Acne Vulgaris

Acne vulgaris (AV) is a disease of the pilosebaceous unit that causes noninflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring. 

The formation of acne lesions: 

• Alteration of follicular keratinization that leads to comedones 
• Increased and altered sebum production under androgen control (androgens stimulate sebum production via androgen receptors on the sebaceous glands).
• Follicular colonization by Propionibacterium acnes 
• Complex inflammatory responses

Risk factor

• Family history of severe acne 
• Diet (chocolate and dairy consumption) 
• Environmental factors (smoking, occlusive cosmetics, occupational exposures) 
• Hormone-based therapies such as oral contraceptive and anti-androgen medications in women with normal androgen levels

Comedones

Papules and pustules

Cysts and/or Nodules

Reference 

Tan, A. U. et al., 2018,'A review of diagnosis and treatment of acne in adult female patients', Int J Womens Dermatol, vol. 4, no. 2, pp. 56-71.