Acne Vulgaris

The cause is unknown. Heredity and age are described as predisposing factors, and the literature also links acne development to dysbiosis of the skin microbiota and activation of innate immunity.

Acne is described as a chronic inflammatory disease of the pilosebaceous unit involving hyperseborrhoea, abnormal follicular keratinization, and inflammation. Reviews also describe a role for Cutibacterium acnes within a disturbed skin microbiome, where loss of microbial diversity and shifts in phylotypes can trigger innate immune activation and cutaneous inflammation. Some literature further notes interactions with other skin microbes and the gut microbiome.

Heredity and age are listed as predisposing factors. The literature also mentions puberty, stress, irritation, cosmetics, and potential dietary factors as contributors to inflammation and lesion formation.

Management is described at the level of topical and systemic therapy, with strong guideline recommendations for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard oral or topical therapy. Other reviewed modalities include hormonal treatments and selected physical therapies such as comedone extraction, cryotherapy, electrocauterization, intralesional corticosteroids, and optical treatments.