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Acne vulgaris

Acne vulgaris · Akné

What it is

Blocked oily follicles colonised by C. acnes; nearly universal in adolescence.

Symptoms & signs

  • Blackheads and whiteheads
  • red papules and pustules
  • cysts and nodules
  • scarring
  • back and chest involvement

🚩 Get help if…

  • call 112 / 911 now Thoughts of self-harm or suicide
  • see a doctor soon Low mood or mood changes while taking isotretinoin
  • see a doctor soon Sudden painful, bleeding lumps with fever or joint pain
  • see a doctor soon Deep, painful cysts that are leaving scars

Where it strikes

Medical treatment

  • Topical retinoid with benzoyl peroxide trials support
  • Antibiotics in a short course — they work and they breed resistance, so not alone and not for months mixed evidence
  • The combined pill or spironolactone trials support
  • Isotretinoin for severe or scarring acne — the one drug that clears it lastingly, and it deforms a fetus, so pregnancy must be excluded trials support
  • Clascoterone cream (Winlevi), a topical anti-androgen — FDA-approved 2020 from age 12
  • Sarecycline (Seysara), a narrow-spectrum tetracycline — FDA-approved 2018 for moderate to severe acne

Natural & lifestyle

  • Gentle non-comedogenic cleansing
  • don't pick
  • low-glycaemic diet and less skim milk (modest evidence)
  • azelaic acid
  • niacinamide
  • sun protection

Emerging & experimental

  • C. acnes phage therapy

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • 5% tea-tree oil gel — one trial found it works like benzoyl peroxide, more slowly and with less irritation mixed evidence
  • Oral zinc — trials show modest benefit mixed evidence
  • Green-tea extract on the skin — small trials early / small studies
  • Toothpaste on spots — irritates; untested anecdotal / traditional

ICD codes