Acne vulgaris affects approximately two-thirds of individuals. It is most common around puberty, but can affect all ages. Approximately 20% of cases are severe, leading to scarring. Acne occurs most commonly on the face, leading to self-consciousness, decreases in self esteem, anxiety, poor body image, and in extreme cases social ostracism and depression. Acne is related to changes of the pilosebaceous unit—the hair follicle and oil gland. The cause of acne is multifactorial. Increases in oil production, inflammation and plugging of the hair follicle, and the bacteria Proprionibacterium acnes all contribute to the formation of acne lesions. Acne is most commonly distributed on the face, chest, and back. Adult female acne often has a hormonal component. It may worsen just prior to or during the start of the menstrual cycle. Both spironolactone and oral contraceptive therapy can be used in conjunction with traditional acne treatment. Acne in pregnancy can be safely treated with a combination of topical antibiotic called erythromycin, azelaic acid, and blue light treatment. read more
Acne can be divided into several forms. Comedonal acne refers to acne predominated by white heads and blackheads. Inflammatory acne consists of pink bumps (papules), and pustules (pink bumps with white pus). Cystic acne has large, painful, swollen, deep bumps that may heal with scarring. Early and appropriately aggressive treatment is needed to control acne. Combination treatment is usually necessary. This may consist of topical antibiotics, sulfur, alpha hydroxy acids, benzoyl peroxide, and retinoids (vitamin A derivatives). Oral antibiotics may be required for a short period of time to control inflammatory acne. Severe cases may require an oral retinoid called isotretinoin, which requires monthly monitoring and blood tests. Other alternative treatment options for acne include laser and light therapy and chemical peels. Photodynamic therapy shrinks oil glands, decreases inflammation, kills Proprionibacterium acnes (bacteria contributing to acne), and improves discoloration from old acne lesions. IPL treatment and salicylic acid peels can lessen the appearance of pigmentation following acne. Acne scarring can be addressed once active acne is under control. Laser resurfacing, subcision therapy, fillers, and liquid injectable silicone can all be used to treat scars related to acne.