Acne Vulgaris

Inflammatory ICD: L70.0

Also known as: Acne, Pimples, Breakouts

Description

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. It is the most common skin condition, affecting up to 85% of adolescents and often persisting into adulthood. Characterised by comedones, papules, pustules, and in severe cases nodules and cysts.

Symptoms

  • Open and closed comedones (blackheads & whiteheads)
  • Inflammatory papules and pustules
  • Nodules and cysts (severe)
  • Post-inflammatory hyperpigmentation
  • Scarring in untreated cases

Causes & Triggers

  • Excess sebum production
  • Follicular hyperkeratinisation
  • Cutibacterium acnes colonisation
  • Hormonal fluctuations (androgens)
  • Genetic predisposition

Severity Classification

Mild Predominantly comedonal with few inflammatory lesions
Moderate Mix of comedones, papules, and pustules over wider area
Severe Widespread inflammatory lesions, nodules, cysts, risk of scarring

Treatment Ladder

  1. 1 Mild: Topical retinoid + benzoyl peroxide
  2. 2 Moderate: Add topical antibiotic (clindamycin) or combination therapy (adapalene + BPO)
  3. 3 Moderate–Severe: Oral antibiotics + topical combination
  4. 4 Severe / Recalcitrant: Oral isotretinoin
  5. 5 Hormonal acne (females): Spironolactone or oral contraceptives

Relevant Compounds

Acetyl Glucosamine

Anti-hyperpigmentation agent — addresses post-inflammatory hyperpigmentation (PIH) commonly following acne lesions

Acetyl glucosamine (N-acetyl-D-glucosamine, NAG) is an amino sugar and the acetylated form of glucos…

Adapalene

First-line topical retinoid — comedolytic and anti-inflammatory

Adapalene is a third-generation synthetic retinoid that selectively binds to RARβ and RARγ receptors…

Alpha Arbutin

Addresses post-inflammatory hyperpigmentation from acne

Alpha arbutin is a biosynthetic glycosylated hydroquinone derivative that inhibits melanin productio…

Azelaic Acid

Anti-bacterial, anti-comedonal, reduces PIH

Azelaic acid is a naturally occurring dicarboxylic acid produced by Malassezia furfur. It has antiba…

Bakuchiol

Anti-comedonal and anti-inflammatory — regulates cell turnover and reduces inflammatory lesions without retinoid-associated irritation

Bakuchiol is a meroterpene (terpenoid phenol) isolated from the seeds and leaves of Psoralea corylif…

Benzoyl Peroxide

Bactericidal — reduces C. acnes without resistance

Benzoyl peroxide is a potent bactericidal agent widely used in the treatment of acne vulgaris. It is…

Capryloyl Glycine

Sebum regulator and antimicrobial — inhibits 5α-reductase to reduce sebum production, disrupts C. acnes cell membranes, and acidifies skin pH to impair bacterial colonization

Capryloyl glycine is a lipoamino acid formed by the conjugation of caprylic acid (octanoic acid, C8)…

Centella Asiatica Extract

Anti-inflammatory — reduces post-acne erythema and supports wound healing of acne lesions

Centella asiatica is a herbaceous plant used for centuries in Ayurvedic and traditional medicine. It…

Clindamycin

Topical antibiotic — anti-bacterial and anti-inflammatory

Clindamycin is a lincosamide antibiotic effective against gram-positive bacteria, particularly Cutib…

Glycolic Acid

AHA — chemical exfoliation and pore refinement

Glycolic acid is the smallest alpha hydroxy acid with the greatest bioavailability due to its low mo…

Green Tea Extract

Anti-inflammatory and antioxidant adjunct

Green tea extract is derived from the leaves of Camellia sinensis. It is rich in polyphenols called …

Jojoba Oil

Non-comedogenic emollient — wax ester structure is not hydrolyzed by C. acnes lipases, provides moisture without pore occlusion, and may help regulate excess sebum production

Jojoba oil is a liquid wax ester extracted from the seeds of the jojoba shrub (Simmondsia chinensis)…

Lactic Acid

Exfoliant — promotes desquamation and reduces comedone formation

Lactic acid is an alpha hydroxy acid (AHA) with a larger molecular weight (90.08 Da) than glycolic a…

Linoleic Acid

Corrects linoleic acid deficiency in sebum — reduces oleic acid ratio, decreases comedone formation and follicular hyperkeratinization

Linoleic acid is an essential omega-6 polyunsaturated fatty acid (PUFA) that cannot be synthesized e…

Niacinamide

Sebum regulation and anti-inflammatory

Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…

Phytosphingosine

Antimicrobial and anti-inflammatory — inhibits P. acnes growth and reduces inflammatory cytokine production

Phytosphingosine is a sphingoid base naturally present in the stratum corneum, where it serves as a …

Piroctone Olamine

Antifungal for Malassezia folliculitis — effective against pityrosporum folliculitis (fungal acne) by targeting Malassezia species colonizing hair follicles

Piroctone olamine (trade name Octopirox) is a second-generation hydroxypyridone antifungal agent wid…

Retinol

OTC retinoid — milder alternative to tretinoin

Retinol is an over-the-counter retinoid and a precursor to retinoic acid (tretinoin). It must be con…

Salicylic Acid

Comedolytic BHA — unclogs pores and reduces sebum

Salicylic acid is a lipophilic beta hydroxy acid with keratolytic, comedolytic, and mild anti-inflam…

Tea Tree Oil

Antimicrobial agent against C. acnes

Tea tree oil is a volatile essential oil derived from the Australian plant Melaleuca alternifolia. I…

Tretinoin

Potent retinoid — normalises keratinisation

Tretinoin is a first-generation retinoid derived from vitamin A. It is one of the most extensively s…

Vitamin C

Anti-inflammatory and post-acne pigmentation reduction

Vitamin C is a potent water-soluble antioxidant essential for collagen synthesis. In topical skincar…

Witch Hazel Extract

Astringent and mild antimicrobial — reduces sebum, tightens pores, and provides bacteriostatic activity against C. acnes via tannins and gallic acid

Witch hazel extract is derived from the bark and leaves of Hamamelis virginiana, a North American sh…

Zinc Oxide

Non-comedogenic UV filter with antimicrobial and anti-inflammatory properties — suitable for acne-prone skin photoprotection

Zinc oxide is an inorganic (mineral) broad-spectrum UV filter that provides protection against both …

Zinc PCA

Sebum control and mild antimicrobial

Zinc PCA is the zinc salt of pyrrolidone carboxylic acid (PCA), a natural component of the skin's Na…

Recommended Drugs

BenzaClin Combination antibiotic + BPO for inflammatory acne Differin First-line OTC retinoid gel (adapalene 0.1%) Doxt-SL Oral tetracycline antibiotic for moderate-to-severe inflammatory acne Epiduo Fixed-dose adapalene + benzoyl peroxide combination Isotroin Oral isotretinoin for severe and recalcitrant acne Kenacort Intralesional steroid for large cystic acne nodules Minoz Second-line oral tetracycline for acne when doxycycline fails Retin-A Prescription tretinoin for moderate–severe comedonal acne Tretiva Oral isotretinoin for severe acne Tricort Intralesional steroid for cystic acne

Suggested Cosmetics

A-Ret Tretinoin Gel 0.05% Prescription tretinoin gel for comedonal and inflammatory acne Acnelak CL Gel (Clindamycin 1% + Nicotinamide 4%) Clindamycin + nicotinamide gel for inflammatory acne Aczone Gel (Dapsone 5%) Topical dapsone for inflammatory acne, especially in adult women Adaferin Forte Adapalene 0.3% Gel High-strength retinoid for moderate-to-severe acne AHAGlow Advanced Face Wash Gel AHA cleanser for comedonal acne and post-acne marks Aklief Trifarotene Cream 0.005% Fourth-generation retinoid for facial and truncal acne Aziderm Cream (Azelaic Acid 20%) Azelaic acid for inflammatory acne and PIH Bioderma Sébium Global Intensive Purifying Care Multi-target acne serum (AHA + BHA + zinc) Brevoxyl Cream (Benzoyl Peroxide 4%) Bactericidal benzoyl peroxide for inflammatory acne CeraVe Foaming Facial Cleanser Non-comedogenic ceramide cleanser safe during acne therapy CeraVe Resurfacing Retinol Serum Retinol for post-acne marks and resurfacing Cetaphil Gentle Skin Cleanser Gentle cleanser safe during tretinoin/adapalene therapy Cetaphil Sun SPF 30 Sunscreen Light Gel Light gel sunscreen suitable during acne therapy Cetaphil Sun SPF 50 Sunscreen Light Gel Light gel sunscreen suitable during acne therapy Chemist at Play 5% AHA + 1% BHA Body Lotion Body acne — exfoliating lotion for trunk/back acne Cipla Acnelak Z SPF 50 Sunscreen Zinc-based anti-acne sunscreen Cipla Excela Moisturiser Non-comedogenic moisturiser for acne-prone skin Clindac A Gel (Clindamycin 1%) Topical clindamycin for inflammatory acne lesions Cos-IQ 10% Niacinamide Face Serum Niacinamide for oil control and acne marks Cos-IQ 20% Niacinamide Face Serum High-dose niacinamide for severe oil control COSRX Aloe Soothing Sun Cream SPF 50+ PA+++ Gentle non-greasy sunscreen for acne-prone skin Deconstruct 5% Niacinamide Serum + 2% Alpha Arbutin Niacinamide controls sebum and fades post-acne marks Deconstruct Gel Sunscreen SPF 50 PA++++ Lightweight non-comedogenic gel sunscreen for acne-prone skin Deconstruct 10% Niacinamide Serum with 0.3% Alpha Arbutin Niacinamide controls sebum and reduces acne marks Deconstruct Pore Control Serum — 2% Salicylic Acid + 3% Niacinamide SA + niacinamide for comedonal and inflammatory acne Deconstruct Vitamin C Serum — 10% Vitamin C + 0.5% Ferulic Acid Post-acne mark reduction Deriva CMS Gel (Adapalene 0.1% + Clindamycin 1%) Fixed-dose adapalene + clindamycin for moderate acne The Derma Co AHA BHA 10% Face Peel Weekly AHA+BHA peel for comedonal acne and marks The Derma Co 1% Hyaluronic Sunscreen Oil-Free Matte Gel SPF 50 PA++++ Oil-free matte sunscreen with Niacinamide and Zinc PCA for acne-prone skin The Derma Co 2% Kojic Acid Face Serum with Alpha Arbutin Reduces post-inflammatory hyperpigmentation The Derma Co 10% Niacinamide Face Serum Sebum regulation and pore refinement for acne The Derma Co Pore Minimizing Face Serum Pore clearing and sebum regulation The Derma Co Pore Minimizing Priming Sunscreen SPF 50 PA+++ Niacinamide-enriched pore-minimizing sunscreen for acne-prone skin The Derma Co Sali-Cinamide Anti-Acne Face Serum BHA + niacinamide for anti-acne action and post-acne marks The Derma Co 2% Salicylic Acid Face Serum 2% SA + willow bark for comedonal acne Dot & Key CICA Calming Mattifying Sunscreen SPF 50 PA++++ CICA + Niacinamide matte sunscreen for acne-prone skin Dot & Key 10% Niacinamide + Strawberry Brightening Face Serum Niacinamide regulates sebum and reduces inflammation Dot & Key 2% Salicylic Acid + Cica Anti Acne Serum Salicylic acid + zinc PCA + niacinamide for comprehensive acne treatment Dot & Key 10% Vitamin C + E Serum with 5% Niacinamide Niacinamide for post-acne mark reduction Dr. Sheth's Gulab & 6% Glycolic Acid & 5% Niacinamide Brightening Serum AHA exfoliation for acne marks Ekran Soft SPF 50+ Silicone Sunscreen Silicone-based matte sunscreen for acne-prone skin Episoft AC Moisturiser with SPF 30 Non-comedogenic moisturiser with SPF for acne patients on retinoids Episoft AC SPF 50+ Sunscreen Sebum-controlling sunscreen designed for acne-prone skin Fixderma Reticuram Retinol Serum OTC retinol as adjunct to acne regimen Fixderma 2% Salicylic Acid Serum with 5% Azelaic Acid & 4% Mandelic Acid Triple acid formula for comprehensive acne treatment Fixderma Shadow Sunscreen SPF 50+ Gel PA+++ Lightweight gel sunscreen for acne-prone skin Foxtale 5% Niacinamide Face Serum Niacinamide regulates sebum and reduces acne marks Foxtale 15% Vitamin C + E + Ferulic Acid Serum Post-acne hyperpigmentation reduction Garnier Super UV Invisible Serum Sunscreen SPF 50 PA++++ Lightweight serum sunscreen with salicylic acid derivative Glyco-A Peel (Glycolic Acid 35%/50%/70%) Professional glycolic acid peel for comedonal acne Heliocare 360 Gel Oil-Free SPF 50 Oil-free gel sunscreen for acne-prone skin Himalaya Purifying Neem Face Wash Herbal antibacterial cleanser Himalaya Purifying Neem Face Serum with 2% Natural Salicylic Acid Neem + natural salicylic acid for acne treatment Hyphen Brightening Face Serum 5% Niacinamide + 1% Alpha Arbutin Niacinamide for oil control and post-acne marks IPCA Sunban Ultra SPF 30 PA+++ Gel Non-comedogenic sunscreen during acne therapy Isotroin Gel (Isotretinoin 0.05%) Topical isotretinoin for mild-to-moderate acne Jessner's Solution Peel (Lactic + Salicylic + Resorcinol) Superficial combination peel for acne and acne marks Joy Revivify Vitamin C Sunscreen SPF 50 PA++++ Affordable matte sunscreen for acne therapy La Roche-Posay Effaclar Duo (+) Anti-Acne Moisturiser Premium anti-acne moisturiser with SA + niacinamide La Shield Fisico Matte Sunscreen Gel SPF 50+ PA+++ Non-comedogenic mineral sunscreen safe during acne therapy Lacto Calamine 10% Niacinamide Face Serum Niacinamide for oil control and acne marks Lacto Calamine 2% Salicylic Acid Face Serum Salicylic acid for pore clearing and acne treatment Lakme Lumi Smooth Serum with 8% AHA-BHA-PHA+ Complex AHA + BHA for exfoliation and pore clearing Lakme Sun Expert 1% Nia C Water-Light Sunscreen Gel SPF 50 PA++++ Lightweight gel sunscreen with Niacinamide for acne-prone skin Lakmé Sun Expert Ultra Matte SPF 50 PA+++ Gel Sunscreen Matte-finish sunscreen for oily skin L'Oreal Paris Glycolic Bright 8% Face Serum AHA exfoliation for post-acne marks Lotus Herbals Safe Sun UV Screen Matte Gel SPF 50 PA+++ Matte sunscreen for oily acne-prone skin Mamaearth Skin Correct Face Serum with Niacinamide & Ginger Niacinamide for oil control and blemish reduction Mamaearth Rice Water Dewy Active Serum with 10% Niacinamide Niacinamide for oil control and acne marks Mamaearth Tea Tree Face Wash Tea tree and neem-based antibacterial cleanser Mamaearth Vitamin C Toner Glycolic acid toner for pore refinement mCaffeine Latte Coffee Face Wash Gentle daily cleanser for acne-prone skin Minimalist 2% Alpha Arbutin Serum + Hyaluronic Acid Addresses post-inflammatory hyperpigmentation from acne Minimalist Cream Sunscreen SPF 50 PA++++ Niacinamide-enriched non-greasy sunscreen during acne therapy Minimalist Light Fluid Sunscreen SPF 50 PA++++ Lightweight fluid sunscreen suitable during acne therapy Minimalist 10% Niacinamide Face Serum Sebum control and pore refinement Minimalist 2% Salicylic Acid Serum OTC salicylic acid for mild comedonal acne Minimalist SPF 50 PA++++ Sunscreen Lightweight non-greasy sunscreen during acne therapy Minimalist 3% Tranexamic Acid Serum Reduces post-inflammatory hyperpigmentation Minimalist 10% Vitamin C Face Serum with Ethyl Ascorbic Acid Reduces post-inflammatory hyperpigmentation Nadoxin Cream (Nadifloxacin 1%) Topical fluoroquinolone for inflammatory acne with lower resistance risk Neutrogena Ultrasheer Age Shield Fluid Sunscreen SPF 50+ PA++++ Lightweight non-comedogenic sunscreen during acne therapy Neutrogena Ultra Sheer Dry-Touch Sunblock SPF 50+ PA+++ Non-greasy sunscreen for acne patients on retinoids Pernex AC Gel (Benzoyl Peroxide 5% + Clindamycin 1%) Combination BPO + clindamycin for inflammatory acne Pilgrim 25% AHA + 2% BHA + 5% PHA Peeling Solution AHA + BHA for deep exfoliation and pore clearing Pilgrim 10% Niacinamide Face Serum Niacinamide + salicylic acid + zinc PCA for comprehensive acne treatment Pilgrim 0.5% Retinol + Vitamin C Serum Retinol for comedowns and cell turnover Pilgrim 10% Vitamin C Face Serum Niacinamide + glycolic acid for post-acne marks Plum 5% Niacinamide & Rice Water Beginner Friendly Face Serum Niacinamide regulates sebum and reduces inflammation Plum Green Tea Pore Cleansing Face Wash Gentle cleanser with AHA + antioxidants Plum 10% Niacinamide Serum with Rice Water Sebum control and blemish reduction Plum SPF 50 PA++++ Sunscreen with 2% Niacinamide Niacinamide sunscreen for acne-prone skin Plum 2% Encapsulated Salicylic Acid Face Serum Salicylic acid unclogs pores and reduces acne lesions Plum 15% Vitamin C Serum with Mandarin Post-acne mark reduction POND'S Serum Boost Sunscreen SPF 50 PA+++ Gel sunscreen with Niacinamide for acne-prone skin Pond's Super Light Gel Oil-Free Moisturiser with Hyaluronic Acid + Vitamin E Oil-free gel moisturiser for acne-prone skin RE'EQUIL Oil Free Aquagel Sunscreen SPF 50+ PA++++ Oil-free non-comedogenic sunscreen for acne-prone skin Re'equil Ultra Matte Dry Touch Sunscreen Gel SPF 50 PA++++ Matte non-greasy sunscreen safe during acne treatment SalPeel (Salicylic Acid 20%/30%) BHA peel for oily/acne-prone skin — penetrates pores Skinoren Gel (Azelaic Acid 15%) Azelaic acid for mild-to-moderate acne Suganda White Lotus Moisturiser with 5% Niacinamide Oil-control moisturiser with niacinamide Suncros Matte Finish Soft Lotion SPF 50+ PA+++ Non-comedogenic mineral sunscreen during acne therapy Sunprotek Sunscreen Gel SPF 50 PA++++ Gel sunscreen suitable during acne therapy SunScoop 3% Niacinamide Fluid Sunscreen SPF 50+ PA++++ Niacinamide fluid sunscreen for acne-prone skin Supatret C Gel (Clindamycin 1% + Tretinoin 0.025%) Fixed-dose tretinoin + clindamycin for moderate-to-severe acne Tazret Tazarotene Cream 0.05% Potent retinoid for resistant comedonal and inflammatory acne TCA Peel (Trichloroacetic Acid 15–35%) TCA CROSS for ice-pick acne scars The Ordinary Niacinamide 10% + Zinc 1% Sebum regulation and anti-inflammatory for acne Tvaksh Face Guard Silicone Sunscreen Gel SPF 50 PA+++ Non-comedogenic silicone sunscreen during acne treatment UV Doux Gold Silicone Sunscreen Gel SPF 50 PA+++ Silicone-based matte sunscreen for acne-prone skin UV Doux Silicone Sunscreen Gel SPF 50 PA+++ Silicone-based matte sunscreen for acne-prone skin VLCC 10% Azelaic Acid Serum Anti-inflammatory and anti-comedonal for mild-moderate acne WOW Skin Science Vitamin C Serum Post-acne hyperpigmentation reduction Yellow Peel (Retinol 5% + Lactic + Ascorbic) Retinol peel for post-acne marks

Lifestyle Tips

  • Use non-comedogenic skincare and makeup products
  • Cleanse twice daily — avoid harsh scrubbing
  • Apply sunscreen daily (SPF 30+) especially with retinoids or AHAs
  • Avoid picking or squeezing lesions to minimise scarring
  • Consider dietary review — some patients benefit from reducing dairy or high-GI foods

When to Refer

  • Severe nodulocystic acne requiring isotretinoin
  • Acne not responding to 3 months of topical therapy
  • Significant scarring or psychological distress
  • Suspected hormonal acne in females needing endocrine workup