Acne Vulgaris: Risk Factors and Diagnosis

Risk Factors

Cosmetics. Skin and hair products that contain oils or dyes can exacerbate acne lesions. Water–based cosmetics are less comedogenic.

Repetitive skin trauma. Rubbing (even with cleansing agents), scrubbing, or occlusive clothing (eg, bra straps, helmets, turtlenecks) can promote inflammatory reactions in the lesions.

Environmental exposures. Humidity and sweating can exacerbate acne. Exposure to certain chemicals (eg, dioxin and other halogenated hydrocarbons) that are found in herbicides and other industrial products can cause severe inflammatory acne and scarring.

Drugs. Certain drugs are likely to cause acne, including corticosteroids, phenytoin, isoniazid, disulfiram, lithium, and B vitamins.

Diet. Milk intake, in particular, has been linked to acne (see Nutritional Considerations).

Climate. Humidity and heavy sweating may lead to acne.

Genetics. Genetics likely plays a role in the manifestation of acne, especially in persistent and late–onset cases.¹

Stress. Stress is believed to be associated with acne exacerbations, but further study is required to establish this connection.

Diagnosis

Acne vulgaris is a clinical diagnosis. History and dermatologic examination are necessary to characterize the distribution and types of acne lesions, and to evaluate underlying medical disorders.

Fever and arthralgia in a patient with severe inflammatory acne suggests acne fulminans, a serious disease that requires immediate treatment with systemic corticosteroids and isotretinoin (see Acne Treatment).

Women with oligomenorrhea should be evaluated for hyperandrogenism, which may occur due to polycystic ovarian syndrome or an androgen–secreting tumor.