Dermatology
Acne Vulgaris
여드름
Chronic inflammatory disease of the pilosebaceous unit
- How common
- Very common (85% adolescents)
- Typical age
- Ages 10–30
What is it?
Four pathogenic factors: excess sebum, follicular hyperkeratinization, C. acnes overgrowth, inflammation.
Commonly affected: Face (T-zone), chest, upper back
How it develops
- Sebum overproductionAndrogens stimulate sebaceous glands
- Follicular pluggingDead keratinocytes plug the follicle (comedone)
- Bacterial growthC. acnes hydrolyzes sebum, releases inflammatory mediators
- InflammationNeutrophilic infiltrate forms papules, pustules, nodules
Symptoms
- Nodules/cystsDeep painful lesions, scarring risk
- Inflammatory papules/pustulesRed, swollen lesions
- Acne scarsIce-pick, boxcar, rolling scars
- ComedonesNon-inflammatory plugged follicles
- SeborrheaOily skin
How it is examined
- Lesion distributionAssess face, chest, back distribution
- Severity gradingMild/moderate/severe (GAGS or IGA scale)
- Endocrine workup if indicatedAcne + hirsutism + irregular menses → suspect PCOS
Imaging
Acne is a clinical diagnosis; imaging not required.
- Visual diagnosis
Pelvic ultrasound (female) if PCOS suspected.
- Polycystic ovaries
Non-surgical care
- Topical retinoidAdapalene/tretinoin (normalizes follicle)
- Benzoyl peroxideAntibacterial and anti-inflammatory
- Topical antibioticsClindamycin, erythromycin
- Oral antibioticsDoxycycline/minocycline (moderate–severe)
- Hormonal therapy (female)OCPs, spironolactone
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe nodulocystic acne, failure of conservative care
Procedures that may be discussed
- Isotretinoin (oral)
- Intralesional corticosteroid
- Laser/chemical peel (scars)
Outlook
Most resolve by late 20s; scar prevention is key.