Acne vulgaris (Acme meaning prime of life and vulgus meaning common) is a common inflammatory disorder of the pilosebaceous unit seen primarily in adolescents. It is one of the most common skin diseases affecting the youth. Nevertheless acne is seen worldwide in all age groups from newborn to old age. It affects all ethnicities and races. The clinical manifestations of varying extents and severities pose a challenge to the treating physician. Although the course of acne may be self-limiting even without treatment in some of the affected individuals, the sequelae like scars persist lifelong in many. Despite best of treatment, not infrequently in disease results in significant psychosocial morbidity leading to tremendous stress in the affected individual. With proper understanding of the etiopathogenesis, astute knowledge about the various clinical presentations, and updated data on the therapeutic armamentarium currently available to treat the disease, every person with acne can be assured of the best medicosurgical assistance and better outcome to give the best cosmetic result possible.
EPIDEMIOLOGY
Acne is a disorder seen worldwide. It is a disorder primarily of the teenagers but can be seen even in newborn children and old adults. Apart from genetics, various factors play a role in the onset, course, severity, and response to treatment in an acne patient.
Age and Gender
Acne is, by and large, a disease of the teenagers. However, the age of acne can be from as early as newborn till as old as even 6th decade. The age of onset of acne varies considerably. Acne vulgaris can have its onset even in the prepubertal age and may start as early as 6–8 years of age. In some persons, the onset can be delayed to as late as 20 years of age or even later. It is not uncommon to see acne in the neonate and as a disturbing ailment in adults as late as in their 6th decade. Acne often heralds the onset of puberty and is not until such time is considered as a significant problem. Though more than 85% of adolescents develop acne, not all seek medical attention at an earlier date; may be because of the self-limiting nature of the disease in some if not all. Earlier onset of puberty, obesity, diet, and other lifestyle factors play significant role in earlier onset of the disease in addition to the positive family history. Awareness and recognition of the problem contribute to increased hospital attendance.
Acne most commonly presents between 10 and 13 years of age. There is no major gender difference in the onset and clinical2 manifestation. However, girls have an earlier onset which can be easily attributed to the earlier onset of puberty in girls than in boys.
No ethnic group is exempt from the development of acne and a higher prevalence was observed between 15 and 20 years. With the advancement of age of menarche in girls, so is the age of onset of acne in the female gender. However, the disease severity is more in boys during the late adolescence. Persistence of acne through the third decade is not uncommon. Both persistent and late or onset acne seen more frequently in females. Women with XYY genotype are more prone for such severe forms of acne. A more severe form of acne variant, acne fulminans, is more common in males as against females, which affects males between 13 and 22 years of age.
Based on the age of onset, acne is classified as given in table 1.