Overview
Acne (acne vulgaris) is a chronic inflammatory condition of the sebaceous follicles and is one of the most common skin diseases overall. Adolescents and young adults between 16 and 30 are particularly affected, although the condition can occur at any age. Typical features are comedones as well as inflamed papules and pustules, mainly on the face but also on the back, shoulders and chest. Severity ranges from a few comedones to deep, painful nodules with a risk of scarring. Acne responds well to medical treatment. Because the diagnosis is primarily a visual one, it is particularly well suited to telemedicine: using photos and a video call, the doctor can assess the skin. Following medical assessment, a topical prescription therapy can be initiated and monitored over the long term through regular follow-up appointments. The aim of treatment is to reduce inflammation, prevent new lesions and avoid permanent scarring as far as possible.
Common causes
Acne results from an interplay of several factors. At its core are increased sebum production, a keratinisation disorder of the follicle openings and colonisation with the skin bacterium Cutibacterium acnes, which together promote inflammation. Hormonal influences play a major role: rising androgen levels during puberty explain why acne is most common in adolescence and young adulthood; the menstrual cycle, hormonal changes or stopping hormonal contraceptives can also affect the skin. A family predisposition further increases the risk. In addition, comedogenic cosmetics, mechanical irritation from tight clothing or helmets, heavy sweating and certain medications can worsen acne. The role of diet is still under scientific discussion; in some people, dairy products or foods high in sugar appear to trigger flare-ups. Contrary to a widespread assumption, acne is not the result of poor hygiene.
When to see a doctor
A medical assessment is advisable if over-the-counter skincare products bring no improvement after six to eight weeks, if inflamed pustules are spreading, or if the first scars or dark spots are appearing. You should also seek medical advice if your skin is causing significant emotional distress — the earlier an effective therapy begins, the lower the risk of scarring. Warning signs that should be evaluated promptly include: deep, painful nodules or abscesses, extensively inflamed and hardened areas, sudden worsening despite ongoing therapy, and acne that first appears in adulthood together with menstrual irregularities or increased body hair. If a high fever and pronounced malaise occur together with painful, rapidly progressing skin changes, or if a new preparation is followed by shortness of breath or swelling of the face or throat, call the emergency number 112.