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].

• Swelling

  If germs get into the pores, the result can be swelling, redness, and pus. See a picture of how pimples form. Adolescent acne usually begins prior to the onset of puberty, when the adrenal gland begins to produce and release more androgen hormone. [streetdirectory.com]

  OBJECTIVE: To present a case report of a young patient who developed skin eruptions over the extremities; myalgias; fatigue; swelling involving the face, hands, and feet; headache; and mood changes after 2 years of using doxycycline. [ncbi.nlm.nih.gov]

  Azelaic acid cream is used to treat the pimples and swelling caused by acne. Azelaic acid is in a class of medications called dicarboxylic acids. It works to treat rosacea by decreasing the swelling and redness of the skin. [nlm.nih.gov]

  When germs enter the pores, redness, swelling and pus often develops. It can affect anyone but is very common amongst teenagers and young adults but usually disappears when they reach their twenties. [nativeremedies.com]

• 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]

• Precocious Puberty

  In patients with infantile acne, the physical examination should include a growth assessment as well as evaluation for any features of precocious puberty or androgen excess, including axillary odor, breast development, clitoromegaly, presence of axillary [dx.doi.org]

  puberty, acne and accelerated bone age Clinical features in adolescent and adult females include persistent acne, moderate-severe hirsutism, menstrual irregularity / fertility problems and a short stature There is often a family history Patients normally [pcds.org.uk]

  In children, 3-6 years of age, acne are more likely caused by increased levels of androgen hormones due to congenital adrenal hyperplasia, Cushing syndrome, 21-hydroxylase deficiency, precocious puberty or androgen-secreting tumors [12]. [ehealthstar.com]

• Surgical Procedure

  Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. [web.archive.org]

  Comparison of results of wire subcision performed alone, with fills, and/or with adjacent surgical procedures. Aesthet Surg J 2008 Nov–Dec; 28(6): 619–26 PubMed CrossRef Google Scholar 87. Balighi K, Robati RM, Moslehi H, et al. [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]

• Cracked Lips

  Common adverse effects include skin dryness, dry cracked lips, retinoid dermatitis and dry mucous membranes. These side-effects usually resolve after ceasing therapy. In rare cases, acute fulminans can occur with isotretinoin therapy. [clinuvel.com]

  Isotretinoin can have quite some side effects, such as cracked lips, mouth sores, dry or itchy skin, changes in skin color, skin peeling, hair loss, rash, excessive sweating, nosebleeds, voice changes, chest pain, depression, drowsiness, seizures, ringing [ehealthstar.com]

• Arthralgia

  Musculoskeletal problems are also well known to occur and these include myalgia, arthralgia and less commonly arthritis and muscle damage, however, isolated Achilles tendonitis has been reported on a rare and sporadic basis. [ncbi.nlm.nih.gov]

  Consider in refractory cases Referral usually indicated Conditions Gram Negative Folliculitis Severe, inflammatory acne Onset months after starting oral antibiotics Acne Fulminans Rapidly progressive, severe inflammatory acne Associated findings Fever Arthralgia [fpnotebook.com]

• 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]

• 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]

• Acneiform Eruption

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

  Acne variants and acneiform eruptions also exist, many of which have an identifiable and reversible etiology. Acne vulgaris is a self-limited disorder of the pilosebaceous unit that is seen primarily in adolescents. [accessmedicine.mhmedical.com]

  A number of medications have been reported to cause acne vulgaris or an acneiform eruption. [visualdx.com]

  Deeptej Singh, Drug and acneiform eruptions, Acne Vulgaris, 10.3109/9781616310097-19, (166-176), (2013). Deeptej Singh, Alan R. Shalita and Guy F. Webster, Drug and acneiform eruptions, Acne Vulgaris, 10.3109/9781616310097.007.3, (166-176), (2011). [doi.org]

• Hyperkeratosis

  There are multiple etiological factors: genetic predisposition, seborrhea, and hyperkeratosis are known to promote the development of acne. [amboss.com]

  Abstract Acne is a common skin condition with sebum overproduction, hyperkeratosis, Propionibacterium acnes ( P. acnes ) and Staphylococcus aureus, and inflammation. [ncbi.nlm.nih.gov]

  Comedones, which are caused by excess sebum secretion and hyperkeratosis in the infundibulum, appear in the first stage of acne. The second stage involves inflammatory eruptions mainly caused by Propionibacterium acnes. [ci.nii.ac.jp]

• 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]

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].

• Staphylococcus Aureus

  Abstract Acne is a common skin condition with sebum overproduction, hyperkeratosis, Propionibacterium acnes ( P. acnes ) and Staphylococcus aureus, and inflammation. [ncbi.nlm.nih.gov]

  Staphylococcus aureus infections. N. Engl. J. Med. 339, 520–532 (1998).Google Scholar [futuremedicine.com]

  aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. [hse.ie]

• Gram-Positive Bacteria

  Acne vulgaris is associated with several immunologic responses including the production of antibodies against Propionibacterium acnes, the gram-positive bacteria found in acne lesions. [ncbi.nlm.nih.gov]

  A Toll-like receptor 2 responsive lipid effector pathway protects mammals against skin infections with Gram-positive bacteria. Infect. Immun. 73, 4512–4521 (2005). [nature.com]

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.