Acne vulgaris
Also called acne
Disease of the pilosebaceous unit: comedones (the defining lesion), inflammatory papules and pustules, and in severe disease nodules and scarring, on the face, chest, and upper back.
How it looks
Open and closed comedones with inflammatory papules and pustules over the cheeks and forehead, with scattered nodules along the jawline.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Post-inflammatory hyperpigmentation and keloidal scarring are more frequent in deeply pigmented skin, treating early to prevent pigment change is a core management goal, not an afterthought.
Forms & variants
Comedonal, papulopustular, and nodulocystic acne
The severity spectrum of acne vulgaris: open and closed comedones alone, then inflammatory papules and pustules, then deep nodulocystic disease, which scars and is the isotretinoin conversation.
Adult female (post-adolescent) acne
Persistent or new acne after the mid-20s, classically inflammatory papules along the jawline and lower face with premenstrual flares; think about hormonal drivers.
Acne fulminans
Abrupt ulcerating, crusting acne with fever, malaise, and bone or joint pain in adolescent boys; a systemic illness treated with corticosteroids before isotretinoin.
Acne conglobata
Severe nodular acne with interconnecting abscesses and sinus tracts; scarring is the rule, so treatment is early and aggressive.
Infantile acne
True comedonal and inflammatory acne between about 3 and 12 months from transient androgen production; it can scar and predicts severe adolescent acne.
Neonatal cephalic pustulosis (neonatal 'acne')
Pustules without comedones in the first weeks of life; not true acne, self-limited, reassurance only.
Acne excoriee
Lesions dominated by picking rather than by the acne itself; unless the picking is addressed alongside the acne, nothing heals.
Secondary acne (drug-induced, occlusion, pomade)
Monomorphic papulopustules from corticosteroids and other drugs, occlusive cosmetics, or hair pomades; uniform same-stage lesions are the clue that this is not ordinary acne.
Solid facial edema
A rare firm, persistent midface swelling complicating chronic acne (and rosacea); it looks infective and is not.
Symptoms & course
- Lesions may be tender
- Psychological burden is often the chief complaint
Diagnostic approach
- None routinely
- Consider hyperandrogenism workup for female patients with resistant acne plus irregular menses or hirsutism
Differential, and how to separate them
- Rosacea
Favours it: Flushing, telangiectasia, no comedones, older onset
Against it: Comedones define acne; their absence should make you re-look
Management principles
- Topical retinoid as the backbone for comedonal disease
- Add benzoyl peroxide ± topical antibiotic for inflammatory lesions
- Systemic therapy (antibiotics, hormonal, isotretinoin) escalates with severity and scarring
Clinical pearl: No comedones, no acne, the single most useful rule for separating acne from its mimics.
Keep going
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