuations: Changing levels of hormones throughout adulthood, such as during the menstrual cycle or pregnancy, can trigger the onset of acne.
• Diet: Sugary and processed foods can cause blood sugar levels to rapidly spike and drop, which might prompt the release of hormones that stimulate sebum production. Some research suggests that dairy products can also trigger acne, especially in people who consume a lot of dairy and foods high on the glycemic index (a measurement of how quickly food can make blood sugar rise).
• Skin type: Acne is more common among people with oily skin than other skin types, such as dry skin.
• Family history: If your parents or siblings had acne, you are more likely to develop it yourself. Researchers have identified several gene variants that play a role in acne development. These genes are linked to sebum production, sebaceous gland function, inflammation, and skin cell turnover.
• Personal care products: Using makeup, skincare, and hair care products that are heavy or oily can clog pores and lead to acne breakouts.
• Medications: Certain medications, such as corticosteroids, lithium, and drugs containing hormones, can cause acne. 
• Smoking: Evidence suggests that smoking cigarettes can trigger acne. 

How Is Acne Vulgaris Diagnosed?  

A healthcare provider such as a general practitioner or dermatologist can diagnose acne. Healthcare providers diagnose acne based on an examination of your skin. They will look for blackheads, whiteheads, papules, pustules, cysts, or nodules. They will also ask about your medical history and risk factors for acne, including medications you are taking and whether you have family members who have or ever had acne.

There are no tests to diagnose acne, but your healthcare provider may order diagnostic tests if they suspect an underlying condition is causing your acne or want to rule out other skin conditions that resemble acne. 

Treatments for Acne Vulgaris

There are many treatment options for acne. Treatment can help control acne breakouts and may prevent long-term scarring. Your healthcare provider can recommend specific treatments based on the severity of your acne. This may include topical treatments applied to the skin, oral prescription medications, or procedures performed in a dermatologist’s office. 

Over-the-Counter Acne Treatments

Mild acne may clear up with over-the-counter acne treatments. Topical over-the-counter medicines are applied directly to the skin. Look for products containing:

• Adapalen: Helps clear whiteheads, blackheads, pustules, and papules 
• Benzoyl peroxide: Kills bacteria that cause acne
• Salicylic acid: Exfoliates the skin, removing dead skin cells that can clog pores
• Sulfur: Helps dry out clogged pores to clear pimples and reduce inflammation
  

When shopping for over-the-counter acne treatments, start with products with a low concentration of the active ingredient. This can help lower your risk of side effects, such as redness, irritation, and dry skin.

Prescription Acne Medications 

If over-the-counter acne treatments are ineffective, your healthcare provider may prescribe topical or systemic (oral) medications. 

Topical creams or gels applied to the skin may contain ingredients such as:

• Retinoids, like tretinoin or tazarotene (also isotretinoin, a stronger retinoid previously sold under the brand name Accutane that can have a wide range of side effects, some of which can be serious) 
• Prescription-strength salicylic acid, benzoyl peroxide, resorcinol, or sulfur 
• Azelaic acid (sold under brand names like Finacea and Azelex)
  

Systemic acne medications are taken orally (by mouth) and may include:

• Antibiotics: These kill bacteria on the skin to reduce pustules and papules. Examples include tetracycline (sold under bands names like Actisite and Sumycin) or doxycycline (sold under brand names like Acticlate and Doryx).
• Spironolactone: Sold under brand names like CaroSpir and Aldactone, this medication reduces the body’s production of androgen hormones. This drug is only prescribed to people assigned female at birth with stubborn, deep acne cysts.
• Hormonal birth control: This can lower the amount of androgen in the body to slow sebum production and control acne. 

Specialist Procedures 

Dermatological procedures can address stubborn or severe acne. This might include laser therapy and corticosteroid injections.

Laser therapy and light devices, when combined with other acne treatments, can reduce inflammation, clear acne, and help prevent scarring.

Corticosteroid injections work quickly to reduce pain and inflammation. The injections help treat severe acne breakouts that are causing painful cysts and nodules.

Lifestyle Modifications 

Certain lifestyle changes can complement acne treatments:

• Cleansing gently: Use a mild cleanser to wash acne-prone skin, and avoid harsh scrubbing.
• Using non-comedogenic products: Choose skincare, hair care, and makeup products that won’t clog pores.
• Following a healthful diet: Eat a well-balanced diet with plenty of whole foods, including fruits, vegetables, lean proteins, and healthy fats. Reducing your intake of processed and high-sugar foods can help control acne.  
• Keeping your hands away: Avoid picking or popping acne blemishes, and try to keep your hands away from your face throughout the day.

How to Prevent Acne Vulgaris 

While you may not be able to prevent acne entirely, adopting certain habits can help reduce the frequency and severity. To prevent acne, you can:

• Wash your face twice a day with a gentle cleanser. Avoid scrubbing too hard, which may irritate your skin and trigger acne breakouts.
• Use non-comedogenic skincare products. These products are less likely to clog pores.
• Avoid touching your face throughout the day to prevent the spread of bacteria and oil.
• Eat a healthful diet with plenty of whole grains, fruits, vegetables, and healthy fats.
• Find stress management techniques that work for you, such as exercise, stretching, breathwork, or spending time with loved ones. Stress can trigger outbreaks.  
• If you have oily hair, shampoo it daily.
• Keep your hair out of your face.

Complications 

Severe or untreated acne vulgaris can lead to complications, such as:

• Scarring: Acne can leave permanent scars once the breakout clears, especially if you have deep cysts or nodules. 
• Hyperpigmentation: Acne can cause dark spots on the skin. Hyperpigmentation is usually temporary but can take several months or years to fade completely.
• Infection: Popping, scratching, or picking at acne blemishes can open the skin, allowing bacteria to enter and cause an infection. 
• Emotional distress: Acne can cause emotional distress, such as low self-esteem and anxiety. Treatment can help improve the skin’s appearance and reduce the impact on your self-esteem and overall mental health. 

A Quick Review

Acne vulgaris, or acne, is a common skin condition that affects people of all ages, but it is most common in adolescents and young adults. Acne develops when excess oil (sebum), dead skin cells, and bacteria block pores. Acne can cause a variety of blemishes, including blackheads, whiteheads, papules, pustules, cysts, and nodules.

Several effective treatments are available, including over-the-counter and prescription medications. The right treatment for you will depend on the severity of your acne and the type of blemishes you have. If you’re struggling to control acne, consider working with a healthcare provider, such as a dermatologist, for treatment. Treatment can help control acne breakouts and give you clearer skin.