Acne

Acne vulgaris is a multifactorial chronic inflammatory disease of the pilosebaceous unit, predominantly affecting adolescents but often persisting into adulthood. It is primarily driven by four key factors: increased sebum production, abnormal follicular keratinization, colonization by Cutibacterium acnes (formerly Propionibacterium acnes), and a subsequent inflammatory response. Hormonal fluctuations, particularly elevated androgens, stimulate sebaceous gland activity and are often responsible for acne flares. Environmental triggers such as high humidity, cosmetic occlusion, and psychological stress may also exacerbate the condition. Diet, especially high glycemic index foods and dairy, has been shown to influence acne severity through increased insulin and IGF-1 levels. Disruption in skin microbiome diversity is also being increasingly recognized as a contributing factor. Additionally, genetic predisposition plays a significant role in the development and persistence of acne.
Modern therapeutic approaches focus on reducing inflammation, normalizing keratinocyte shedding, regulating sebum production, and targeting bacterial overgrowth. Topical agents such as retinoids (adapalene, tretinoin), benzoyl peroxide, and salicylic acid remain first-line treatments for mild to moderate acne. Inflammatory lesions may require topical antibiotics like clindamycin or erythromycin, often combined with benzoyl peroxide to prevent resistance. For severe or nodulocystic acne, oral isotretinoin is the most effective monotherapy, with long-term remission in many patients. Hormonal treatments, including combined oral contraceptives or spironolactone, are beneficial for hormonally driven acne in females. Adjunctive treatments such as chemical peels, laser therapy, blue light, and photodynamic therapy are also used. Long-term management should include non-comedogenic skincare, sunscreen use, and strategies to maintain the skin barrier and prevent recurrence.