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  • Acne vulgaris is a common disorder of the pilosebaceous unit.

  • There are four key elements of pathogenesis: (1) follicular epidermal hyperproliferation, (2) sebum production, (3) the presence and activity of Propionibacterium acnes, and (4) inflammation and immune response.

  • Clinical features include comedones, papules, pustules, and nodules on the face, chest, and back.

  • Treatment often includes combinations of oral and topical agents such as antimicrobials, retinoids, and hormonal agents. Laser and light sources are additional treatment options.


Acne vulgaris is a common disorder of the pilosebaceous unit that is seen primarily in adolescents. Most cases of acne present with a pleomorphic array of lesions, consisting of comedones, papules, pustules, and nodules with varying extent and severity. Although the course of acne may be limited in the majority of patients, the sequelae can be lifelong, with scar formation and psychological impairment, especially in young people.


Acne is one of the top three most common skin diseases, particularly in adolescents and young adults, in whom the prevalence is estimated at 85% (ages 12–25 years).1,2 Acne has no predilection for ethnicity; thus, it is an important disease worldwide and is considered one of the top 10 most prevalent global diseases.3-5 It is also considered the third most important disease defined by the global burden of disease.6 Acne patients report a Dermatology Life Quality Index (DLQI) score of 11.9, considered more detrimental to quality of life than psoriasis (DLQI = 8.8). Thus, acne is not only important for health of a significant number of people in the United States but has an impact globally.

Acne can occur at any age, starting at birth with neonatal acne (presents in the first few weeks of life) and infantile acne (presents between 1 and 12 months) and extending into adulthood. Acne may persist from adolescence into adulthood, or it can have its onset after the adolescent period. The prevalence of acne in adolescents is higher in males, but in adults is higher in females. The prevalence rates in adults have been reported to be as high as 64% in the 20s and 43% in the 30s.7 After the age of 50 years, 15% of women and 7% of men have been reported to have acne.8 Because the age of adrenarche appears to be dropping over the years, patients may be presenting with acne at an earlier age.9 Globally, the incidence of acne vulgaris appears to be rising. The reasons are unclear, although increased exposure to a westernized diet is postulated.2

Family history of acne has been reported in 62.9% to 78% of patients.10,11 Those with family history tend to be male and have an earlier onset of acne, truncal involvement, and scarring.11 Several twin studies have been done, finding that ...

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