Zits Acne Vulgaris

Medically reviewed by Dennis A Porto, MD, and The Dermatologists

Common: Almost all teenagers have elements of acne. The most severe cases are usually seen in adolescents aged 17-19 years

  • Often self-diagnosable
  • Symptoms: Inflammatory skin condition, blackheads, whiteheads, pimples and deeper lumps
  • Color: Typically red
  • Location: On the face, neck, chest, back, shoulders and upper arms
  • Treatment: Topical medications, including benzoyl peroxide, antibiotics, retinoids and salicylic acid
ICD-10: L70.0 ICD-9: 706.1


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Acne vulgaris, or simply “acne” is a common, treatable inflammation of the hair follicles and sweat glands.

Almost all teenagers have elements of acne. The most severe cases are usually seen in adolescents aged 17-19 years. Acne occurs equally in both sexes, but men are harder hit than women. The problem usually disappears before the age of 30 years. In women, however, it can last a little longer.

Acne is caused by a combination of three factors. First, due to abnormal maturation of the skin, pores get plugged forming white heads and black heads. Second, these black and white heads can become infected, forming pus bumps. Third, hormones play a role as well because they stimulate the sweat glands. For this reason, many women notice that their acne flares around the time of their period.

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The treatment of acne also relates to these three causative factors. Topical retinoids like Retin-A (tretinoin) and oral retinoids like Accutane (isotretinoin) help with skin maturation. Antibiotics like doxycycline and minocycline pills and clindmaycin lotion help with the infectious component, as do washes like benzoyl peroxide. Birth control pills can help with the hormonal component.

Based on the severity and type of acne, you may be treated with topical medications alone or a combination of topical and oral medications. The most effective medication for acne is Accutane (isotretinoin) and eliminates acne for almost everyone, but requires extensive laboratory monitoring and diligent efforts to prevent pregnancy due to possible birth defects while on this medication.

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Over the counter acne treatments

There are several over the counter acne treatments that you can try without a prescription. The most effective and simple treatment is a daily benzoyl peroxide wash. For the face, I usually recommend benzoyl peroxide 5% wash and for the body I recommend 10% wash. The 10% wash is usually too drying for the face. Also beware that this can bleach clothing and towels when you are drying off. Salicylic acid washes are less effective and mostly just help with black heads and white heads. Moisturizers will help heal any sores you have from acne.

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Acne misconceptions

Acne is not related to hygiene, although there is a stereotype that people with acne have bad hygiene. There isn’t good evidence that acne is related to what you eat. “Natural” and “organic” products are no more helpful than traditional products in treating acne and sometimes can make things worse. “Popping” acne bumps does not make them resolve faster. In fact, a sore will develop which can take weeks to heal or even scar. Acne is not just a temporary cosmetic problem, as we are lead to believe. Instead, longstanding acne can cause scarring of the skin which can be permanent (although your dermatologist can help improve their appearance). Because of the psychological effects of acne and potential for scarring, it is important to treat acne aggressively. Almost all cases of acne should be able to be treated and cleared completely by working closely with your dermatologist.

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A typical acne patient

I’ve had acne pretty much since I was 12 and recently it’s been flaring up and causing unnecessary and annoying breakouts. I went on Doxycycline for about a year and that helped, two years later I’m off of it and my acne seems to be coming back. These pimples are large, long lasting, very itchy and make my face hurt. I wash my face 2-3 times a day with a Mario Bedesco cleanser, toner and moisturizer in the morning, afternoon and night and drink about 3-4 bottles of water a day.

Dermatologist answer
Thank you for sending your case. Based on the information and images of your face this is possibly a ACNE NODULOCYSTICA: In your case the inflammation is quite strong. Red slightly raised spots (papules), pus-filled spots (pustules) and deeper inflamed cysts which may be painful are typical findings. It can affect the face, but also the chest and/or back. This type of acne may lead to scarring. I would therefore strongly recommend that you see a dermatologist in person to receive adequate treatment. Oral treatment with an antibiotic (eg Doxycycline) plus a topical treatment with benzoylperoxide combined with adapalene (Epiduo gel) may help, but isotretinoin (Accutane) is probably necessary in your case.. This type of medication can only be controlled and prescribed by a dermatologist in person. I hope this was to your help. Kind regards.

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Sources:

Merck Manual. Acne Vulgaris. Disponible en: https://www.merckmanuals.com/professional/dermatologic-disorders/acne-and-related-disorders/acne-vulgaris.

American Academy of Dermatology. Acne. Disponible en: https://www.aad.org/media/stats/conditions

Hamilton, Fiona, Josip Car, and Alison Layton. 2009. “10-MINUTE CONSULTATION: Acne Vulgaris”. BMJ: British Medical Journal 339 (7714). BMJ: 237–38. Disponible en: https://www.bmj.com/content/338/bmj.a2738

Assessing effectiveness in acne clinical trials: steps towards a core outcome measure set. Thiboutot DM et al Br J Dermatol. 2019 Oct;181(4):700-706.  

Update in the management of acne in adolescence. Mwanthi M et al. Curr Opin Pediatr. 2018 Aug;30(4):492-498. 

What is new in the pathophysiology of acne, an overview. Dréno B. J Eur Acad Dermatol Venereol. 2017 Sep;31 Suppl 5:8-12.

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