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Medical Dermatology Conditions


What is Acne

The main causes of acne vulgaris are genetics and hormones, and there are many factors that can exacerbate this skin condition. Acne generally develops during the teen years, during the onset of puberty. As the body develops its sexual functions, hormone levels fluctuate, causing excessive sebum production. This leads to acne breakouts due to the clogging of pores. As hormonal levels fluctuate for a woman during her monthly menstrual cycles, some women are also prone to acne breakouts during those periods. Children whose parents have dealt with acne are more likely to struggle with this skin condition as acne can also be a result of hereditary factors. At times, stress can also trigger or exacerbate an acne breakout.

acne on face

Causes of Acne

Acne (also called acne vulgaris) is a common skin condition that affects both teenagers and adults. It affects the skin’s oil glands and hair follicles. Small holes in the skin called pores connect to oil glands under the skin via canals called follicles. The oil glands make an oily substance called sebum while inside hair follicles, oil carries dead skin cells to the surface of the skin as waste. These follicles have hair growing out of the skin as well. Sometimes hair, dead cells and sebum clump together into a plug, clogging the follicle and bacteria grows on the plug. This causes a swelling under the skin surface which eventually turns into acne. Acne primarily affects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. Acne is usually not a serious health threat. However, if left untreated or if treated poorly it can cause scarring.

Types and Symptoms of Acne

Acne is typically categorized into two main types: non-inflammatory and inflammatory acne.


Noninflammatory acne includes blackheads and whiteheads. These normally don’t cause swelling and are the result of clogged pores that do not become infected. These are the least severe forms of acne and are easily treatable.

Blackheads (Open Comedone) occur when a pore is clogged by a combination of sebum and dead skin cells. The top of the pore stays open, despite the rest of it being clogged, hence the surface appears black.

Whiteheads (Closed Comedone) also occur when a pore gets clogged by sebum and dead skin cells. However, unlike blackheads, the top of the pore closes up with a thin layer of skin and appears as a small bump. Whiteheads are more difficult to treat than blackheads as the pores are already closed.


Although sebum and dead skin cells contribute to inflammatory acne, bacteria interacting with the clogged pores can cause an infection deep beneath the skin’s surface. This may result in painful acne spots that are hard to get rid of. Pimples are a form of inflammatory acne.

Other forms of inflammatory acne include papules which are inflamed lesions that may appear red, and occur when the walls surrounding your pores break down from severe inflammation. Pustules are acne that also form when the walls surrounding pores break down. However, they are also generally pus-filled and may appear white or yellow. Nodules are inflammatory acne which occur when clogged, swollen pores endure further irritation and grow larger. Unlike pustules and papules, nodules occur deeper underneath the skin. They also do not contain pus and therefore feel hard when touched. Because nodules are so deep within the skin, they are more difficult to treat.

Cysts are the most severe and largest forms of acne and can develop when pores are clogged by a combination of bacteria, sebum, and dead skin cells. The clogs occur deep within the skin and are further below the surface than nodules causing large red or white bumps on the surface of the skin that are often painful to touch. They are also filled with pus and fluid. Their formation usually results from a severe infection and is also the most likely to scar. These require professional treatment by a dermatologist.

Severity of Acne

Acne Vulgaris is measured on grades of severity, and can be diagnosed in four different classifications.


Patients diagnosed with Grade I acne generally exhibit mild forms of this skin condition and there is usually no inflammation present. Blackheads, whiteheads and mild forms of pimples fall under this category.


Patients exhibiting Grade II of acne will likely exhibit multiple comedones (blackheads and whiteheads) on the skin. They will have more frequent breakouts, likely accompanied by papules and pustules


Those with Grade III acne will have a large amount of inflammatory acne compared to those in Grade I and II. They will also have numerous papules and pustules, and possibly some nodules.


Patients with Grade IV acne have the most severe form of acne. Their skin will be filled with papules, pustules, nodules and cysts. Acne this severe may also be present in all parts of the body and not just the face. The neck, back, chest and even genital area may have acne present. Acne of this severity is likely to cause severe scarring if left untreated by a dermatology specialist.

Treatments for Acne

There are various treatment options for acne, depending on the severity of your acne and the dermatologist’s assessment.


The most important topical product is a retinoid (which is a Vitamin A derived product). Topicals are applied directly on the acne to treat them as they also include antibiotics such as benzoyl peroxide. Sometimes this product is combined in one formulation.


Oral antibiotics are frequently prescribed for acne. They treat the infection that causes the inflammation in the acne. They are useful in reducing the inflammatory lesions (the ones with pus, or those that are large and tender), and have to be taken regularly between a 2-3 month period.


For women who have acne and also require contraception, many combined oral contraceptive pills are useful. One of the most commonly used formulations contains cyproterone acetate. This pill tends to reduce the acne flares that are noted around menses, and also reduce the oiliness of the face to some extent.

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