Acne Vulgaris

Acne vulgaris – or acne, as it is commonly known – is a skin condition that affects almost every individual at some point in their life. It is mostly incident among adolescents – around 14-17 years of age in girls, and around 16-19 years of age in boys. However, in some cases, it is more or less a lifelong condition that continues well into adulthood. Acne may be mild or severe, chronic or manageable, and can be rather painful, depending on how it manifests.


Acne can manifest in several ways, its appearance subsequently depending on what type of condition prevails. The image below depicts the six types of acne that may occur:

Types of acne
Image from VectorStock

– blackheads – small black/yellowish bumps on the skin that appear black because of the colour (pigment) produced by the inner lining of the hair follicle

 – whiteheads – similar to but firmer than blackheads, and cannot be squeezed out

 – papules – small red bumps that usually feel tender/sore

 – pustules – papule-like bumps with a white tip caused by the build-up of pus

 – nodules – large, hard bumps beneath the surface of the skin that are usually quite painful

 – cysts – large, pus-filled bumps that appear similar to boils and often cause permanent scarring

While acne often presents on the face of the sufferer, it affects the back of about half of these cases, and appears on the chest in about 15% of cases.


Acne is often associated with oily skin, which might be particularly difficult to control in warm or tropical climates. The use of dermatologically tested face powders and oil wipes might help with ‘shine’ control – the oily appearance of skin.

The deeper and bigger the bumps, the more the pain and discomfort associated with them. In some cases, pain may be severe enough to extend to more areas of the affected side or region of the face.

Depending on your skin type (how sensitive it is) and the intensity of acne, there is a significant likelihood of scarring. Scars may appear as black ‘marks’ that fade off over time, or may form blemishes on the skin surface that are usually permanent.


In order to understand the cause of acne, it helps to understand a few things related to the basic anatomy of our skin. Our skin contains thousands of hair follicles, which open up on the surface as pores, all over the body. These hair follicles are linked to sebaceous glands which produce sebum (an oily substance) which lubricates the skin and hair that comes out through the hair follicle.

Basic anatomy of human skin with hair follicles
Image from

Acne occurs when these sebaceous glands produce an excess of sebum, which then combines with dead skin cells to plug (block) the hair follicle. These plugged follicles are then easily contaminated by bacteria present on the skin that are otherwise harmless. This in turn results in the formation of blackheads, whiteheads, papules, pustules, nodules or cysts (more than one type may occur simultaneously).

A few risk factors for acne include:

  • increased levels of testosterone, particularly during puberty
  • a family history of acne (with likelihood for severe acne being high if both parents had acne)
  • pre-menstrual syndrome in women, with cyclic break-outs
  • pregnancy, particularly during the first trimester
  • polycystic ovarian syndrome (PCOS) in women
  • certain steroidal and other medications
  • the use of cosmetic products that have not been dermatologically-tested (rare)
  • regular use of accessories that cause pressure on the affected areas, e.g. face mask, backpack
  • smoking


A visual observation, and in some cases pain and soreness, are a straightforward diagnosis of acne. A dermatologist, or even a general physician, should be able to identify whether a case is mild, moderate or severe, and decide on what line of treatment to follow, accordingly.


While maintaining a healthy, balanced diet is recommended for everyone in general, there is actually little, if any, link between diet and acne. Despite many publications being made on the contrary, the effect of items such as chocolate, caffeine, greasy food, etc. have not been proven to be significant enough to categorise them as risk factors or causal agents.

Similarly, associating acne with personal hygiene is also a mythical impression, and therefore should not be used to stigmatise people with acne – particularly chronic cases.

Acne is also not communicable, and therefore should not be regarded as a reason to keep a distance or not associate with someone suffering from the condition.

In other words, there is little one can do to prevent the incidence of acne. However, if prevalent, one should avoid ‘popping’ the bumps or touching the affected areas frequently as this could make it worse. If you are acne-prone, it is also a good idea to wear clothes or accessories that allow the affected areas to breathe freely.


A pharmacist may be able to recommend a topical ointment to bring mild acne under control. However, it is best to consult a general physician – or in worse cases, a dermatologist – to get a suitable recommendation on treatment for persistent or moderate/severe acne. Treatment options that might be considered include:

  • benzoyl peroxide ointment (topical) – works as an antiseptic to reduce skin bacteria
  • retinoids (topical) – exfoliates (removes dead skin cells)
  • antibiotic ointment (topical) – kills skin bacteria
  • azelaic acid (topical) – exfoliates and kills bacteria
  • antibiotic tablets (oral) – mostly tetracyclines, reduce or kill skin bacteria; often prescribed in combination with topical treatment

All these forms of topical medication run the risk of causing skin irritation, burning or other discomfort. They should therefore be introduced with caution, and the respective doctor should be informed of any such persistent or escalating discomfort. In cases where exposure to sunlight is not recommended, advice should be adhered to accordingly.

In the case of PCOS or other hormonal imbalances causing acne, the above-mentioned treatment methods may not be effective as the problem is inherent. Therefore, it would be best to treat the underlying cause rather than to persist with treatment for the symptoms alone, without much result. Treatment for PCOS has been discussed here.

Some individuals prefer to stick to or accompany medical treatment with a cosmetic line of response – such as peeling, facial cleansing, light therapy, etc. While such treatment may provide an short-term observable result, it may not necessarily ‘treat’ the problem. It is therefore recommended to seek medical advice, particularly in the case of moderate/severe acne, without risking further damage to your skin.

Cover illustration adapted from Depositphotos.

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