Paeds · paediatric-dermatology
Acne vulgaris in adolescents
Also known as adolescent acne · common acne · comedonal acne · inflammatory acne · nodulocystic acne · acne vulgaris · adapalene · tretinoin · benzoyl peroxide · doxycycline · isotretinoin · acne fulminans
A fellowship approach to acne vulgaris in the adolescent: the comedones and the papules and the pustules over the sebum-rich skin of the face and the upper back and the chest that mark the androgen-driven pilosebaceous unit, the four drivers of the sebum and the Cutibacterium acnes and the follicular plugging and the inflammation that the treatment targets, the split between the comedonal and the inflammatory disease that frames the topical retinoid and the benzoyl peroxide and the oral doxycycline, the oral isotretinoin for the nodulocystic and the refractory disease with the pregnancy prevention and the lipid and the liver monitoring, the antibiotic stewardship that never prescribes the monotherapy and always pairs the antibiotic with the benzoyl peroxide, and the psychosocial and the scarring burden that the early and the effective treatment prevents.
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- The sudden onset of the severe ulcerative acne with the fever and the arthralgia and the malaise in the adolescent boy is acne fulminans, the dermatological emergency that demands the systemic corticosteroid first and the low-dose isotretinoin second, never the abrupt isotretinoin or the oral antibiotic alone
- The adolescent whose acne distress meets the hopelessness or the suicidal ideation needs the urgent psychosocial escalation, because the acne itself harms the mood and the untreated severe disease carries the mental-health risk
- The oral isotretinoin is highly teratogenic, and the female adolescent needs the reliable contraception and the negative pregnancy test before the first dose and at every visit, because no exclusion is worth the congenital defect
- The refractory or the treatment-resistant acne in the adolescent girl with the irregular menses and the hirsutism is the polycystic ovary syndrome or the hyperandrogenism until the workup, and it reframes the management toward the combined oral contraceptive and the spironolactone
- The acne that appears before the age of seven or with the clitoromegaly or the rapid growth is the endocrine red flag of the precocious adrenarche or the androgen-secreting tumour, and it needs the paediatric endocrinology referral
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- Dermatology - recognise and grade adolescent acne vulgaris and initiate first-line topical therapy
- Adolescent health - the psychosocial impact of acne and the safety-net for mood and self-harm
- Dermatology - the stepwise pharmacological ladder, antibiotic stewardship, and oral isotretinoin candidacy
- Acute and critical care - acne fulminans as the dermatological emergency requiring corticosteroid-to-isotretinoin management
- Dermatology 10-12
- Adolescent medicine 10-12
- Short Cases
- Long Cases
- 9. Dermatology - acne vulgaris in the adolescent
- 10. Young people's health - the psychosocial and sexual-health context of acne and isotretinoin
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Adolescent Medicine Content - dermatology and the management of acne vulgaris
- Content Outline - Universal Task 3: Physical Examination and Universal Task 5: Patient Management
- Patient Care 5: Patient Management
- Medical Knowledge 2: Conditions common in pediatric and adolescent primary care including acne vulgaris
- Medical Expert
- Pediatrics: Adolescent dermatology applied domain
A fifteen-year-old boy is brought to the general practice by his mother, who has watched his forehead and his cheeks break out over the past year into the blackheads and the red papules and the occasional pustule, with a few deeper lumps now appearing on his jawline. He has become quieter, he has stopped swimming, and he admits the acne bothers him a great deal. On examination the face and the upper back carry the open and the closed comedones, the inflammatory papules, and a few tender nodules, with early atrophic marks over the cheeks. The picture is the moderate inflammatory acne vulgaris of the adolescent, and the plan is the topical retinoid and the benzoyl peroxide at night, the oral doxycycline for three months, the photoprotection, and the clear pathway to the isotretinoin if the nodulocystic disease or the scarring progresses. [2] [12]
Hold the pathogenesis in four words. Sebum — the pubertal androgens switch on the sebaceous gland and the oily output rises. Bugs — the lipophilic Cutibacterium acnes overgrows on the lipid-rich follicle. Block — the follicular keratinocyte sheds abnormally and the microcomedone plugs the opening. Burn — the follicle wall ruptures and the inflammation ignites the papule, the pustule, and the nodule. The comedonal disease is the first three; the inflammatory disease is the fourth. [3] [8]
Overview & Definition
Picture the adolescent skin at moment sebaceous glands wake. Under the pubertal androgen surge, the glands enlarge and pour out the sebum, the hair follicles clog with the retained keratin and the lipid, and the resident Cutibacterium acnes thrives on the feast. The blocked follicle swells into the comedone, and when its wall gives way the immune system meets the follicular contents and the redness and the pus follow. That cascade, playing out over the face, upper back, chest, and the shoulders of the teenager, is acne vulgaris. [3] [8]
Acne vulgaris is the commonest skin disorder of adolescence, and the generalist meets it at every clinic. The definition the fellowship wants is operational rather than abstract: it is the chronic inflammatory disease of the pilosebaceous unit that produces the open and the closed comedones and the inflammatory lesions, on the sebum-rich skin, driven by the four factors of the sebum, organism, plugging, and the inflammation. The severity runs from the few comedones to the confluent nodulocystic disease, and the severity, not the name, governs the treatment. [1] [4]
Why the adolescent focus matters is that the disease, the distress, and the scarring all peak here. The onset tracks the adrenarche and the gonadarche between eleven and thirteen years, and the prevalence climbs to roughly four in five teenagers by the mid-teens. The generalist who recognises the severity, treats early, and escalates in time prevents the permanent scarring and the mood harm that no later treatment fully reverses. [2] [9]
References12ShowHide
- [1]Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris Journal of the American Academy of Dermatology, 2024.PMID 38300170
- [2]Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review JAMA, 2021.PMID 34812859
- [3]Williams HC, Dellavalle RP, Garner S. Acne vulgaris Lancet, 2012.PMID 21880356
- [4]Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne Pediatrics, 2013.PMID 23637225
- [5]Bagatin E, Costa CS. The use of isotretinoin for acne - an update on optimal dosing, surveillance, and adverse effects Expert Review of Clinical Pharmacology, 2020.PMID 32744074
- [6]Costa CS, Bagatin E, Martimbianco ALC, et al. Oral isotretinoin for acne Cochrane Database of Systematic Reviews, 2018.PMID 30484286
- [7]Zhu C, Wei B, Li Y, et al. Antibiotic resistance rates in Cutibacterium acnes isolated from patients with acne vulgaris: a systematic review and meta-analysis Frontiers in Microbiology, 2025.PMID 40535003
- [8]Dréno B, Pécastaings S, Corvec S, et al. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates Journal of the European Academy of Dermatology and Venereology, 2018.PMID 29894579
- [9]Gieler U, Gieler T, Kupfer JP. Acne and quality of life - impact and management Journal of the European Academy of Dermatology and Venereology, 2015.PMID 26059729
- [10]Liu L, Xue Y, Chen Y, et al. Prevalence and risk factors of acne scars in patients with acne vulgaris Skin Research and Technology, 2023.PMID 37357642
- [11]Santer M, Burden-Teh E, Ravenscroft J. Managing acne vulgaris: an update Drug and Therapeutics Bulletin, 2023.PMID 38154809
- [12]Gebauer K. Acne in adolescents Australian Family Physician, 2017.PMID 29464224