Acne is a chronic inflammatory disorder of the pilosebaceous unit, meaning the hair follicle and its associated sebaceous gland. It manifests as comedones, papules, pustules, nodules, or cysts. It commonly begins in adolescence but can persist into adulthood. Because it affects hair follicles, acne tends to occur on the face, neck, chest, and back. Its prevalence and persistence make it one of the most commonly encountered skin conditions worldwide.
Why Does Acne Develop?
Several interlinked processes underlie acne formation. Increased sebum production driven by androgens contributes to oily skin and follicular clogging. Abnormal follicular keratinization leads to blockage of the follicular opening, forming a microcomedo. Colonization by Cutibacterium acnes within the follicle triggers inflammation through cytokine release and immune cell activation. These combined mechanisms produce visible lesions such as papules or pustules. Effective treatments target one or more of these pathogenic pathways.
How Is Acne Classified by Severity?
Acne is categorized as mild, moderate, or severe based on lesion type, number, and presence of nodules or scarring. Mild acne usually consists of comedones; moderate forms have papules and pustules; severe acne involves nodules or cysts. Classification also considers the psychological effect on patients. Different grading systems exist, which can complicate treatment comparisons.
Can Dermatoscope Detect Acne?
Dermoscopy is a noninvasive, office-based imaging technique that enlarges and illuminates the skin surface and follicular openings, allowing visualization of features that are not apparent to the naked eye. The IBOOLO DE-4100 PRO features four lighting modes: polarized light, non-polarized light, amber polarized light, and UV light. Combined with 10X magnification, it allows excellent visualization of acne’s overall morphology and severity.
What are the Dermoscopic Features of Non-inflammatory Acne?
Non-inflammatory acne lesions show dermoscopic signs that reflect follicular occlusion by keratin and sebum: closed comedones appear as round, whitish or yellowish structureless plugs within follicular openings, while open comedones show brown to dark-brown central plugs with a surrounding perifollicular rim; enlarged follicular openings and keratinous material can be seen as central, well-defined plugs against otherwise normal skin.
What Dermoscopic Signs Indicate Inflammatory Acne?
Inflammatory acne lesions have dermoscopic features that reflect intrafollicular inflammation and vascular reaction: papules typically appear as round, whitish to pale yellow structureless areas with thin brownish or erythematous peripheral rims; pustules show central yellow-white or yellow-brown material with an erythematous halo and may display polymorphous vessels at the periphery; deeper nodules and cysts demonstrate ill-defined borders, heterogeneous coloration and increased vascularity on dermoscopy, consistent with deeper dermal inflammation.
How Does Dermoscopy Help Distinguish Acne From Mimickers?
Under dermoscopy, skin conditions that resemble acne show distinct features that help differentiate them. Malassezia folliculitis typically presents with perifollicular scaling and dotted vessels, without the central keratinous or purulent plugs seen in acne. Rosacea usually demonstrates linear and polygonal vascular networks rather than follicular-centered inflammation. In contrast, acne vulgaris characteristically shows central yellowish or whitish keratin plugs or pus within follicular openings, surrounded by a red inflammatory halo. These dermoscopic differences make it possible to distinguish acne from its clinical mimickers with accuracy and confidence.
What Treatments Are Recommended?
Non-pharmacologic strategies can support acne management but rarely control moderate or severe disease on their own. Gentle cleansing with a mild, non-soap cleanser twice daily helps maintain the skin barrier. Over-washing or harsh scrubbing may worsen inflammation. Non-comedogenic moisturizers and consistent sun protection reduce irritation and pigmentary change. Although basic care can help mild acne, most patients need medical treatments for lasting improvement.
Guidelines recommend a stepwise approach depending on severity. For mild to moderate acne, first-line therapy includes topical agents such as benzoyl peroxide, topical retinoids, topical antibiotics, and azelaic acid. Combination regimens improve efficacy and reduce bacterial resistance. For moderate to severe acne, oral agents like doxycycline or isotretinoin may be indicated. Hormonal therapy is an option for women with androgen-related acne. Treatment plans should balance efficacy with safety, and long-term antibiotic use should be minimized.
How Acne Affects People's Mental Health?
Acne not only affects the skin but also imposes a significant psychological burden on many individuals. Research has consistently demonstrated an increased prevalence of depression, anxiety, lowered self-esteem, and social withdrawal among people with acne. Patients often report embarrassment, dissatisfaction with appearance, and reluctance to engage in social interactions, which may lead to isolation and impaired quality of life. The severity of acne has been shown to correlate with the depth of psychological distress: those with more intense or widespread lesions often experience stronger depressive symptoms, mediated in part through the negative impact on their perceived quality of life. Given these findings, clinicians are encouraged to assess psychological wellbeing alongside dermatologic treatment, and to consider referrals or psycho-support when mental health symptoms are present.