title: Acne vulgaris.
abstract: Acne vulgaris is a chronic inflammatory disease - rather than a natural part of the life cycle as colloquially viewed - of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.
authors.affiliation: Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, North Carolina 27104, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Moradi Tuchayi
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany.|Department of Dermatology and Allergology, Ulm University, Ulm, Germany.|Research Group Geriatrics, Charité Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Makrantonaki
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany.|Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Lithuania.
authors.forename: Ruta
authors.initials: R
authors.lastname: Ganceviciene
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany.|Andreas Syngros Hospital, National and Capodistrian University of Athens, Athens, Greece.
authors.forename: Clio
authors.initials: C
authors.lastname: Dessinioti
authors.affiliation: Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, North Carolina 27104, USA.|Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.|Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany.
authors.forename: Christos C
authors.initials: CC
authors.lastname: Zouboulis
mesh_terms: D000152:Acne Vulgaris / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002921:Cicatrix / Q000209:etiology; D018859:Hair Follicle / Q000503:physiopathology; D006801:Humans; D011788:Quality of Life; D012307:Risk Factors; D012627:Sebaceous Glands / Q000378:metabolism; D012629:Sebum / Q000378:metabolism