Acne Vulgaris and Acneiform Eruptions

Andrea L. Zaenglein
Emmy M. Graber
Diane M. Thiboutot
John S. Strauss
ACNE VULGARIS
Acne vulgaris is a self-limited disorder of the pilosebaceous unit that is seen primarily in
adolescents. Most cases of acne present with a pleomorphic variety of lesions, consisting of
comedones, papules, pustules, and nodules. Although the course of acne may be self-limiting,
the sequelae can be lifelong, with pitted or hypertrophic scar formation.
Epidemiology
Acne is sufficiently common that it often has been termed physiologic. Mild degrees of acne
are frequently seen at birth, probably resulting from follicular stimulation by adrenal
androgens, and may continue into the neonatal period. However, in the vast majority of cases
it is not until puberty that acne becomes a more significant problem. Acne is often an early
manifestation of puberty; in the very young patient the predominant lesions are comedones.
In girls, the occurrence of acne may precede menarche by more than 1 year. The greatest
numbers of cases are seen during the middle-to-late teenage period. Afterward, the incidence
steadily decreases. However, particularly in women, acne may persist through the third
decade or even later. Acne seems to be familial, but owing to the high prevalence of the
disease this has been extremely difficult to assess. Nodulocystic acne has been reported to be
more common in white males than in black males, and one group of investigators has found
that acne is more severe in patients with the XYY genotype.
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