Acne Vulgaris Workup

Updated: Aug 27, 2020
  • Author: Jaggi Rao, MD, FRCPC; Chief Editor: William D James, MD  more...
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Laboratory Studies

The diagnosis of acne vulgaris is clinical. Consider polycystic ovarian syndrome (PCOS) in female patients with oligomenorrhea, hirsutism, and/or acanthosis nigricans in addition acne: These patients should be evaluated with total and free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, luteinizing hormone, and follicle-stimulating hormone values, as well as a lipid panel, glucose value, and insulin level.

Also see Polycystic Ovarian Syndrome.

Skin lesion cultures to rule out gram-negative folliculitis are warranted if the patient does not respond to long-term antibiotic treatment or improvement with antibiotics is not maintained. [33]

Also see the Medscape Acne Resource Center.


Histologic Findings

The microcomedo is characterized by a dilated follicle with a plug of dense keratin. With progression of the disease, the follicular opening becomes dilated, and an open comedo results. The follicular wall thins, and it may rupture. Inflammation and bacteria may be evident, with or without follicular rupture. Follicular rupture is accompanied by dense inflammatory infiltrate throughout the dermis. Later, extensive fibrosis and scarring may develop. [34]