Acne vulgaris

What is acne vulgaris?

Acne vulgaris is the commonest skin problem that dermatologists see. Acne arises because of genetic factors, the presence of androgens (male hormones), and the inflammation caused by the bacteria Propionebacterium acnes on the skin. Teenagers and youths can get severe acne which result in permanent scarring if not treated. Many women also get hormonal acne at middle age (acne tarda). Acne can affect the face, chest, back, shoulders and scalp.

How to treat acne vulgaris?

Acne range in severity from comedones (blackheads, whiteheads) to papules, pustules (“zits”) to nodules and cysts (deep, painful lesions). Mild acne can be managed with over the counter pharmaceutical products. If the acne is not managed with over the counter products, one should seek a medical consultation. If the acne is severe with multiple or deep painful lesions, it is advised to seek treatment.

The goal of acne treatment is reduction of severity of skin inflammation and prevention of permanent scars. Treatment options include topical medication, light treatments, oral medication and steroid injection into cysts.

Topical medication include benzoyl peroxide, salicylic acid, glycolic acid, azelaic acid, topical antibiotics (e.g. clindamycin, erythromycin) and retinoids (e.g. adapalene, tretinoin, trifarotene).

Light therapy with LED light (blue and red light) or intense pulsed light (IPL) can help clear acne-causing bacteria on the skin and lighten acne marks. These can be used concurrently with topical and/or oral medication to speed up acne clearance.

Oral medication may be prescribed for moderate to severe acne. These include oral antibiotics (e.g. doxycycline, erythromycin, minocycline), anti androgen therapy in women (oral contraceptives, spironolactone) and isotretinoin for severe acne.  Usually oral medication is prescribed for a minimum period of several months for effective control.

Steroid injections into large, painful or recurrent acne cysts may sometimes be required.

The choice of treatment differs from one person to another. Your dermatologist will need to assess the severity of acne, your skin type, the response to previous medication, side effects experienced and other factors like pregnancy and lifestyle. All options should be discussed before a treatment plan is prescribed.