Acne Vulgaris Clinical Presentation

  • Author: James Fulton Jr, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 26, 2011
 

History

Local symptoms of acne vulgaris may include pain or tenderness.

Systemic symptoms are most often absent in acne vulgaris. Severe acne with associated systemic signs and symptoms such as fever is referred to as acne fulminans. Additionally, acne vulgaris may have a psychological impact on any patient, regardless of the severity or the grade of the disease.[16]

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Physical

Acne vulgaris is characterized by comedones, papules, pustules, and nodules in a sebaceous gland distribution. A comedone is a whitehead (closed comedone) or a blackhead (open comedone) without any clinical signs of inflammation. Papules and pustules are raised bumps with obvious inflammation. The face may be the only involved skin surface, but the chest, back, and upper arms are often involved.

In comedonal acne, no inflammatory lesions are present. Comedonal lesions are the earliest lesions of acne, and closed comedones are the precursor lesion of inflammatory lesions. Note the image below.

Acne, grade I; multiple open comedones. Acne, grade I; multiple open comedones.

Mild acne is characterized by comedones and a few papulopustules. Note the image below.

Acne, grade II; closed comedones. Acne, grade II; closed comedones.

Moderate acne has comedones, inflammatory papules, and pustules. Greater numbers of lesions are present than in milder inflammatory acne. Note the image below.

Acne, grade III; papulopustules. Acne, grade III; papulopustules.

Nodulocystic acne is characterized by comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter. Scarring is often evident. Note the image below.

Acne, grade IV; multiple open comedones, closed coAcne, grade IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.
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Causes

The main underlying cause of acne is a genetic predisposition. The condition is inherited in an autosomal dominant pattern with incomplete penetrance. For example, acne vulgaris may skip a generation. The following aggravating factors are recognized:

  • Cosmetic agents and hair pomades may worsen acne.
  • Medications that can promote acne development include steroids, lithium, some antiepileptics, and iodides.
  • Congenital adrenal hyperplasia, polycystic ovary syndrome, and other endocrinological disorders associated with excess androgens may trigger the development of acne vulgaris. Even pregnancy may cause a flare-up.[17]
  • Mechanical occlusion with headbands, shoulder pads, back packs, or under-wire bras can be aggravating factors
  • Excessive sunlight may either improve or flare acne. In any case, the ultraviolet exposure ages the skin.
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Contributor Information and Disclosures
Author

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

Specialty Editor Board

Alexa F Boer Kimball, MD, MPH  Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital

Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Julie C. Harper, MD, to the development and writing of this article.

References

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Acne, grade I; multiple open comedones.
Acne, grade II; closed comedones.
Acne, grade III; papulopustules.
Acne, grade IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.
Acne with reactive hyperpigmentation; before treatment.
Acne with reactive hyperpigmentation; after treatment.
 
 
 
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