Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris
- Diane Thiboutot, MD
Diane Thiboutot, MD
- Professor and Vice Chair of Dermatology Research
- Penn State University College of Medicine
- Andrea Zaenglein, MD
Andrea Zaenglein, MD
- Professor of Dermatology and Pediatrics
- Penn State/ Milton S. Hershey Medical Center
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Pediatrics and Medicine
- Dell Medical School/University of Texas, Austin
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Acne vulgaris is the most common cutaneous disorder affecting adolescents and young adults. Patients with acne can experience significant psychological morbidity and, rarely, mortality due to suicide [1,2]. The psychological effects of embarrassment and anxiety can impact the social lives and employment of affected individuals. Scars can be disfiguring and lifelong. In one prospective study of 90 patients with acne, a significant improvement in self-esteem was found with treatment of the acne . Thus, it is imperative that clinicians are familiar with acne vulgaris and its treatment.
The pathogenesis, clinical manifestations, diagnosis, and differential diagnosis of acne vulgaris will be reviewed here. The treatment of acne vulgaris is discussed elsewhere. (See "Treatment of acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris" and "Light-based, adjunctive, and other therapies for acne vulgaris".)
Estimates of the prevalence of acne vulgaris in adolescents range from 35 to over 90 percent [4,5]. Acne tends to resolve in the third decade, but it may persist into or develop de novo in adulthood. The exact prevalence in adults is uncertain, and studies using a clinical examination typically find a lower prevalence than surveys asking for patients to self-report acne.
Postadolescent acne predominantly affects women, in contrast to adolescent acne, which has a male predominance . In one survey of over 1000 adults, self-reported acne in men and women was documented as follows :
●20 to 29 years: 43 and 51 percent, respectively
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- Pilosebaceous follicles
- Types of acne lesions
- Role of androgens
- External factors
- Family history
- Insulin resistance
- Body mass index
- CLINICAL MANIFESTATIONS AND CLASSIFICATION
- Acne variants
- - Acne fulminans
- - Acne conglobata
- - SAPHO syndrome
- - PAPA syndrome
- - Gram-negative folliculitis
- - Neonatal acne and infantile acne
- - Childhood acne
- - Acne excoriée des jeunes filles
- - Solid facial edema
- DIAGNOSTIC EVALUATION
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- Non-acne dermatoses
- Acneiform eruptions
- - Drug-induced acne
- - Acne cosmetica
- - EGFR inhibitor acneiform eruption
- - Occupational acne
- - Tropical acne
- - Radiation acne
- - Apert syndrome
- INFORMATION FOR PATIENTS