Acne vulgaris is estimated to affect about 50 million people in the U.S. About 85% of teenagers are affected by acne, but it can occur in any age group with many cases persisting into adulthood.
Types of Acne Vulgaris
Acne is a word that actually refers to a variety of blemishes that can occur on the skin. Breakouts may include one or a combination of the different types of acne vulgaris:
Whitehead: This is one type of blemish known as a comedone. Whiteheads look like small raised white or skin-colored bumps. They occur when oil and dead skin cells clog the pore. This is also known as closed-pore acne. Blackhead: With this type of comedone, the build-up of oil and dead skin widens the pore so it looks open. The substance in the pore reacts with oxygen to form a black color. This is known as open-pore acne. Pustule: When bacteria get trapped in a pore along with dead skin cells and oil, it forms a pimple. These may swell and look inflamed. If the pimple has pus inside, it’s a pustule. Papule: If the pimple does not have pus, it is called a papule. Nodule: Nodular acne is a severe type of acne. Nodules are bigger than typical pimples. They go deep into the skin and cause inflammation. Breakouts can be widespread and painful. In addition, nodules are hard to the touch and do not contain pus. Cyst: Cystic acne is another severe form of acne vulgaris. Like nodules, the pimples are inflamed and go deep into the skin. They can be very large and are filled with pus.
Symptoms of Acne Vulgaris
Most acne occurs on the face, chest, back, and shoulders. Symptoms can be mild, moderate, or severe.
If you have mild acne, you probably have less than 20 blackheads or whiteheads. Whiteheads are small flesh-colored or whitish blemishes, while blackheads have a dark center. You might also develop pimples, which are round, inflamed whiteheads on the skin.
If you have moderate acne, you’ll have a larger number of blackheads, whiteheads, and pimples.
Severe acne may include widespread blemishes with nodules or cysts, which are larger and more solid than pimples. Nodules and cysts tend to be more painful than pimples.
Causes
Acne vulgaris is caused by a combination of hormones, oil, and bacteria. Hormonal changes as well as lifestyle factors, such as diet and skincare, can affect breakouts.
Hormones
During puberty, hormones called androgen increase and small, oil-producing glands called 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. When sebum, skin cells, and bacteria clog the follicles, the sebum can’t escape through the pores, which causes acne.
As you enter early adulthood, those hormones may decrease enough that acne will start to disappear. For about 40% of women, acne may continue into their 40s because of hormonal changes and other causes, including:
Hormonal changes in pregnancy or from the menstrual cycle Some medications Certain cosmetics and lotions High humidity and sweating Polycystic ovary syndrome (PCOS)
Diet
Researchers have done in-depth analyses of the relationship between the foods a person eats and the risk of acne breakouts. Specific types of foods seem to promote acne while others seem to protect your skin from problems.
Regularly eating high glycemic index (GI) or high glycemic load foods can promote acne. These are foods that raise your blood sugar. Starchy foods (white bread, potatoes, and white rice) and processed foods are examples of high-GI foods. Dairy foods, fast food, and chocolate may also cause acne.
In contrast, adding the following to your diet may reduce breakouts:
Foods high in fatty acids such as certain types of fish and seafood (salmon, sardines, oysters, and more) Nuts and seeds including walnuts and flaxseed Plant oils (flaxseed oil, soybean oil, and canola oil) Kidney beans
Skincare
Another factor that can affect acne is how you care for your skin. To reduce breakouts, gently wash your face with a non-abrasive cleanser up to twice daily and after sweating.
Skincare products that can cause acne include:
Alcohol-based productsAstringentsTonersExfoliants
Diagnosis
Most of the time, you’ll be able to recognize when you have acne. If you’re dealing with acne on a regular basis, though, it’s best to make an appointment with a dermatologist. They can check your blemishes and make sure that your condition is acne and not another similar condition, like rosacea.
Once diagnosed, your healthcare provider can help you determine a treatment based on the cause and whether your acne is mild, moderate, or severe.
Acne Vulgaris Treatment
Your healthcare provider may suggest one treatment or a combination, depending on the severity of your acne. Mild acne may be able to be treated with over-the-counter topical medicine in creams, gels, and washes with benzoyl peroxide or salicylic acid.
Benzoyl peroxide targets the bacteria that causes acne and is contained in over-the-counter (OTC) acne products such as PanOxyl Acne Foaming Wash and Clean & Clear Continuous Control Acne Cleanser. Salicylic acid works by easing inflammation and unclogging pores. It can be found in OTC brands like CeraVe Salicylic Acid Cleanser and Vichy Normaderm Daily Deep Cleansing Gel.
Retinoids are available over the counter as well as via prescription (e.g., Differin). They help to break up whiteheads and blackheads, as well as prevent blocked pores.
Moderate acne is often treated with oral antibiotics, including doxycycline, minocycline, azithromycin, erythromycin, and tetracycline. Your healthcare provider may suggest you use one of these with a topical treatment for about 12 weeks, then stop the oral medication to see if your acne can be kept under control with just the topical option.
Severe acne may be treated with antibiotics and topical medication. If these medications aren’t successful in treating your acne, your healthcare provider may suggest the oral drug Zenatane (isotretinoin). This drug can cause birth defects. Women taking it must use at least two forms of birth control. Other serious side effects may occur, such as depression and severe stomach pain, so talk to your healthcare provider about the pros and cons of using this medication.
Coping
Acne vulgaris can cause emotional stress for adolescents or anyone feeling self-conscious about their appearance. If you’re feeling depressed or anxious, seek help from a counselor or therapist while you’re going through treatment for acne.
A Word From Verywell
Acne vulgaris can be a stressful problem to have, but it is treatable. It may take several weeks or even months of treatment to see improvement, but your healthcare provider will work with you to find a treatment that’s successful for you.
