Acne vulgaris
Acne is a very common skin condition that is accompanied by pimples, pustules and comedones (blackheads). Young people are particularly affected. After a few years, the acne usually disappears on its own. In many cases, treatment with medication is recommended.
Common acne (acne vulgaris) is a chronic, inflammatory skin condition characterized by pimples, comedones, and pustules. The condition affects the sebaceous-rich skin on the face and neck, and often also on the chest and back. This skin condition typically appears during puberty and usually resolves on its own afterward.
In addition to this “typical” acne, there are several other forms that differ from one another in terms of their triggers, nature, and severity of the inflammatory skin lesions. These include, for example:
Acne is the most common skin disease worldwide. On average, around 70 to 95 percent of all young people are affected. However, only in 15 to 30 percent of cases is it severe enough to require medical treatment.
Common acne usually begins between the ages of 15 and 18. Males are affected just as often as females, but are more likely to suffer a severe course of the disease.
Various factors contribute to the development of common acne. This includes excess sebum production: The sebaceous glands produce too much oily secretion, stimulated by male sex hormones (androgens such as testosterone), which are produced in particular during puberty (including in girls).
Androgens also trigger increased production of keratin in the skin (hyperkeratosis). The horn material can block the duct of a sebaceous gland. This results in a closed blackhead—a skin-colored to whitish, hemispherical plug of sebum and keratin.
As sebum continues to be produced, such a blackhead can grow larger and larger and open up—resulting in an open blackhead whose central keratin plug turns black when exposed to the air.
Blackheads provide a good breeding ground for bacteria: Bacteria of the species Propionibacterium acnes can multiply in the sebaceous glands. They metabolize sebum and can trigger purulent inflammatory processes.
Other factors that can influence the development of acne include, for example:
Acne-prone skin is oily and has a greasy sheen, and is covered with numerous closed (white) and open (black) blackheads, known as comedones. When the skin is characterized primarily by comedones, we refer to this condition as “acne comedonica.” Blackheads can develop into inflammatory papules and pustules (“acne papulopustulosa”). Papules are hemispherical nodules, up to the size of a pea, that protrude above the surface of the skin. Pustules are pus-filled “blisters” on the skin that are up to 0.5 centimeters in size and surrounded by a ring of redness.
In severe cases, the condition progresses to “acne conglobata”: In addition to blackheads, papules, and pustules, other skin changes develop, such as large inflammatory nodules, encapsulated collections of pus (abscesses), deep scars, and scabs.
If it is the special form of acne fulminans mentioned above, other symptoms such as high fever and joint inflammation are also present.
Many people with acne suffer not only from the physical symptoms of this skin condition but also from the associated emotional distress: When the face is covered with pimples, blackheads, and pustules, this can significantly erode self-confidence and impair quality of life.
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We can usually recognize acne-prone skin at first glance, especially when blackheads, pimples, and pustules appear during puberty. If we suspect that you do not have common acne (acne vulgaris) but rather a specific form triggered by an external factor, we can ask you specific questions—for example, about the cosmetics and medications you use or your exposure to tar or lubricating greases.
We can take a swab from areas of the skin with severe inflammation to test for a bacterial infection. Sometimes we perform additional tests, such as measuring hormone levels in the blood. This may be appropriate, for example, for women who develop acne after the age of 25 and also exhibit signs of “masculinization” (virilization), such as an irregular menstrual cycle and male-pattern hair growth (e.g., facial and chest hair). Affected women produce too many male sex hormones, for example, due to an adrenal disorder or polycystic ovary syndrome (PCOS). The latter is a common hormonal disorder in women.
Hormone levels are also measured in children who have had acne for more than 16 to 24 weeks after birth or who develop acne between the ages of three and seven.
It is virtually impossible to effectively prevent the complex development of acne. The best thing you can do is address the external factors that may contribute to skin conditions. Here are a few tips:
Common acne is a chronic condition. It usually begins during puberty and worsens in episodes until it gradually resolves on its own in late adolescence or early adulthood.
However, in 10 to 40 percent of those affected, acne persists beyond the age of 25 or does not even begin until that age. This form of late-onset acne mainly affects women.
Acne scars often result from severe acne. They can permanently alter the appearance of the skin and cause psychological distress to those affected. There are different types of acne scars—including depressed (atrophic) and raised (hypertrophic) scars.
There are many treatment options available today. Superficial scars can often be improved with chemical peels or microneedling. For deeper scars, options such as laser treatments (e.g., CO₂ laser), hyaluronic acid injections, or minor surgical procedures may be considered. In some cases, a combination of several methods may also be appropriate.
It is important that the treatment be tailored to the individual’s skin type and the nature of the scars. Please feel free to contact us for a consultation regarding acne scar treatment.
The treatment of your acne depends above all on the form, severity and current status of the disease. Various medications are used, sometimes also physical therapies. In the case of acne with known external triggers, such as cosmetics or medication, these should be avoided if possible.
