Acne Vulgaris: Causes, Severity, and Treatment Options

Acne vulgaris is one of the most common dermatological conditions affecting individuals worldwide. It predominantly occurs during adolescence but can persist into adulthood, causing not only physical discomfort but also significant emotional distress. The condition is characterized by the presence of comedones, papules, pustules, and, in severe cases, cysts and nodules. Understanding the causes, progression, and available treatment options is crucial for managing acne effectively and preventing long-term complications, such as scarring.

The Main Cause of Acne Vulgaris

Acne develops due to a combination of factors that interact within the skin. The primary cause is an overproduction of sebum by the sebaceous glands, which, when combined with dead skin cells, clogs the hair follicles. This creates an ideal environment for the proliferation of Cutibacterium acnes (formerly known as Propionibacterium acnes), a bacterium naturally present on the skin. The bacteria trigger an inflammatory response, leading to the development of red, swollen lesions.

Hormonal fluctuations play a significant role in acne formation. Androgens, the hormones responsible for increased sebaceous gland activity, surge during puberty, making adolescents more susceptible. However, hormonal imbalances in adults, such as those caused by polycystic ovary syndrome (PCOS), pregnancy, or stress, can also lead to persistent acne. Genetic predisposition is another critical factor, as a family history of acne increases an individual’s likelihood of experiencing breakouts. Additionally, external factors such as diet, skincare products, and environmental pollutants can exacerbate the condition.

The Four Grades of Acne Vulgaris

The severity of acne is classified into four grades, ranging from mild to severe, based on the type and number of lesions present.

Grade 1, or mild acne, consists mainly of blackheads and whiteheads (open and closed comedones) with minimal inflammation. This type is typically manageable with over-the-counter treatments and a consistent skincare routine.

Grade 2, or moderate acne, is characterized by a combination of comedones and inflamed papules and pustules. The presence of mild inflammation differentiates it from Grade 1, and it often requires topical treatments with antibacterial and exfoliating properties.

Grade 3, or moderately severe acne, includes a greater number of inflamed pustules and deeper nodules. This level of acne carries a higher risk of scarring and requires more aggressive treatment, often combining topical and oral medications.

Grade 4, or severe cystic acne, presents with numerous large, painful cysts and nodules. It is often resistant to conventional treatments and necessitates prescription medications such as isotretinoin.

Can Acne Vulgaris Spread?

Unlike infectious skin conditions, acne is not contagious and does not spread from person to person. However, it can worsen and become more extensive over time if left untreated. The spread of acne across different areas of the face and body is typically due to increased sebum production, hormonal fluctuations, or improper skincare habits. Picking or squeezing lesions can also lead to bacterial dispersion, worsening inflammation and increasing the risk of scarring.

The Age When Acne is Worst

Acne severity peaks during adolescence, typically between the ages of 14 and 19. This period coincides with puberty when hormonal changes cause an increase in sebum production. However, adult-onset acne is also common, especially among women in their 20s, 30s, and beyond. Factors such as stress, pregnancy, birth control use, and underlying medical conditions can trigger breakouts later in life. While teenage acne is often more severe due to hormonal surges, adult acne tends to be persistent and influenced by lifestyle and environmental factors.

How to Get Rid of Acne Vulgaris Fast

The speed of acne treatment depends on the severity of the condition. Mild cases may improve within weeks with appropriate topical treatments, while moderate to severe acne can take months to show significant improvement. A combination of proper skincare, medication, and lifestyle adjustments offers the best results.

For fast relief, topical treatments containing benzoyl peroxide or salicylic acid can help reduce inflammation and clear pores. In moderate cases, dermatologists may prescribe oral antibiotics or hormonal therapy to control breakouts. Severe cases often require isotretinoin, a potent oral retinoid that significantly reduces sebum production and inflammation. Regardless of the treatment method, consistency and patience are key to achieving long-term improvement.

The Best Treatment for Acne Vulgaris

Effective acne management involves a combination of topical and systemic treatments tailored to the individual's needs. Retinoids, particularly tretinoin (Retin-A), are among the most effective topical therapies available. Tretinoin works by promoting cell turnover, preventing clogged pores, and reducing inflammation. It is often prescribed for mild to moderate acne and is a cornerstone of long-term acne maintenance.

For moderate to severe cases, dermatologists may recommend oral antibiotics such as doxycycline or minocycline to reduce bacterial overgrowth and inflammation. In women with hormonally driven acne, oral contraceptives or anti-androgen medications like spironolactone can be beneficial. Isotretinoin remains the most effective treatment for severe cystic acne, offering long-term remission for many patients.

Lifestyle modifications also play a crucial role in managing acne. Maintaining a balanced diet, reducing dairy and high-glycemic foods, managing stress, and following a gentle skincare routine can support medical treatments and enhance overall skin health.

The Role of Retin-A (Tretinoin) in Acne Treatment

Tretinoin, a derivative of vitamin A, is widely used in acne therapy due to its ability to regulate skin cell turnover. By accelerating the shedding of dead skin cells and preventing pore blockages, tretinoin reduces the formation of new acne lesions. Additionally, it possesses anti-inflammatory properties that help decrease redness and swelling associated with acne.

When initiating tretinoin treatment, it is common to experience an initial "purging" phase where breakouts temporarily worsen as the skin adjusts. This phase usually subsides within a few weeks, revealing clearer skin over time. Consistent use is crucial, as improvements become more apparent after several months.

Tretinoin is often combined with other acne treatments, such as benzoyl peroxide or antibiotics, for enhanced efficacy. It also plays a role in post-acne care by improving skin texture, reducing hyperpigmentation, and minimizing the appearance of scars. However, it can cause dryness and irritation, making proper moisturization and sun protection essential during treatment.

Final Thoughts

Acne vulgaris is a multifactorial skin condition that affects individuals of all ages, requiring tailored treatment approaches based on severity. While hormonal fluctuations, genetics, and bacterial activity contribute to its development, proper skincare, medication, and lifestyle modifications can effectively manage and reduce breakouts. Treatments such as tretinoin, oral antibiotics, and isotretinoin offer substantial relief, helping individuals achieve clearer skin. Consulting a dermatologist for a personalized treatment plan ensures the best outcomes and minimizes the risk of long-term scarring. With patience and adherence to the right regimen, acne can be controlled, allowing individuals to regain confidence in their skin.

Medically Reviewed by Dr. Mevan Nandaka Wijetunga, MD