Acne Vulgaris: Definition, Causes, and Best Treatment Options

Acne vulgaris is the medical term for acne. It develops when excess sebum (oil) and dead skin cells block the hair follicles, triggering blackheads, whiteheads, pimples, or deeper cysts. Hormonal changes, genetics, bacteria (C. acnes), and inflammation contribute to these breakouts. OTC products and prescription medicines help manage milder cases, while dermatological procedures may be required for persistent or severe acne.

While acne often resolves within a few years for some, others experience acne vulgaris for 5 to 10 years, with breakouts usually peaking during adolescence before improving in their early twenties. However, adult acne is becoming increasingly common, and some individuals continue experiencing flare-ups into their 30s or even 40s.

While individual pimples often heal within one to two weeks, deeper cystic lesions may take several weeks or even months to resolve.

What is Acne Vulgaris?

Acne vulgaris is a chronic inflammatory skin condition that affects the hair follicles and oil glands (sebaceous glands).

Healthy pores allow the oil to travel freely to the skin's surface. However, when excess oil combines with dead skin cells, the pore becomes blocked. This creates an ideal environment for Cutibacterium acnes (C. acnes) bacteria to multiply, which then triggers inflammation and causes visible breakouts.

Acne vulgaris can appear anywhere oil glands are most active, including the face, forehead, chin, jawline, chest, upper back, and shoulders.

The severity can vary from a few occasional blackheads to widespread inflamed cysts that may leave permanent scars if left untreated.

What are the Symptoms of Acne Vulgaris?

Acne vulgaris doesn't always look the same. Some people experience only small clogged pores, while others develop painful inflammatory lesions. The diagnostic symptoms of acne vulgaris typically manifest as follows:

• Blackheads (Open Clogged Pores): Small, dark-coloured bumps that form when clogged pores remain open and are exposed to air.
• Whiteheads (Closed Clogged Pores): Tiny, flesh-coloured or white bumps that develop when clogged pores stay closed beneath the skin.
• Small Red Bumps (Papules): Inflamed, tender red bumps without visible pus that can be sensitive to touch.
• Pus-Filled Pimples (Pustules): Red, inflamed bumps with a white or yellow pus-filled center.
• Large, Painful Nodules: Hard, deep lumps beneath the skin that are often painful and take longer to heal.
• Deep Cysts Beneath the Skin: Large, soft, painful lesions filled with pus that develop deep within the skin and may cause scarring.
• Oily Skin: Excess sebum production that leaves the skin looking shiny and increases the risk of clogged pores.
• Redness and Inflammation: Visible redness and swelling around acne lesions caused by the body's inflammatory response.
• Acne Scars or Dark Marks After Healing: Persistent indentations, raised scars, or dark spots that remain after acne lesions have healed.

Many people develop multiple types of acne lesions at the same time. For example, someone may have blackheads on the nose, whiteheads on the forehead, and inflamed pimples along the jawline.

What Causes Acne Vulgaris?

Dermatological research indicates that acne is multifactorial, driven primarily by four interconnected primary pathways.

Excess Sebum Production

Sebaceous glands naturally produce oil to protect the skin. However, overactive glands produce more oil than necessary, increasing the risk of clogged pores.

Dead Skin Cell Build-Up

Dead skin cells are normally shed on their own. When this process slows, the cells accumulate within hair follicles and combine with excess oil to form blockages.

Bacterial Growth

C. acnes bacteria naturally live on healthy skin. Inside clogged pores, they multiply rapidly and trigger inflammation, resulting in swollen, red pimples.

Hormonal Changes

Hormones are one of the biggest acne triggers. Puberty, menstrual cycles, pregnancy, menopause, and stress can all increase oil production by stimulating the sebaceous glands.

Genetics

If your parents experienced persistent acne, you're more likely to develop it too. Genetics influence a lot, from oil production to inflammatory responses.

Certain Skincare Products

Heavy, pore-clogging (comedogenic) cosmetics or skincare products may worsen acne in susceptible individuals.

Lifestyle Factors

While daily habits do not initiate the underlying genetic condition, several secondary lifestyle factors can exacerbate flare-ups:

• Chronic Stress: Stress increases cortisol levels, which can stimulate oil production and worsen inflammation, making acne breakouts more frequent or severe.
• Poor Sleep: Inadequate sleep may disrupt hormone balance and increase inflammation, reducing the skin's ability to repair itself and contributing to acne flare-ups.
• High Humidity: Humid conditions increase sweating and oil production, making it easier for pores to become clogged with sebum and dead skin cells.
• Friction from Helmets or Tight Clothing: Constant rubbing and pressure on the skin can irritate hair follicles, trap sweat, and trigger acne in affected areas.
• Picking or Squeezing Pimples: Touching or squeezing acne lesions pushes bacteria and debris deeper into the skin, increasing inflammation and the risk of scarring.

What Are the Stages of Acne Vulgaris?

Acne vulgaris is commonly classified into four stages based on the type, severity, and number of lesions present. Identifying the stage helps determine the most appropriate treatment approach.

Stage 1: Mild Acne

This stage mainly includes blackheads, whiteheads, and occasional small pimples. Breakouts are generally limited and respond well to over-the-counter treatments.

Stage 2: Moderate Acne

Moderate acne includes multiple inflamed papules, pustules, and larger areas of breakouts. Prescription topical medications are often recommended at this stage.

Stage 3: Severe Acne

Severe acne features numerous painful nodules, deep inflammatory lesions, and widespread redness. Scarring is more likely to occur if treatment is delayed.

Stage 4: Nodulocystic Acne

The most severe form includes large cysts, painful nodules, and significant inflammation with a high risk of permanent scarring. This stage usually requires specialist dermatological care.

How Is Acne Vulgaris Diagnosed?

Dermatologists diagnose the condition through visual evaluation, specifically mapping the following clinical parameters:

• Types of Acne Lesions Present: Your dermatologist will examine whether you have blackheads, whiteheads, papules, pustules, nodules, or cysts, as each type helps determine the severity of your acne.
• Number and Severity of Breakouts: They will assess how many spots are present, how inflamed they are, and whether your acne is mild, moderate, or severe.
• Areas of the Body Affected: Acne commonly appears on the face, chest, shoulders, and back. The location and spread of breakouts can provide important clues about the condition.
• Presence of Acne Scars: Your skin will be checked for any post-acne marks, pigmentation, or permanent scarring, as these may influence the treatment plan.
• Family History: Since acne can run in families, your dermatologist may ask whether your parents or siblings experienced persistent or severe acne.
• Hormonal History: They may ask about puberty, menstrual cycles, pregnancy, menopause, or any recent hormonal changes that could be contributing to your breakouts.
• Current Medications and Skincare Routine: Your dermatologist will review any prescription medicines, supplements, cosmetics, or skincare products you use, as some can trigger or worsen acne.

Additional testing isn't usually necessary. However, if hormonal acne is suspected or breakouts appear alongside irregular periods, excessive hair growth, or other symptoms, blood tests may be recommended to check for underlying hormonal conditions.

When Should You See a Dermatologist for Acne Vulgaris?

Mild acne often improves with consistent skincare, but professional treatment may be needed if:

• Acne lasts longer than three months despite treatment.
• Breakouts are painful or widespread.
• Deep cysts or nodules develop.
• Acne leaves scars or dark marks.
• Over-the-counter products aren't working and giving results.
• Acne is affecting your confidence or mental well-being.

Early treatment can reduce inflammation, shorten recovery time, and help prevent permanent scarring.

Acne Vulgaris Treatment and Management

The best acne vulgaris treatment depends on how severe the acne is and what type of lesions are present.

For Mild Acne

Many mild cases improve with over-the-counter ingredients such as:

• Salicylic acid: Unclogs pores, reduces blackheads and whiteheads, controls excess oil, and prevents new blemishes from forming.
• Benzoyl peroxide: Reduces acne-causing bacteria, helps inflamed pimples heal faster, and lowers the risk of bacterial resistance when used with antibiotics.
• Adapalene (retinoid): Regulates skin cell turnover to prevent microcomedones (the microscopic starting point of all pimples) and downregulates inflammatory pathways.
• Gentle, non-comedogenic moisturisers that are fragrance-free and suit your skin type.

Consistency is essential, as visible improvements usually take several weeks.

For Moderate Acne

A dermatologist may recommend a combination of topical treatments, such as:

• Prescription retinoids to prevent clogged pores, speed up skin renewal, reduce inflammation, and lower the risk of future breakouts.
• Topical antibiotics (used alongside benzoyl peroxide) to reduce bacterial growth and inflammation.
• Azelaic acid fades pigmentation left after acne clears up, calms redness, reduces inflammation, and improves acne.

These treatments help reduce inflammation while preventing new clogged pores.

For Severe Acne

More persistent cases may require oral antibiotics, targeted hormonal therapies (such as combined oral contraceptives or spironolactone for female patients), oral isotretinoin, or corticosteroid injections for large cysts. These medicines and treatments are generally prescribed for limited periods to reduce the risk of antibiotic resistance and should always be supervised by a dermatologist.

Professional Dermatology Procedures

Some patients benefit from procedures that complement medical treatment, including chemical peels, LED light therapy, laser treatments, acne scar treatments, and comedone extractions. These options are often considered once active inflammation is under better control.

Can Acne Vulgaris Be Prevented?

Acne cannot always be prevented, especially when hormones and genetics play a major role. However, healthy skincare habits can reduce the frequency and severity of breakouts.

Helpful habits include:

• Cleanse your face twice daily with a gentle cleanser.
• Remove makeup before sleeping.
• Use non-comedogenic skincare and sunscreen.
• Avoid picking or squeezing pimples.
• Wash pillowcases and makeup brushes regularly.
• Shower after heavy sweating.
• Manage stress where possible.
• Stick to a consistent skincare routine instead of constantly changing products.
• Switch to gentle chemical exfoliants instead of using harsh physical scrubs.

Remember, over-cleansing and scrubbing can irritate the skin and make your acne worse rather than better.

Clear Ritual's Approach to Managing Acne Vulgaris

At Clear Ritual, we believe skincare should be personalised rather than based on guesswork. Our approach focuses on identifying your skin concerns first, then recommending products and routines that match your individual needs.

The Clear Ritual Skin Test is designed to help you better understand your breakouts and discover products that support healthier-looking skin. Combined with consistency and, where necessary, professional dermatological advice, the right routine can help reduce active acne, minimise future flare-ups, and lower the risk of long-term scarring.

Frequently Asked Questions

1. What is the main cause of acne vulgaris?

Acne vulgaris develops when excess sebum (oil), dead skin cells, and C. acnes bacteria combine to clog hair follicles, triggering inflammation. Hormonal changes, genetics, certain skincare products, and lifestyle factors such as stress can also contribute to breakouts.

2. How to remove acne vulgaris on the face?

Treating acne vulgaris requires a consistent skincare routine and appropriate acne treatments. Use a gentle cleanser, non-comedogenic skincare products, avoid picking spots, and apply treatments containing ingredients such as salicylic acid, benzoyl peroxide, or retinoids. For persistent or severe acne, you should get it assessed by a dermatologist, who may prescribe stronger medications.

3. How do you treat severe acne vulgaris?

Severe acne typically requires systemic prescription therapies managed by a dermatologist, such as oral isotretinoin or oral antibiotics paired with prescription topicals, complemented by a barrier-supportive skincare routine.

4. What is the best medicine for acne vulgaris?

The best medicine varies depending on the type and severity of your acne. Common treatments include topical retinoids, benzoyl peroxide, salicylic acid, azelaic acid, topical or oral antibiotics, hormonal medications for some women, and oral isotretinoin for severe cystic acne.

5. Is acne vulgaris serious?

Acne vulgaris is not usually a serious medical condition, but it can become severe if left untreated. Mild acne often clears with appropriate skincare and over-the-counter treatments, while moderate to severe acne can cause painful nodules, cysts, permanent scarring, and post-inflammatory pigmentation.

References

• https://www.ncbi.nlm.nih.gov/books/NBK459173/
• https://www.aafp.org/afp/2019/1015/p475