What Is Acne Vulgaris?

Table of Contents
View All
Table of Contents

Acne vulgaris is a common skin condition that occurs when hair follicles become blocked with dead skin cells, bacteria, and skin oils (sebum). The blocked follicles cause inflammatory and non-inflammatory blemishes like pimples, blackheads, and whiteheads.

Acne vulgaris is the most common form of acne. It is closely linked to changes in hormones, diet, stress, and family genetics. An estimated 50 million people in the United States are thought to be affected. It is common in teens but can occur at any age.

The article looks at the types, symptoms, and causes of acne vulgaris, including how this common skin condition is diagnosed, treated, and prevented.

I don't think water will get rid of this...
LaylaBird / Getty Images

Types of Acne Vulgaris

Acne refers to a variety of blemishes caused by the blockage of pores by dead skin cells and sebum. Breakouts may involve one or several of the different types of acne vulgaris, including:

  • Whitehead: This is a non-inflammatory blemish known as a closed comedone. Whiteheads look like small, raised white or skin-colored bumps. They occur when skin cells and oils block a pore but remain below the skin.
  • Blackheads: This is a non-inflammatory blemish called an open comedone. Blackheads form when the plug of skin cells and oils emerges through a pore. Exposure to oxygen causes the plug to turn dark brown or black.
  • Pustules: Also known as a pimple, this is when bacteria within a blocked pore cause an infection, manifesting with pus and inflammation.
  • Papules: This is when a blockage causes an inflamed bump without pus. Papules can often progress to pustules.
  • Nodular acne: This is a form of severe acne that causes larger bumps (nodules) that are hard, inflamed, and painful to the touch. A pocket of pus lies far beneath the surface of the skin.
  • Cystic acne: This is an outdated term for nodular acne in which the nodule is not only larger but softer (due to the expansion of pus closer to the surface of the skin). Today, the preferred term is severe nodular acne.

Symptoms of Acne Vulgaris

Acne most commonly occurs on the face, chest, back, and shoulders. The condition can be broadly categorized by the following symptoms:

  • Mild acne: This is when you have less than 20 blackheads and/or whiteheads and less than 15 inflamed papules and pimples.
  • Moderate acne: This is when you have 20 to 100 whiteheads and/or blackheads and 15 to 50 inflamed papules and pustules. There may be up to 5 acne nodules.
  • Severe acne: This is when you have more than 100 whiteheads or blackheads, over 50 inflamed papules and pustules, and over 5 acne nodules. There may also be significant scarring.

What Causes Acne?

Acne vulgaris is associated with hormonal changes as well as lifestyle factors that promote the development of comedones and pimples.

Hormones

During puberty, male sex hormones called androgens increase, triggering changes in the teenage body. Among the changes, oil-producing glands called sebaceous glands will secrete large amounts of sebum. These oils can capture dead skin cells on the surface of the skin and clog pores. The more sebum that is produced, the greater the risk of acne.

As you enter early adulthood, androgen levels tend to decrease enough that acne breakouts will occur less frequently and eventually start to disappear.

For around 40% of women, however, acne may continue well into their 40s because of hormonal changes influenced by conditions like:

For most people, recurrent acne will usually stop by the time they reach their 30s. But some adults continue to have acne in their 40s or 50s. 

How Stress and Acne Are Linked

Some people get acne when they are stressed, overworked, or sleep deprived. When this happens, the body produces a hormone called cortisol that can increase blood sugar and provoke whole-body inflammation. Inflammation, in turn, increases the production of sebum.

Diet

Despite considerable debate, some researchers believe there is a link between the foods a person eats and their risk of acne breakouts.

Regularly eating high glycemic index (GI) foods is thought by some to promote acne. These foods raise blood sugar, causing inflammation and the increased production of sebum. Processed foods, sugary foods, and starchy foods like white bread, potatoes, and white rice are examples of high-GI foods.

Skin Care

Certain skincare products can contribute to acne by blocking pores or stripping away oils that block bacteria from entering follicles.

These include skincare products like:

  • Alcohol-based toners
  • Astringents
  • Exfoliants
  • Oil-based cosmetics
  • Thick skin creams and moisturizers
  • Harsh soaps or cleansers

Does Dirty Skin Cause Acne?

Dirty skin does not cause acne but can contribute to breakouts by increasing the risk of bacterial exposure. On the flip side, over-cleaning the skin can lead to dryness, which can trigger the overproduction of sebum and an outbreak of acne.

Family History

Having a first-generation relative with acne, such as a parent or sibling, may predispose you to acne as an adult.

Some studies suggest that certain gene mutations passed from parents to children are linked to overactive sebaceous glands. This seems particularly true in families where one or both parents have severe acne with scarring; rarely do their children escape significant acne breakouts.

Medications

Many medications can affect hormones that influence the production of sebum. Others cause acne when treatment is stopped and hormone levels are suddenly imbalanced.

These include drugs like:

Diagnosing Acne Vulgaris

Most of the time, acne is diagnosed with a visual inspection of the skin. Your healthcare provider may also ask you several questions about:

  • Your symptoms, including when they started and what makes them better or worse
  • Your family history of acne
  • Your menstrual cycles and the timing of your breakouts
  • Any medications you may have started or recently stopped

If there is any doubt about the cause of your breakout, you may be referred to a skin specialist called a dermatologist to rule out other possible explanations, such as:

How Acne Is Treated?

Based on the severity of your acne (mild, moderate, severe), your healthcare provider can prescribe the appropriate treatment. It may involve one or several of the following treatment options:

Lifestyle Modifications

There are a number of lifestyle changes that reduce your risk of acne:

  • Get plenty of rest to reduce cortisol levels
  • Manage your stress with mind-body therapies like yoga and meditation
  • Clean your skin gently after exercise or strenuous activity
  • Avoid over-cleansing the skin, particularly with harsh soaps
  • Use gentle oil-free moisturizers
  • Eat foods high in fatty acids such as nuts, seeds, and oily fish (like salmon and sardines)

Acne Medications

Different acne medications can be used either alone or in combination. Some are delivered topically (on the skin) while others are taken orally (by mouth).

Some of the most common acne medications include:

  • Benzoyl peroxide: This topical drug targets the bacteria that cause acne and is found in numerous over-the-counter (OTC) acne creams and ointments.
  • Salicylic acid: This OTC agent is also delivered topically and works by easing inflammation and unclogging pores.
  • Retinoids: These OTC and prescription drugs are derivatives of vitamin A. Topical or oral formulations containing adapalene, tazarotene, and tretinoin can speed the rate at which skin cells are shed to prevent build-up.
  • Oral antibiotics: Antibiotics like doxycycline, minocycline, azithromycin, erythromycin, and tetracycline can ease the burden of bacteria that lead to the formation of papules and pustules.
  • Aldactone (spironolactone): This drug has anti-androgenic effects and may be useful in treating acne in adolescent girls and women.

Specialist Procedures

For cases of moderate to severe acne that don't respond to medications, certain in-office procedures may be recommended, including:

  • Drainage and extraction: This involves special tools that gently remove whiteheads, blackheads, or pimples by a trained practitioner.
  • Chemical peel: This involves repeated applications of salicylic acid, glycolic acid, or retinoic acid to help removed damaged areas of skin and improve general appearance.
  • Steroid injection: This is used with nodular acne to quickly ease swelling, inflammation, and pain.

Does Light Therapy Help?

While a little sun exposure may be good for the skin, ultraviolet (UV) light therapy used for skin conditions like psoriasis is no longer recommended for acne. It has not been shown to ease acne symptoms and can end up causing skin damage in some people.

Summary

Acne vulgaris is the most common form of acne. Teens are frequently affected but people of any age can experience breakouts. Acne breakouts are influenced by changes in hormones, diet, stress, medications, improper skin care, and family genetics.

Acne can usually be diagnosed with a physical inspection and, depending on the severity, may be treated with changes in diet or lifestyle, topical or oral medications, and/or specialist procedures like chemical peels or steroid injections.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037

  2. American Academy of Dermatology. Acne: Signs and Symptoms.

  3. Tan JKL, Jones E, Allen E, Pripotnev S, Raza A, Wolfe B. Evaluation of essential clinical components and features of current acne global grading scalesJ Am Acad Dermatol. 2013;69(5):754–61. doi:10.1016/j.jaad.2013.07.029

  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne.

  5. Keri J. Acne Vulgaris. Merck Manual Professional Version.

  6. Dall'Oglio F, Nasca MR, Fiorentini F, Micali G. Diet and acne: review of the evidence from 2009 to 2020Int J Dermatol. 2021 Jan 18. doi:10.1111/ijd.15390

  7. American Association of Dermatology. Tips for managing acne.

  8. Keri J. Acne. Merck Manual Consumer Version.

  9. Heng AHS, Say YH, Sio YY, Ng YT, Chew FT. Epidemiological risk factors associated with acne vulgaris presentation, severity, and scarring in a Singapore Chinese population: a cross-sectional studyDermatology. 2022;238(2):226-35. doi:10.1159/000516232

  10. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne: diagnosis, treatment, and steps to take.

Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.