Acne Vulgaris

Orin M. Goldblum, MD


Skinmed. 2003;2(5) 

In This Article


A 16-year-old boy presents with a 2-year history of an increasing number of pimples on his face, chest, shoulders, and back. Some of his lesions occasionally become red and painful. During the summer months, his acne improves if he spends time outdoors. He has tried over-the-counter topical benzoyl peroxide preparations on his face with no noticeable improvement. His father had acne during his teenage years, which also required treatment. On examination, he has a moderate amount of open and closed comedones, papules, and pustules located on his face, chest, shoulders, and back. Based on your findings, you diagnose him as having moderate comedonal and inflammatory acne vulgaris.

Acne vulgaris (acne) is a common, familial disorder of the sebaceous glands, usually beginning during adolescence. Although typically a self-limited disease, acne may persist into adulthood or even develop during the postadolescent period. The cause of acne is unknown, but a number of factors play a role in its pathogenesis. These include abnormal keratinization, overactivity of sebaceous glands, Propionibacterium acnes-induced inflammation, and hyperandrogenism. In acne patients with suspected hyperandrogenism, laboratory evaluation to identify the source of hyperandrogenism may be warranted. Various strategies used to treat acne are directed toward these underlying disorders. Acne most commonly involves the face. Lesions may also be present on the chest, shoulders, and back. Acne lesions are noninflammatory (open and closed comedones) and inflammatory (papules, pustules, and nodules). Most cases of acne exhibit a mixture of non-inflammatory and inflammatory lesions (Figure 1); however, some patients may present with predominantly noninflammatory or inflammatory lesions. Pitted scars may result after inflammatory lesions have resolved (Figure 2).

Mixed inflammatory (papules) and noninflammatory (closed comedones) acne lesions on the face (Image used with permission of Logical Images, Inc., Rochester, NY,

Inflammatory acne lesions on the chest, consisting of papules and nodules. Atrophic and pitted scars, resulting from acne lesions, are visible (Image used with permission of Logical Images, Inc., Rochester, NY,


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