Acne Vulgaris Treatment

Acne vulgaris is one of the most common skin conditions, annually affecting as many as 50 million people in the United States, according to the American Academy of Dermatology. Acne vulgaris, the scientific name for the condition that is colloquially referred to as “acne,” often affects adolescents but can be experienced by patients of any age. Patients may be affected by many types of acne, including open comedones (blackheads), closed comedones (whiteheads), papules, pustules, nodules, and cysts. Caused by a combination of factors, including increased sebum production, clogged pores, bacteria, and inflammation, acne vulgaris can range in severity from mild acne vulgaris to severe acne vulgaris. Characterized by small blemishes that can be red, painful, and inflamed, acne vulgaris can cause patients physical discomfort and psychological distress, leading many to search for the best treatment for acne vulgaris. The first step in finding the best acne therapy for you is to schedule a consultation appointment with expert board-certified dermatologist Dr. Michele Green.

According to the American Academy of Dermatology’s “Guidelines of Care for the Management of Acne Vulgaris,” the best method for treating active acne vulgaris breakouts is a combination approach. For a case of mild acne, a combination of topical therapies, which can include topical benzoyl peroxide, topical antibiotics, and topical retinoids, is the recommended course of action. For moderate acne, Dr. Green may prescribe an oral antibiotic, such as tetracycline, doxycycline, and minocycline, in addition to topical acne medication. Dr. Green may also recommend hormonal therapy for moderate to severe acne, such as the antiandrogen medication spironolactone or combined oral contraceptives. With many treatment options available, Dr. Green will begin by examining the treatment area to determine the severity of the breakout and generate a treatment plan that will be safe and effective for you.

Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options for an array of cosmetic concerns and medical skin conditions, including acne vulgaris. Dr. Green takes a holistic approach to acne treatment and is a master at incorporating a combination of topical therapies and oral acne medications into her patients’ individualized treatment plans that will provide them with clear, smooth, blemish-free skin that lasts. She is consistently identified as one of New York City’s best dermatologists by Super Doctors, Castle Connolly, New York Magazine, and the New York Times for her dedication to her patients and expertise. In addition to prescribing acne medication, Dr. Green has other acne treatment options available at her office, including chemical peels, light therapy, and physical acne lesion extraction.

What is acne vulgaris?

Acne vulgaris is the scientific name for the skin condition commonly referred to as acne. It is one of the most common skin conditions worldwide. Acne vulgaris is commonly associated with adolescents but can occur in patients of any age. Acne is most commonly found on highly visible areas of the body, such as the forehead, chin, nose, upper back, and shoulders; however, lesions can develop anywhere oil glands are present. Acne occurs when the oil glands in the skin’s pores become clogged with excess sebum, dead skin cells, and other debris. Within the pores, bacteria rapidly multiply, leading to swelling, redness, tenderness, and irritation associated with a pimple. Acne can be caused by a combination of factors, including genetics, hormones, diet, stress, hygiene, skincare, environment, and even as a side effect of certain medications. A board-certified healthcare professional, such as board-certified dermatologist Dr. Green, can work with you to determine the underlying factors contributing to your breakouts and develop a personalized plan for addressing them. Untreated or incorrectly treated acne, whether a single cyst or a persistent breakout of whiteheads, can have long-lasting ramifications, including permanent scarring (acne scars), hyperpigmentation, poor self-image, and depression. While acne vulgaris is the overarching category, several types of acne can occur on the body, including:

• Closed Comedones (Whiteheads): Whiteheads are characterized by white bumps that form due to clogged hair follicles (follicular hyperproliferation). They are a type of non-inflammatory acne (meaning that the clogged pores do not contain bacteria) that is closed underneath the skin.
• Open Comedones (Blackheads): Similarly to whiteheads, blackheads are a type of non-inflammatory acne. However, blackheads are open comedones, meaning that the clogged pore is open to the air—the resulting chemical reaction between the sebum and the air causes the bumps to appear black on top.
• Papules: Papules are inflammatory lesions that form when a clogged hair follicle becomes inflamed. They are characterized by the appearance of small red bumps that may be tender to the touch.
• Pustules: Pustules are similar to papules but differ in that they are filled with pus due to a buildup of white blood cells. It is essential not to pick at or pop pimples, as the pus that is released may spread to other pores, leading to further infection.
• Nodular Acne: Nodules are acne lesions that form when bacteria is trapped beneath the skin’s surface. They form a hard lump that is painful to the touch. Nodular acne has a high risk of resulting in acne scarring following the infection.
• Cystic Acne: Acne cysts occur when nodular acne is filled with bacteria and pus. Similarly to nodule acne, cystic acne extends deep under the skin’s surface, potentially leading to permanent scarring.

The safest, fastest, most effective way to determine what type of acne you have and how to treat it once and for all is to consult a board-certified dermatologist like Dr. Green. When you consult with Dr. Green at her private dermatology office in Manhattan’s Upper East Side neighborhood, she will physically evaluate your skin condition, collect a thorough medical and family history, and potentially order certain blood tests for laboratory evaluation. Depending on your consultation, Dr. Green will recommend a unique combination of topical treatments, oral medications, and in-office procedures to treat your existing acne, prevent new breakouts, and reduce the appearance of acne scars, resulting in a smooth, clear, healthy complexion.

Why does acne vulgaris happen?

The pilosebaceous units in the skin consist of the hair follicles and sebaceous glands. Acne vulgaris occurs when the hair follicle becomes clogged with excess oil, dead skin cells, and other debris. This causes naturally occurring skin bacteria to become trapped in the pore, where it multiplies, leading to irritation, inflammation, and tenderness that is characteristic of a pimple. Four main factors can contribute to acne breakouts: the overproduction of sebum (oil) on the skin’s surface, the hair follicle becoming clogged, an excess of the acne-causing bacteria Propionibacterium acnes (P. acne), and inflammation. The treatment options available for acne vulgaris typically target one of these factors when treating and preventing acne breakouts. There are several risk factors for developing acne vulgaris, including hormone fluctuations, family history, medications (such as corticosteroids), diet, and stress. Hormones, genetics, diet, stress, hygiene, environmental factors, and even certain medications can also trigger or worsen acne breakouts. An experienced board-certified dermatologist, such as Dr. Green in NYC, will work with you to determine the underlying factors contributing to the presence of your acne and establish a personalized treatment plan for eliminating your breakouts once and for all.

Which bacteria causes acne vulgaris?

The bacteria responsible for inflammatory acne is the Propionibacterium acnes (P. acnes) bacteria, which already lives on the skin’s surface. When many patients hear that bacteria can be responsible for acne breakouts, they worry that acne may be contagious. In fact, acne vulgaris is not contagious and cannot be passed on to another person. Acne vulgaris occurs when the naturally occurring P. acnes bacteria becomes stuck in a hair follicle clogged with sebum and debris. P. acnes bacteria are anaerobic bacteria, meaning that they increase well when in an environment without oxygen. When bacteria are trapped in pores with excess sebum, they become an ideal environment for P. acnes proliferation, which can lead to inflammation and moderate-to-severe acne lesions (doi: 10.1016/j.clindermatol.2004.03.009).

Will my acne vulgaris go away?

Acne vulgaris can be a chronic skin condition that affects patients for a prolonged amount of time. While some patients find that washing their face with salicylic acid or azelaic acid-based cleanser twice daily can keep acne breakouts at bay, others may find that over-the-counter medication and a regular skincare routine are not enough to stave off acne breakouts. If you are experiencing chronic acne, the best course of action is to schedule a consultation appointment with board-certified dermatologist Dr. Michele Green to determine the treatment plan to help you get rid of your acne vulgaris based on the type of acne you have and the underlying factors contributing to your breakouts.

What is the best topical treatment option for acne vulgaris?

Many topical treatment options are available at Dr. Green’s New York City dermatology office. According to the American Academy of Dermatology’s “Guidelines of Care for the Management of Acne Vulgaris” (J Am Acad Dermatol. May 2016;74(5):945–973.e33), the best approach for eliminating acne vulgaris is typically a customized combination approach (Am J Clin Dermatol 2001;2(1):33-9), meaning combining various forms of topical therapies that each treat different acne pathogenesis (factors that lead to acne breakouts). Many acne vulgaris treatment plans contain a combination of benzoyl peroxide, topical retinoids, and topical antibiotics. Depending on the cause of the breakouts, other common treatment options include isotretinoin, oral contraceptives, spironolactone, and Winlevi, a topical androgen inhibitor. The best way to customize your acne treatment plan to your specific skin condition is by consulting a board-certified dermatologist like Dr. Green in NYC. Below are some of the most common topical treatment options:

• Benzoyl peroxide, which is available in many formulations and found in gels, washes, creams, and lotions, is an antimicrobial and anti-inflammatory ingredient. Most often used in mild-to-moderate acne, benzoyl peroxide is a highly effective treatment option. Side effects of benzoyl peroxide products can include dermatitis, redness, dryness, and irritation, especially when used in higher concentrations.
• Topical retinoids, which are derivatives of vitamin A, have been used to treat acne vulgaris for more than 30 years and are highly effective at reducing inflammation and follicular clogging. Many formulations of topical retinoids are available, including tretinoin, adapalene, tazarotene, and isotretinoin. Retinoids are often combined with benzoyl peroxide but should be taken at different times of the day (benzoyl peroxide in the morning and topical retinoids at night) to avoid any adverse effects.
• Topical antibiotics manage acne breakouts by eliminating the bacteria responsible for causing acne vulgaris and reducing inflammation. The most common topical antibiotics prescribed for treating acne vulgaris are erythromycin and clindamycin, which can be found in concentrations of 1-4%. It is best to limit the amount of time that you are using antibiotics as acne therapy to avoid bacterial resistance to the treatment. Side effects of topical antibiotics can include erythema (redness), dryness, itching, and burning.
• Winlevi is a topical treatment containing clascoterone, an androgen inhibitor that blocks hormones in the skin from producing too much oil. By preventing the production of excess sebum, Winlevi helps keep pores clear to prevent and treat active acne breakouts. The most common side effects of using Winlevi include mild redness and dryness in the treatment areas. The topical treatment of acne vulgaris with Winlevi is not associated with side effects for male treatment options like the other hormonal treatments. This means that unlike some other hormonal acne treatment options, such as spironolactone and oral contraceptives, Winlevi is suitable for both males and females aged twelve and older. Winlevi requires a prescription from a board-certified dermatologist.

Pediatric acne patients should be careful to choose topical products that are safe for their skin. Dr. Green typically prescribes topical adapalene, known by the brand name Differin, tretinoin, known by the brand name Retin-A, and benzoyl peroxide, which are safe to use for children below the age of adolescence.

Which cream is best for acne vulgaris?

Creams to treat acne vulgaris can be acquired over the counter or by prescription from a dermatologist, such as Dr. Green. Any cream prescribed by a dermatologist will be more powerful and effective at treating moderate-to-severe acne than what can be purchased from a pharmacy. For cases of mild acne or to maintain clear skin on a regular basis, a 20% azelaic acid cream can be helpful in reducing acne breakouts when applied twice daily. Derived from the acid produced by yeast, azelaic acid has antimicrobial properties and can help reduce discoloration that occurs due to acne breakouts. Another ingredient to look for in creams, lotions, or cleansers is salicylic acid, which can help reduce the production of sebum and clear the pores. Dapsone gel 5% is another topical therapy with antimicrobial and anti-inflammatory properties to treat mild-to-moderate acne breakouts.

Which antibiotic is best for acne vulgaris?

For moderate-to-severe cases of acne vulgaris, oral antibiotics can be prescribed to reduce the prevalence of acne-causing bacteria on the skin’s surface. Taking oral antibiotics for a prolonged period increases the risk of developing bacterial resistance to the medication (D. Thiboutot et al., DOI: 10.1016/j.jaad.2009.01.019), which is why Dr. Green typically prescribes acne medication for 6-8 months. Additionally, oral antibiotics should never be used as a monotherapy (meaning the only active treatment). They should always be combined with a topical treatment, such as topical retinoids or benzoyl peroxide. Very few oral antibiotics are FDA-approved as a treatment for acne vulgaris. The most common is tetracycline, though some studies have shown that doxycycline and minocycline may be more effective than tetracycline (doi: 10.4103/0019-5154.77543). For patients who cannot tolerate tetracycline, trimethoprim may be another option.

Will tretinoin help acne vulgaris?

Topical tretinoins are very helpful in treating acne vulgaris and can be found in many formulations and concentrations. Derivatives of vitamin A and topical retinoids such as tretinoin can be used for moderate-to-severe acne breakouts to prevent hair follicles from becoming clogged. Often used together, tretinoin and benzoyl peroxide should not be applied at the same time of day to avoid unwanted side effects. Other types of retinoids that are commonly used to treat acne vulgaris include adapalene and tazarotene.

How does Accutane help with acne vulgaris treatment?

Accutane is the popular brand name for the prescription medication Isotretinoin, a derivative of vitamin A that treats and prevents mild to severe acne by decreasing sebum production, reducing the size of the sebaceous glands, increasing the rate of skin cell turnover, and inhibiting the growth of acne-causing bacteria on the skin’s surface. Other brand names of oral isotretinoin include Absorica, Amnesteem, Claravis, Myorisan, and Zenatane. In the past, oral isotretinoin was a treatment option commonly reserved for patients struggling with very persistent or severe acne that failed to respond to other treatment options, such as oral antibiotics or topical treatments. Now, Accutane is regularly recommended as a safe and effective treatment option to address all types of acne, including mild to moderate breakouts.

What medication is best for acne vulgaris?

When determining the best medication for acne vulgaris, Dr. Green will consider the severity and scope of the breakout before creating the treatment plan that will best meet your needs. When treating a mild case of acne vulgaris, Dr. Green will likely prescribe a combination of topical therapies consisting of benzoyl peroxide and a topical retinoid, such as tretinoin, adapalene, or tazarotene. In addition to topical treatments, moderate-to-severe acne breakouts may require a topical or oral antibiotic. In some cases, Dr. Green may prescribe an oral contraceptive (containing estrogen), oral isotretinoin, or spironolactone in combination with topical treatments. No one medication is inherently “the best,” and in fact, research has shown that acne treatment works best when different therapies are combined. As such, it is all about finding the combination of treatments that will be safe and effective for you.

When does acne vulgaris go away?

Acne medications target the factors that cause acne breakouts, such as excess sebum production, high concentrations of bacteria on the skin’s surface, inflammation, and clogged pores. These therapies can take time to work fully, meaning patients will see results after several weeks or several months of treatment. Consistency within your treatment plan is key to ensuring that acne vulgaris is eliminated and stays away.

Frequently Asked Questions about Acne Vulgaris:

Is acne vulgaris the same as acne?

Acne vulgaris is the medical term for the skin condition that we commonly refer to as acne. Within the broader term acne vulgaris, there are several types of acne, including open and closed comedones, papules, pustules, cysts, and nodular acne. The treatment method will change depending on the type of acne present on the skin, which is why it is essential to consult with a board-certified dermatologist when creating your treatment plan.

Is acne vulgaris a bacterial infection?

The presence of excess Propionibacterium acnes bacteria on the skin’s surface is one risk factor for the development of acne vulgaris. When the pores become clogged with oil and dead skin cells, the bacteria can procreate, which triggers inflammation in the affected area. However, not all types of acne vulgaris are infected with the P. acnes bacteria.

What type of skin disorder is acne vulgaris?

Many patients wonder, “What type of infection is acne vulgaris?” The answer is that acne vulgaris is considered a chronic inflammatory skin condition that affects the pilosebaceous unit, which consists of the hair follicle, hair shaft, and sebaceous glands. It is one of the most common skin conditions, affecting as many as 50 million Americans and resulting in costs of up to $3 billion every year. While acne vulgaris is very prevalent, it can still result in feelings of low self-esteem and depression, causing many to seek out treatment options.

Why is it called acne vulgaris?

The term “acne vulgaris” has old roots – going as far back as ancient Greece, where physicians referred to the skin condition as “ethos” or “acne,” which were words associated with the beginning of puberty. The term “vulgaris” was first written down by a physician in 1840 and means “common,” as the skin condition was historically and remains one of the most common conditions worldwide. While the understanding of the condition has shifted over time, the words remain in our vocabulary today.

Who discovered acne vulgaris?

Acne vulgaris is a condition that has been noted since the time of Ancient Greece and Ancient Egypt, so no one person throughout history “discovered” the condition. In more recent history, Francois Boissier de Sauvage de Lacroix was one of the first to provide a written description of acne in the mid-1500s, and research on the subject of acne continued to move forward into the 17th, 18th, and 19th centuries where Erasmus Wilson was the first write about the difference between acne and rosacea. The first medical study published specifically on acne was written by Lucius Duncan Bulkley in 1885.

When was acne vulgaris discovered?

Acne vulgaris has been noted by physicians for as long as humans have been able to make notes, with descriptions stemming back to Ancient Egypt and Ancient Greece. For much of history, the widely held belief was that acne vulgaris was an infectious disease that could be passed from person to person. Throughout the 19th century, however, advancements in medical research allowed scientists to question the root causes of the condition. They led to the discovery that several factors lead to acne breakouts, including sebum production, bacteria on the skin’s surface, and clogged pores.

What is moderate acne vulgaris?

Dermatologists have three classifications for the severity of acne vulgaris breakouts: mild acne, moderate acne, and severe acne. Mild acne is characterized by a low comedone count (less than 20) and fewer than 15 inflammatory lesions. Moderate acne vulgaris is defined as a breakout with between twenty and one hundred comedones or between fifteen and fifty acne lesions. In comparison, severe acne vulgaris is defined as more than one hundred comedones and more than 50 acne lesions. Severe acne lesions may also include cystic acne.

What is cystic acne vulgaris?

Cystic acne is a type of acne vulgaris that is characterized by pus-filled cysts, which are large, deep acne lesions. Cysts form when bacteria are trapped in the pores, leading to inflammation. They appear as lumps on the skin and are often painful to the touch. When left untreated, cystic acne can leave permanent acne scars on the skin’s surface.

Why do I keep getting acne vulgaris?

Acne vulgaris occurs when the pores become clogged with oil, dead skin cells, and debris, leading to red bumps on the skin’s surface. Several risk factors can lead to the continued prevalence of acne vulgaris, including:

• Changes in hormone levels associated with puberty or pregnancy
• Medications such as corticosteroids, lithium, or testosterone
• Family history of acne breakouts
• A diet that is high in carbohydrates, sugars, and dairy may also contribute to acne breakouts.
• Stress can worsen active breakouts

How to get started with acne vulgaris treatment today?

Acne vulgaris is a skin condition that affects as many as 50 million Americans annually, making it one of the most common skin conditions. While acne breakouts are typically associated with adolescence, they often persist or develop in adulthood. With so many over-the-counter treatment options, breakouts can be challenging to treat on your own. Luckily, many professional treatment options are available at Dr. Green’s private dermatology office, including topical treatments, such as topical retinoids, topical antibiotics, and oral antibiotics, such as tetracycline, doxycycline, and minocycline; and hormonal agents, such as oral contraceptives and spironolactone. Research has shown that the best way to combat acne vulgaris is to take a combination approach, combining various topical and oral therapies for smooth, clear, bright skin. With many treatment options to choose from, it can be difficult to know which treatments will be best for you, which is why the best first step for acne vulgaris treatment is to schedule an appointment with expert dermatologist Dr. Michele Green.

Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive treatment options, including for acne vulgaris. Dr. Green takes a holistic approach and embraces a less-is-more philosophy, creating customized skincare routines and treatment plans that cater to the unique concerns and aesthetic goals of her patients. She is consistently identified as one of New York’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her dedication to her patients and expertise. Please call us at 212-535-3088 or email our New York City-based office today to schedule a consultation with Dr. Michele Green and get started with your personalized acne treatment.