Acne vulgaris is a common inflammatory condition of the hair follicles and oil glands, driven by excess oil, blocked pores, Cutibacterium acnes bacteria and inflammation. It usually starts in the teen years and can leave scars and affect mood and self-esteem.
Key symptoms
- Blackheads and whiteheads
- Red bumps and pus-filled spots
- Painful deep nodules or cysts
- Lesions on the face, chest and back
- Distress, low mood or social withdrawal
What you find on exam
- Lesion types: comedones, inflammatory papules and pustules, nodules
- Scarring and dark spots left by healed lesions
- Signs of androgen excess in women: excess hair, irregular periods
- Drugs that worsen acne, such as steroids
Tests
- Clinical diagnosis; usually no tests
- Hormone tests if there are signs of androgen excess
- Before isotretinoin: pregnancy test, lipids and liver tests
Treatment basics
- Mild: topical retinoid such as adapalene and benzoyl peroxide
- Moderate: add topical clindamycin, or oral doxycycline for about 3 months, always with benzoyl peroxide
- Women: combined oral contraceptive or spironolactone
- Severe, nodular or scarring acne: oral isotretinoin with strict pregnancy prevention
- Gentle skin care; avoid picking
Red flags
- Sudden severe acne with fever and joint pain
- Rapid signs of virilization such as a deeper voice
- Depression or suicidal thoughts, especially on isotretinoin
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.