Acne vulgaris presents the following signs and symptoms:

• Acne vulgaris usually develops on the face in 90% of the cases. The acne occurs along with papules, comedones and pustules. 
• Acne can get painful and may be tender to touch. The affected area becomes hot.
• The skin of the affected area turns greasy with development of blackheads and whiteheads.
• Acne vulgaris, regardless of severity especially in the face can impair patients psychologically in most cases [7].

• Candidiasis

  BACKGROUND: The use of special silk textiles (Dermasilk) has shown positive effects on chronic inflammatory diseases like lichen sclerosus et atrophicus, atopic dermatitis, diabetic ulcerations, and vulvovaginal candidiasis. [ncbi.nlm.nih.gov]

  Cephalexin 250 mg–500 mg BID Vaginal candidiasis, rare drug reactions; routine use for acne not recommended. [dx.doi.org]

  Enteric-coated, delayed-release formulations of doxycycline can further reduce gastrointestinal adverse effects. [46] Oral antibiotic use can lead to vaginal candidiasis; doxycycline can be associated with photosensitivity; and minocycline has been linked [emedicine.medscape.com]

  Advice and recommendations Common adverse effects experienced by those taking oral antibiotics include vaginal candidiasis (in women), gastrointestinal upset and phototoxicity. [pharmaceutical-journal.com]

• Epilepsy

  Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, like diabetes and epilepsy. [ncbi.nlm.nih.gov]

  These include anabolic substances (drugs that increase muscle growth) and medications such as steroids, as well as some drugs for the treatment of epilepsy. Prevalence Acne is the most common skin condition in teenagers. [web.archive.org]

  Acne also increases the feeling of embarrassment [12] and is associated with a poorer quality of life. [13] Using validated scales for assessment, Mallon et al. suggested that the psychological impact of acne is comparable to that of chronic asthma, epilepsy [cdriadvlkn.org]

• Noncompliance

  TABLE 1 Patient demographics and disposition ENROLLED, N 97 COMPLETED STUDY, N 91 (4 noncompliant, 1 lost to follow-up, 1 protocol violation) MEAN AGE, YEARS 18.4 years (SD+/-7.6 years) age range 12-45 years median age 16 years 71 subjects (78%) between [ncbi.nlm.nih.gov]

  Rosenberg M, Waugh MS: Causes and consequences of oral contraceptive noncompliance. Am J Obstet Gynecol 1999; 180: 276–9. MEDLINE 5. Mansour D, Inki P, Gemzell-Danielson K: Efficacy of contraceptive methods: a review of the literature. [doi.org]

• Pediatric Disease

  Acne life cycle: the spectrum of pediatric disease. Semin Cutan Med Surg. 2011; 30 :S4-6;S23. [ PubMed ] [ Google Scholar ] 6. Lucky AW, Biro FM, Simbartl LA, et al. [ncbi.nlm.nih.gov]

  Acne life cycle: the spectrum of pediatric disease. Semin Cutan Med Surg. 2011;30(3 Suppl):S2–S5. doi:10.1016/j.sder.2011.07.003 [CrossRef] Williams HC, Dellevealle RP, Garner S. Acne vulgaris. [dx.doi.org]

• Abdominal Pain

  Nausea and abdominal pain are common side effects and, therefore, advise the patient that if they experience any vomiting or diarrhoea, it can reduce the effectiveness of the contraceptive and additional protection should be used for at least seven days [pharmaceutical-journal.com]

  There were five of 388 (1·3%) control patients who withdrew from studies due to nausea, vomiting, diarrhoea or abdominal pain, but these were all in antibiotic groups. [doi.org]

• Acne Vulgaris

  Acne Vulgaris Acne vulgaris, commonly known as acne, is a skin condition that involves the oil glands located at the base part of hair follicles. Acne vulgaris occurs when oil and dead skin cells clog up the pores. [adult-acne.net]

  This study aimed to determine if skin sebum, pH, and moisture affect the number of Demodex spp. in acne vulgaris and rosacea patients. METHODS: This study focused on 30 patients each with acne vulgaris and rosacea. [ncbi.nlm.nih.gov]

  What Causes Acne or Acne Vulgaris? Three Important Contributing Factors of Acne or Acne Vulgaris Are: Sebum (oil) overproduction. If the dead skin cells do not slough off properly and accumulate and block the hair follicles. Bacteria buildup. [epainassist.com]

• Papule

  Severe acne has numerous comedones, papules, pustules, and may have painful nodules. [skinsight.com]

  Most cases of acne present with a pleomorphic array of lesions, consisting of comedones, papules, pustules, and nodules with varying extent and severity. [accessmedicine.mhmedical.com]

  They were also expressed in microcysts, but in lower amounts compared to those in papules. [ncbi.nlm.nih.gov]

• Skin Disease

  Tissue Diseases Skin Diseases Acneiform Eruptions Acne Vulgaris Acne Conglobata All MeSH Categories Diseases Category Skin and Connective Tissue Diseases Skin Diseases Sebaceous Gland Diseases Acne Vulgaris Acne Conglobata [ncbi.nlm.nih.gov]

• Eruptions

  When this question arises, we can presume that we have crossed the boundaries of "acneiform eruptions" of the face. [ncbi.nlm.nih.gov]

  BPO acts on both comedones and inflammatory eruptions, and it can be used for maintenance therapy because it does not induce antibiotic-resistant P. acnes. [ci.nii.ac.jp]

• Hirsutism

  Acne vulgaris and hirsutism are important signs related to hyperandrogenaemia and present a serious medical problem for the patients and a challenge for medical doctors in terms of effective treatment. [ncbi.nlm.nih.gov]

  Cutaneous manifestations of hyperandrogenism include hirsutism, acne and androgenic alopecia and are commonly observed in women with polycystic ovary syndrome. [doi.org]

• Suicidal Ideation

  In order to its potential risk for chronicity and the involvement of visible anatomical sites such as face and upper torso, acne has been associated with a wide spectrum of psychological and social dysfunction such as depression, anxiety, suicidal ideation [ncbi.nlm.nih.gov]

• Facial Scar

  Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. [ncbi.nlm.nih.gov]

  Permanent facial scars or pitting of the skin. Acne Vulgaris Treatment General measures If your skin is oily, cleanse it as follows: Gently massage face with unscented soap for 3 to 5 minutes. Don't massage sorest places. [nmihi.com]

  Laser treatment for improvement and minimization of facial scars. Facial Plast Surg Clin N Am 2011; 19: 527–42 CrossRef Google Scholar 105. Wang Y, Kwang Tay Y, Kwok C. [doi.org]

  In addition, the acne has already caused some scarring, which is common, for instance, one study of nearly 1,000 patients found some level of facial scarring in 87% of patients [47]. [pharmaceutical-journal.com]

• Metrorrhagia

  Some patients noted health benefits beyond improved in acne such as decreased facial oiliness, decreased hirsutism, improvement of premenstrual syndrome symptoms, decreased metrorrhagia, reduced endometriosis pain, and increased libido. [clinicaladvisor.com]

• Onset in Adolescence

  Learn about this topic in these articles: occurrence during adolescence In childhood disease and disorder: Disorders associated with adolescence Acne vulgaris (common acne) is a prevalent skin condition that has its onset during adolescence. [britannica.com]

  Additional agents produced by C. acnes contribute towards tissue damage as well as initiation of comedogenesis The onset of adolescence is characterised by an increase in the production of sex hormones (mainly androgens) that cause sebaceous gland hyperplasia [pharmaceutical-journal.com]

Acne vulgaris is diagnosed using the grading scale system. Here, the lesions are compared with standard photographs for determining the grade of the condition.

Acne is categorized into 3 categories namely: mild, moderate and severe acne. Individuals with <20 comedones and< 15 inflammatory lesions are known to have developed mild acne. Those with 20 to 100 comedones and 15 to 50 inflammatory lesions are known to have developed moderate acne. Severe acne is described as having > 5 pseudocysts, total comedones greater than 100 and inflammatory lesions beyond 50.

Severe and persistent acne with a high rate of suspicion for a secondary gram negative bacterial infection may warrant culture and sensitivity tests [8].

• Androgens Increased

  Other causes include increased male hormone levels (androgen), increased oil production, topical medications, oral medications, and skin care or cosmetic products. Symptoms Acne may appear as small whiteheads or blackheads. [bumrungrad.com]

  During puberty, a hormone called androgen increases and the sebaceous glands produce more of the oily substance sebum. Typically, sebum and dead skin cells come up through the hair follicles and out through the pores in the skin. [verywellhealth.com]

  At puberty androgens increase the production of sebum from enlarged sebaceous glands that become blocked. [patient.info]

  These units are mostly on the face, neck, upper chest, shoulders and back.[3] Excess keratin combined with sebum can plug the opening of the follicle.[3][8] This small plug is called a microcomedo.[8] Androgens increase sebum (oil) production.[3] If sebum [en.wikipedia.org]

Treatment of acne vulgaris depends on extent of severity of the disease and age of the individual. Various medications exist for treating this skin disorder. These include oral medications and topical creams and ointments to be applied on the affected area.

Medications that include benzoyl peroxide, antibiotics, hormones, salicyclic acid and retinols are administered. Benzoyl peroxide usually forms the primary line of treatment which causes the skin to shed its layer of dead skin [9]. Oral antibiotics are given to treat infections, if they are the source of acne vulgaris development. Contraceptives are given if antibiotics do not work. These are method of choice when hormonal imbalance is the cause of acne breakouts.

In case of severe acne, retinoids are the treatment regime [10]. Such medications work by reducing the sebum production of the sebaceous glands of the skin.

The prognosis of the condition is generally good and with appropriate medications it should generally fade off within some years. However, in certain cases, the acne may continue to go on for several years together.

Complications

The following are the complications of acne:

• Acne can cause permanent scarring which is a grave cause of depression and lowered self-esteem among the affected individuals.
• It is can also cause social morbidity, anxiety and suicidal ideation.
• Patients can suffer from post–inflammatory hyperpigmentation.
• Treatment with medications such as erythromycin or tetracycline can cause long term effects such as development of gram negative folliculitis.

Acne is a common complaint amongst the adolescents which points towards the fact that the onset of puberty is one of the major reasons for development of such a skin disorder. Other causes include:

• Hormonal changes during the menstrual period which trigger the development of acne.
• Heredity is yet another reason for acne vulgaris [2].
• Cosmetic moisturizers which are oily in nature.
• Overproduction of sebaceous glands of the skin increases the oil production giving rise to acne [3].
• Certain medications such as steroids.
• Diseases such as polycystic ovarian syndrome and Crushing’s syndrome.

Acne vulgaris is a common disorder of the skin affecting about 80 to 90% of teenagers in the United States and in other Western nations [4]. The year 2010 witnessed a high incidence of acne vulgaris and it was in this year that this skin disease was ranked as the 8th most common disorder worldwide. It has also been estimated that about 650 million globally develop acne vulgaris.

Acne vulgaris is more common in males during adolescence but tends to be more frequent in women during adulthood [5]. In majority of the cases, acne tends to get better and then gradually disappear as one ages. However, in some individuals, the acne worsens and continues to haunt then till adulthood years.

The skin contains oil producing glands known as sebaceous glands. These glands produce sebum (natural oil). Due to overproduction of sebum, the hair follicles in the skin get blocked with the oil and dead skin cells. As a result the oil and dead skin gets trapped in the hair follicles giving rise to a spot which is known as acne. In some cases, the normal microflora of the skin can also cause inflammation of the skin causing development of acne. It is not an infectious condition, and therefore does not spread by contact. Although the anaerobic bacterium known as Propionibacterium acnes has been found to activate the proinflammatory mediators at the follicular walls causing an inflammatory type of acne [6].

Keeping skin clean and free from excess of oil can help to a great extent in preventing acne breakouts. The skin should be washed at least twice in a day with a mild, fragrance free soap. Individuals should remember not to use to harsh scrubs for removing dead skin.

Acne vulgaris, also commonly referred to as acne, is a skin disease characterized by development of scaly reddish skin along with pimples, papules and nodules. Acne vulgaris may present as an inflammatory lesion, non-inflammatory lesion, or combination of both occurring in the face, chest and back [1]. It is common among the teenage population.

Acne vulgaris in some cases takes a more severe turn when one reaches adulthood. In rare cases, even newborn babies develop acne during the first few weeks. The disorder causes scarring and leaves behind marks which can be a cause of depression and low self-esteem among the affected individuals.

Definition

Acne vulgaris is defined as the development of spot along with pimples, papules, nodules and comedones on the skin. It is a major condition affecting millions of teenagers across the globe. With advancing age, acne disappears but may leave behind permanent scars which are a great cause of depression, anxiety and low self esteem amongst individuals. 

Cause

Overproduction of sebaceous glands is one of the major reasons for development of acne vulgaris. In addition, certain types of medications may also trigger acne breakouts. Hormonal changes during menstruation are also a major cause for acne vulgaris.

Symptoms

Acne usually develops in conjugation with comedones, papules and pustules. The area is painful and tender to touch. Inflammation may also be noticed along with reddish scaly skin. Face is the most common area for development of acne.

Diagnosis

The acne is compared with the standard pictures and diagnosis is made accordingly. There are three grades of acne which are dependent on the number of comedones and inflammatory lesions.

Treatment

Treatment of acne vulgaris is directed towards treating the cause of the condition. In case of increased production of sebaceous glands, oral administration of medications containing retinoids is given that work by reducing the oil production. Oral antibiotics are given to reduce infection if they are the source of acne breakout. In addition to oral medications, topical ointments and creams are given to be applied on the affected area.

1. Dawson AL, Dellavalle RP. Acne vulgaris. BMJ. May 8 2013; 346:f2634. 
2. Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol. Aug 1999; 141(2):297-300.
3. Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. May 2009; 60(5 Suppl):S1-50.
4. Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. Jan 2008; 58(1):56-9.
5. Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol. Sep 2001; 137(9):1252-3. [
6. Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. Aug 1 2002; 169(3):1535-41.
7. Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. Feb 1999; 140(2):273-82.
8. Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. Apr 2007; 56(4):651-63.
9. Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. May 2013; 131 Suppl 3:S163-86.
10. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. Jul 2003; 49(1 Suppl):S1-37.