Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

Dis Mon. 2021 Apr;67(4):101103. doi: 10.1016/j.disamonth.2020.101103. Epub 2020 Oct 9.


Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.

Keywords: Acne; Acne conglobata; Acne excoriée; Acne fulminans; Acne neonatorum; Acne rosacea; Acne vulgaris; Acneiform disorders; Antibiotic resistance; Antibiotics; Emotional sequelae; Hidradenitis suppurativa; Isotretinoin; SAPHO syndrome; Topical retinoids.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Acne Vulgaris / microbiology
  • Acne Vulgaris / pathology*
  • Acne Vulgaris / psychology
  • Acquired Hyperostosis Syndrome / epidemiology
  • Administration, Oral
  • Administration, Topical
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Awareness
  • Benzoyl Peroxide / administration & dosage
  • Benzoyl Peroxide / adverse effects
  • Benzoyl Peroxide / therapeutic use
  • Child
  • Contraceptives, Oral / therapeutic use
  • Dermatologic Agents / administration & dosage
  • Dermatologic Agents / adverse effects
  • Dermatologic Agents / therapeutic use*
  • Diagnosis, Differential
  • Female
  • Hidradenitis Suppurativa / epidemiology
  • Humans
  • Isotretinoin / administration & dosage
  • Isotretinoin / adverse effects
  • Isotretinoin / therapeutic use*
  • Male
  • Propionibacteriaceae / isolation & purification
  • Psychological Distress


  • Anti-Bacterial Agents
  • Contraceptives, Oral
  • Dermatologic Agents
  • Isotretinoin
  • Benzoyl Peroxide

Supplementary concepts

  • Cutibacterium acnes subsp. acnes