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Acne Vulgaris: The Most Common Type of Long-Term Acne

Acne vulgaris is a common, long-lasting inflammatory skin condition that mainly affects the pilosebaceous units—these are the hair follicles and oil (sebaceous) glands. It shows up as different kinds of skin spots, including non-inflamed blackheads and whiteheads, as well as inflamed red bumps, pus-filled spots, and in more severe cases, larger lumps and cysts. If left untreated or if it lasts a long time, acne can cause permanent issues like scarring and dark marks after inflammation.

Acne vulgaris usually appears in areas with lots of oil glands: the face (especially the forehead, cheeks, and chin), the upper chest, the upper back, and the shoulders. These parts tend to produce more oil, making them more prone to blocked pores and inflammation.

This type of acne is most common during the teenage years, typically starting between ages 11 and 13. Boys often get acne during puberty, and it tends to be more severe because of higher levels of male hormones (androgens). Girls usually start earlier but often have milder cases. However, acne vulgaris isn’t just a teenage problem—adult acne is also common, especially in women.

It’s thought that up to 80% of people worldwide will experience acne vulgaris at some point. Despite how common it is, many still see acne as just a cosmetic issue and delay treatment until it becomes severe or leaves lasting marks.

Acne vulgaris develops due to several factors. It starts with the skin producing too much oil, followed by the hair follicles becoming clogged with dead skin cells. These blockages form blackheads or whiteheads. If bacteria like Cutibacterium acnes multiply in these blocked follicles, the body’s immune system reacts, causing inflammation and the development of red bumps and pus spots—classic signs of inflammatory acne.

What Causes Acne Vulgaris?

There isn’t one single cause of acne vulgaris. Instead, it’s a mix of internal and external factors. Knowing what triggers acne can help create better treatment plans and prevent flare-ups.

Genetics: Family history plays a big role. If close relatives had severe acne, you’re more likely to get it too. Studies, including those on twins, show that inherited traits affect oil production and inflammation.
Hormonal changes: The rise in androgens during puberty stimulates oil glands, leading to excess oil. Conditions like polycystic ovary syndrome (PCOS) in women or certain hormone medications can also cause persistent acne.
Bacteria and microbes: While Cutibacterium acnes is a normal skin resident, its overgrowth in blocked pores can trigger inflammation. Other factors like Demodex mites and secondary infections may worsen symptoms.
Skin care mistakes: Using heavy, pore-blocking (comedogenic) products, not cleansing often enough, or irritation from helmets, tight clothing, or masks can all make acne worse.
Environment and lifestyle: Chronic stress, poor sleep, smoking, pollution, and high humidity can affect oil production and how the skin’s immune system works.
Diet: Although research is ongoing, some studies and reports suggest that eating lots of dairy, chocolate, sugar, and refined carbs might contribute to acne in some people. Cutting back on these foods could help, but responses vary from person to person.

How Is Acne Vulgaris Diagnosed?

Diagnosing acne vulgaris is usually straightforward and based on looking at the skin and hearing about the patient’s history. During a consultation, the dermatologist will ask about when the acne started, how it has changed, how severe it is, and any possible triggers like hormones, diet, stress, skincare habits, or medications.

On examination, the types of spots present—blackheads, red bumps, pus spots, or lumps—help determine the acne’s form and severity. If the diagnosis isn’t clear or if there are unusual or isolated spots, dermatoscopy (a close skin examination with a special device) may be used to rule out other skin conditions.

A thorough diagnosis helps classify the acne as mild, moderate, or severe and identifies any underlying causes, allowing for a more personalised treatment plan.

What Does Acne Vulgaris Look Like?

Acne vulgaris usually shows a mix of non-inflamed and inflamed spots. Key features include:

Comedones: These are the earliest acne spots and can be open (blackheads) or closed (whiteheads). Closed comedones are small, raised, and skin-coloured or whitish. Open comedones have a black centre caused by oxidised oil. They’re common on the back and shoulders and can be 5–7 mm across.
Papules: These are inflamed red or pink bumps without visible pus. They’re slightly raised and tender to touch. Usually 1–3 mm wide, the skin around them may look inflamed in more severe cases.
Pustules: These spots contain visible pus and have a yellow or white head. Surrounded by red skin, they’re raised, painful, and may feel firmer than the surrounding area. Pustules can heal on their own or burst, releasing their contents.
Nodules and cysts: Less common but possible in severe acne. These are deep, painful lumps filled with pus or solid tissue that can cause scarring.
Scars: These form when deeper or repeatedly inflamed spots heal. Atrophic scars look like shallow dents, while hypertrophic scars are raised and thickened. The longer and more intense the inflammation, the higher the chance of scarring.
Hyperpigmentation: These are dark brown marks left after acne spots heal. They may fade over time but can last longer, especially on darker skin tones.

Acne vulgaris most often affects the forehead, cheeks, chin, upper back, chest, and shoulders. Acne in other areas is uncommon and might suggest a different condition.

Other Conditions That Can Look Like Acne

To be sure it’s acne vulgaris, dermatologists sometimes need to rule out other skin problems with similar signs, such as:

Rosacea: Especially the type with red bumps and pus spots, which looks like acne but doesn’t have blackheads and may cause flushing and visible blood vessels.
Milia: Tiny white cysts filled with keratin that look like whiteheads but aren’t inflamed.
Perioral dermatitis: Small red bumps around the mouth, often worsened by steroid creams.
Acne-like drug reactions: Caused by medications like corticosteroids, lithium, or isoniazid.
Skin cancers: Rarely, persistent or lump-like spots in adults might be basal cell carcinoma or amelanotic melanoma, so these need to be excluded.

Why Treat Acne Vulgaris?

While acne vulgaris isn’t dangerous, it reflects changes in the body and environment, such as hormone shifts, immune system changes, or metabolism. Ignoring it might delay recognising other health issues.

Acne can also seriously affect mental health. Many people—especially teens and young adults—feel less confident, socially isolated, anxious, or depressed because of their skin. Scars and dark marks can cause long-lasting worries about appearance and quality of life.

Untreated or poorly managed acne can lead to bacterial infections, painful cysts, or abscesses. Picking or squeezing spots increases the risk of injury, infection, and scarring.

When to See a Doctor

Getting early and regular care from a dermatologist helps avoid problems. You should see a specialist if:

Your acne continues past your teenage years or suddenly gets worse as an adult.
Your spots are painful, form lumps, or keep coming back.
Scars or dark marks appear quickly.
Over-the-counter treatments don’t work.

Dermatologists can offer a clear treatment plan tailored to your skin type, acne severity, and lifestyle. It’s also a good idea to have check-ups before big changes like starting hormone therapy, changing your diet or skincare, or moving to a new climate.

How Is Acne Vulgaris Treated?

Treatment should be personalised and usually combines several approaches. The best results often come from using both topical and oral treatments alongside good skincare. Common options include:

Topical treatments: These include benzoyl peroxide, salicylic acid, topical antibiotics like clindamycin, and retinoids such as adapalene or tretinoin. They help reduce inflammation, clear blocked pores, and speed up skin renewal.
Oral treatments: Antibiotics like doxycycline (a tetracycline) are used for moderate to severe acne under medical supervision. Hormonal treatments, such as the contraceptive pill or spironolactone, can help women with hormone-related acne.
Cosmetic procedures: Manual removal of spots, chemical peels, and non-ablative laser treatments can reduce the number of lesions and improve skin texture.
Scar treatment: Laser resurfacing, microneedling, and dermabrasion are options for stubborn scars.
Emotional support: Psychological counselling may benefit those struggling with anxiety or low self-esteem linked to acne.

It’s important to stick with treatments for several months before seeing major improvements. Missing doses, using the wrong products, or stopping early can slow progress and cause acne to return.

How to Help Prevent Acne

While you can’t always stop acne vulgaris, these habits can reduce how often and how badly it flares up:

Keep a steady skincare routine: Use a gentle cleanser twice a day and avoid over-washing or harsh scrubbing.
Pick non-comedogenic products: Choose oil-free, fragrance-free makeup and moisturisers.
Protect your skin from the sun: Use sunscreen with at least SPF 30 daily to prevent inflammation and dark marks.
Eat skin-friendly foods: Cut back on sugary, dairy-rich, and processed foods; eat more fibre, vegetables, and antioxidants.
Manage stress: Stress hormones can trigger breakouts. Regular exercise, meditation, and good sleep help keep skin healthy.
See a dermatologist regularly: Routine check-ups help track progress, avoid complications, and adjust treatment as needed.

With expert advice and consistent self-care, acne vulgaris can be managed effectively, preventing lasting skin damage and helping you feel confident and well.