Acne Vulgaris
Also known as: Acne, Pimples, Breakouts
Description
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. It is the most common skin condition, affecting up to 85% of adolescents and often persisting into adulthood. Characterised by comedones, papules, pustules, and in severe cases nodules and cysts.
Symptoms
- Open and closed comedones (blackheads & whiteheads)
- Inflammatory papules and pustules
- Nodules and cysts (severe)
- Post-inflammatory hyperpigmentation
- Scarring in untreated cases
Causes & Triggers
- Excess sebum production
- Follicular hyperkeratinisation
- Cutibacterium acnes colonisation
- Hormonal fluctuations (androgens)
- Genetic predisposition
Severity Classification
Treatment Ladder
- 1 Mild: Topical retinoid + benzoyl peroxide
- 2 Moderate: Add topical antibiotic (clindamycin) or combination therapy (adapalene + BPO)
- 3 Moderate–Severe: Oral antibiotics + topical combination
- 4 Severe / Recalcitrant: Oral isotretinoin
- 5 Hormonal acne (females): Spironolactone or oral contraceptives
Relevant Compounds
Adapalene
First-line topical retinoid — comedolytic and anti-inflammatory
Adapalene is a third-generation synthetic retinoid that selectively binds to RARβ and RARγ receptors…
Alpha Arbutin
Addresses post-inflammatory hyperpigmentation from acne
Alpha arbutin is a biosynthetic glycosylated hydroquinone derivative that inhibits melanin productio…
Azelaic Acid
Anti-bacterial, anti-comedonal, reduces PIH
Azelaic acid is a naturally occurring dicarboxylic acid produced by Malassezia furfur. It has antiba…
Benzoyl Peroxide
Bactericidal — reduces C. acnes without resistance
Benzoyl peroxide is a potent bactericidal agent widely used in the treatment of acne vulgaris. It is…
Clindamycin
Topical antibiotic — anti-bacterial and anti-inflammatory
Clindamycin is a lincosamide antibiotic effective against gram-positive bacteria, particularly Cutib…
Glycolic Acid
AHA — chemical exfoliation and pore refinement
Glycolic acid is the smallest alpha hydroxy acid with the greatest bioavailability due to its low mo…
Green Tea Extract
Anti-inflammatory and antioxidant adjunct
Green tea extract is derived from the leaves of Camellia sinensis. It is rich in polyphenols called …
Niacinamide
Sebum regulation and anti-inflammatory
Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…
Retinol
OTC retinoid — milder alternative to tretinoin
Retinol is an over-the-counter retinoid and a precursor to retinoic acid (tretinoin). It must be con…
Salicylic Acid
Comedolytic BHA — unclogs pores and reduces sebum
Salicylic acid is a lipophilic beta hydroxy acid with keratolytic, comedolytic, and mild anti-inflam…
Tea Tree Oil
Antimicrobial agent against C. acnes
Tea tree oil is a volatile essential oil derived from the Australian plant Melaleuca alternifolia. I…
Tretinoin
Potent retinoid — normalises keratinisation
Tretinoin is a first-generation retinoid derived from vitamin A. It is one of the most extensively s…
Vitamin C
Anti-inflammatory and post-acne pigmentation reduction
Vitamin C is a potent water-soluble antioxidant essential for collagen synthesis. In topical skincar…
Zinc PCA
Sebum control and mild antimicrobial
Zinc PCA is the zinc salt of pyrrolidone carboxylic acid (PCA), a natural component of the skin's Na…
Recommended Drugs
Suggested Cosmetics
Lifestyle Tips
- Use non-comedogenic skincare and makeup products
- Cleanse twice daily — avoid harsh scrubbing
- Apply sunscreen daily (SPF 30+) especially with retinoids or AHAs
- Avoid picking or squeezing lesions to minimise scarring
- Consider dietary review — some patients benefit from reducing dairy or high-GI foods
When to Refer
- Severe nodulocystic acne requiring isotretinoin
- Acne not responding to 3 months of topical therapy
- Significant scarring or psychological distress
- Suspected hormonal acne in females needing endocrine workup