• Clinical science

Acne vulgaris


Acne vulgaris is a common skin disease that affects most individuals at some point in their lives. It is classified into different forms which vary in severity, lesion type, and localization, with the face commonly involved. The hallmark of acne are comedones, which can develop further into inflammatory papules, pustules, or even abscesses and nodules. Symptoms typically begin in early puberty and cease spontaneously during the third decade of life. There are multiple etiological factors: genetic predisposition, seborrhea, and hyperkeratosis are known to promote the development of acne. Topical and systemic treatment options are available to counteract inflammation and hyperkeratosis, as well as to help purify the skin.


  • Prevalence: 85% of the population is affected (!)
  • Age of onset: typically by 11–12 years, with symptoms usually disappearing around 20–30 years of age
  • Sex: more common in males during adolescence, but more common in women during adulthood


Epidemiological data refers to the US, unless otherwise specified.



Clinical features


Subtypes and variants

  • Hidradenitis suppurativa (also acne inversa): inflammation of the hair follicles and apocrine glands, most likely triggered by a blockage
    • Risk factors: obesity, smoking, family history
    • Clinical presentation
      • Localization: in folded skin areas containing apocrine glands (most commonly the axillae, groin, inner thigh, and perineal area)
      • Formation of abscesses, fistulas, and keloids
      • Formation of draining sinuses with scarring and foul odor
    • Treatment
  • Neonatal acne
    • Age of onset: first few weeks of life
    • Clinical presentation: papulopustular rash
    • Treatment: self-limiting disease ; no specific treatment
  • Infantile acne
    • Age of onset: ≥ 3 months
    • Clinical presentation: papulopustular rash, closed comedones, and sometimes formation of nodules. More common in boys.
    • Treatment: In contrast to neonatal acne, treatment is indicated to avoid scarring



Acne treatment

Mild (e.g., comedonal) Moderate (e.g., papular/pustular) Severe (e.g., conglobata)
  • Therapy is particularly important for patients with inflammatory acne to prevent complications such as scarring.


Retinoid therapy should be discontinued at latest one month before planned conception!