Understanding Acne Vulgaris

Most things that can go wrong with your body are out of sight. A bad case of acne vulgaris, though, can mean what your body is suffering from is literally written across your face.

What is Acne Vulgaris?

Though the appearance of acne vulgaris is immediately recognizable, the science behind what is happening to your skin is quite complex. A combination of factors lead to lesions in the skin of the face, sometimes the chest or back, and occasionally other parts of the body as well.

Most people are familiar with the common terms such as whitehead, blackhead, or pimple that are used to describe the various manifestations of acne. The technical terms that explain the characteristic acne lesions are less well known.

There are several types of acne including superficial comedonal lesions (both open and closed comedones), deep cystic acne, and what are known as secondary lesions that arise as a result of the first two types of lesions. Lesions arise from excess sebum production, keratinocyte or sebum follicular plugging, and the presence of bacteria on the skin.

What Causes Acne Vulgaris?

There are two main levels of understanding the development, or pathogenesis, of acne. Individual lesions are a result of localized inflammation or blockages to hair follicles. At a higher level, changes in body chemistry and the presence of bacteria help to bring about acne, which helps to explain the reason skin lesions are often seen during puberty for many people, or are sometimes present during pregnancy or menopause for women. The presence of high amounts of Propionibacterium acnes bacteria also contributes to the formation of various forms of acne lesions.

An individual lesion is typically caused when a pilosebaceous unit, or hair follicle, becomes blocked. This can result in forms of inflammation called papules, pustules, or nodules. It can also lead to non-inflammatory manifestations like pseudocysts and comedones (or blackheads).

One of the main high level triggers that leads to eruptions of acne lesions are changes in androgen production. This can be an additional risk factor for acne lesion formation in women at various stages in life, as changes in hormone and androgen levels occur naturally throughout the menstrual cycle and can be affected by medications like birth control pills.

What is the Best Treatment for Acne Vulgaris?

Treatment or management of acne needs to address the primary causes present for a particular patient. This can mean working to reduce sebum production from your sebaceous glands. For other people, that will mean taking oral antibiotics to lower topical bacteria counts.

For mild cases of acne, there are several kinds of over-the-counter medications and treatments available. Some of the most common are:

• topical retinoids
• adapalene gel
• salicylic acid
• azelaic acid cream

Lifestyle changes can also help reduce the severity of acne symptoms. These changes are often small steps like avoiding occlusive cosmetics, skim milk, and high-glycemic foods. For some people, exposure to high humidity or sweating can also increase symptoms, and should be avoided. In some cases, taking corticosteroids such as lithium or phenytoin can also lead to eruptions of acne lesions.

Other Drugs Used for Treatment of Acne Vulgaris

In many cases of moderate to severe acne, topical antibiotics or oral contraceptive antibiotic therapy can be used in an attempt to help reduce bacteria levels that contribute to comedone and papule formation. Some of the most common drugs include:

• doxycycline
• minocycline
• tetracycline
• erythromycin
• azithromycin
• tretinoin

Erythromycin or clindamycin can also be incorporated in topical antimicrobial lotions for localized outbreaks. For more widespread lesions that are not readily treated with topical creams, oral antibiotics are often the answer.

​One challenge that can arise with long-term use of these antibiotics is the development of resistance to treatment. Studies have shown that combining benzoyl peroxide with antibiotics can help prevent or limit resistance.

Treating severe, persistent acne with oral antibiotics can create other challenges as well. For some long-term acne patients, pustular folliculitis can form around the center of the face. This can require discontinuing antibiotic treatment and taking oral isotretinoin instead. Isotretinoin is not without its own potential problems, though. Though effective, use of this drug carries elevated risk of depression, elevated lipid levels, and even the possibility of birth defects.

For women, there can even be further problems with prolonged courses of antibiotic treatment. Issues such as candidal vaginitis sometimes lead health care providers to suggest oral antiandrogens such as oral contraceptives or spironolactone as alternative treatments.

Getting Treatment for Acne Vulgaris

There could be a temptation to say that treating acne is not a major medical concern for kids or young adults since it is merely a matter of dermatology. This attitude should be resisted, though. Severe acne is a serious skin condition that can end up leading to dangerous abscesses and even create permanent scarring. Given that many people who suffer from acne vulgaris develop symptoms when they enter puberty, concern over the visible effects of acne can have profound psychological effects. For young adults, concern over one’s appearance can lead to withdrawal and possible barriers to social development or engagement.

For most people the most serious adverse effects of acne during their teen years are mild acne scars. For others who suffer from more severe forms of inflammatory acne, more serious issues can arise. These can include abscesses and significant, long-term presence of inflammatory lesions, rosacea, significant scarring and hyperpigmentation.

Not every young adult who sees their face start to break out will need to see a dermatologist. Acne vulgaris can be a serious and complicated skin disease, though, and consulting with a healthcare professional who understands the pathophysiology of this skin condition can help narrow in on appropriate treatments as quickly as possible. Given the variety of potential causes and the potential downsides of long-term drug treatments, consulting with your doctor or a dermatologist can help narrow in on the most successful treatment more quickly.

For many people, getting seen by a specialist such as a dermatologist requires being seen by a primary care physician first. TrustCare maintains several locations that are open seven days a week to give you access to health care when and where you need it. Whether it is bothersome skin lesions, or something much deeper under the surface, TrustCare is here to help you get the treatment you need.