An Overview of Acne Vulgaris

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Acne vulgaris is a skin condition that occurs when hair follicles are blocked with dead skin cells, bacteria, and oil (sebum). The blocked follicles cause blemishes on the skin, including pimples, blackheads, whiteheads, and cysts. Also known as common acne, one of its main causes is hormones, especially around puberty.

Acne vulgaris is estimated to affect about 50 million people in the U.S. About 85% of teenagers are affected by acne, but it can occur in any age group with many cases persisting into adulthood. 

I don't think water will get rid of this...
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Most acne occurs on the face, chest, back, and shoulders. Symptoms can be mild, moderate, or severe.

If you have mild acne, you probably have less than 20 blackheads or whiteheads. Whiteheads are small flesh-colored or whitish blemishes, while blackheads have a dark center. You might also develop pimples, which are round, inflamed whiteheads on the skin.

If you have moderate acne, you’ll have a larger number of blackheads, whiteheads, and pimples. 

Severe acne may include widespread blemishes with nodules or cysts, which are larger and more solid than pimples. Nodules and cysts tend to be more painful than pimples.

If not treated promptly, both moderate and severe acne can result in scarring. 


Acne vulgaris is caused by a combination of hormones, oil, and bacteria. During puberty, a hormone called androgen increases and the sebaceous glands produce more of the oily substance sebum. Typically, sebum and dead skin cells come up through the hair follicles and out through the pores in the skin. When sebum, skins cells, and bacteria clog the follicles, the sebum can’t escape through the pores, which causes acne.

As you enter early adulthood, those hormones may decrease enough that acne will start to disappear. For about 40% of women, acne may continue into their 40s because of hormonal changes and other causes, including:

  • Hormonal changes in pregnancy or from the menstrual cycle
  • Some medications
  • Certain cosmetics and lotions
  • High humidity and sweating
  • Polycystic ovary syndrome (PCOS)


Most of the time, you’ll be able to recognize when you have acne. If you’re dealing with acne on a regular basis, though, it's best to make an appointment with a dermatologist. They can check your blemishes and make sure that your condition is acne and not another similar condition, like rosacea.

Once diagnosed, your healthcare provider can help you determine a treatment based on the cause and whether your acne is mild, moderate, or severe.


Your healthcare provider may suggest one treatment or a combination, depending on the severity of your acne. Mild acne may be able to be treated with over-the-counter topical medicine in creams, gels, and washes with benzoyl peroxide or salicylic acid.

Benzoyl peroxide targets the bacteria that causes acne and is contained in over-the-counter (OTC) acne products such as PanOxyl Acne Foaming Wash and Clean & Clear Continuous Control Acne Cleanser. Salicylic acid works by easing inflammation and unclogging pores. It can be found in OTC brands like CeraVe Salicylic Acid Cleanser and Vichy Normaderm Daily Deep Cleansing Gel.

Retinoids are available over the counter as well as via prescription (e.g., Differin). They help to break up whiteheads and blackheads, as well as prevent blocked pores.

Moderate acne is often treated with oral antibiotics, including doxycycline, minocycline, azithromycin, erythromycin, and tetracycline. Your healthcare provider may suggest you use one of these with a topical treatment for about 12 weeks, then stop the oral medication to see if your acne can be kept under control with just the topical option.

Severe acne may be treated with antibiotics and topical medication. If these medications aren’t successful in treating your acne, your healthcare provider may suggest the oral drug Zenatane (isotretinoin). This drug can cause birth defects so women taking it must use at least two forms of birth control. Other serious side effects may occur, such as depression and severe stomach pain, so talk to your healthcare provider about the pros and cons of using this medication.

It can take time to find the right treatment for acne. Medications that work for one person may not work for another. It’s important to stick with your treatment long enough to see results. 


Acne vulgaris can cause emotional stress for adolescents or anyone feeling self-conscious about their appearance. If you’re feeling depressed or anxious, seek help from a counselor or therapist while you’re going through treatment for acne.

A Word From Verywell

Acne vulgaris can be a stressful problem to have, but it is treatable. It may take several weeks or even months of treatment to see improvement, but your healthcare provider will work with you to find a treatment that’s successful for you.

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  2. Keri J. Acne. Merck Manual Consumer Version. Updated December 2018. 

  3. Keri J. Acne Vulgaris. Merck Manual Professional Version. Updated December 2018. 

  4. Harper J. 10 Things to Try When Acne Won’t Clear. American Academy of Dermatology. 

  5. Cleveland Clinic. Acne. Updated March 22, 2017. 

  6. Cleveland Clinic. Isotretinoin capsules

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