What is acne vulgaris?

By: Dr. Loretta Lanphier, ND, CN, HHP, CH

Acne vulgaris almost everyone at some point in their life. Up to 90% of adolescents, and nearly 25% of adults will experience at least some degree of acne. Acne vulgaris is typified by a variety of blemishes, including blackheads, whiteheads, pimples, cysts, and nodules. It most often occurs on the face, neck, chest, back, shoulders, and upper arms. While not a dangerous condition, acne vulgaris can be painful, disfiguring, and embarrassing. It can also cause both physical and emotional scars. Please read on for more information about the most common types of acne and their causes.

Types of Acne

Acne may manifest itself in numerous ways. Different types of lesions mean different types of acne. The blemishes vary in severity from a simple blackhead to a cyst that can produce deep scarring. If you suffer from acne, your dermatologist or health care provider can help you determine which form of acne you have, and what the best options are for treating it.


A comedone is a sebaceous (oil-producing) gland that has become clogged with debris on the skin such as oil, tiny hairs, or bacteria. An “open” comedone is one that is inflamed below the skin’s surface. The tops of these are usually black, thus they are also called blackheads. A “closed” comedone typically has a whitish appearance and is therefore referred to as a whitehead. Never pick at these blemishes, as they can easily become infected by common skin bacteria like staphylococci and streptococci.


A papule is a small, hard blemish that appears just above the surface of the skin. A grouping of tiny papules and comedones may be difficult to see, but they can be felt on the skin as rough to the touch.


Pustules are round, dome-shaped lesions that are full of pus. Pus is composed of white blood cells, dead skin cells, and bacteria. A pustule may form around a hair follicle, and thus have a hair at its center. Sometimes pustules will turn into cysts.


A macule is actually a healed (or mostly healed) acne blemish. They are typically flat and pink, and very well defined. Macules usually disappear within several weeks or less. If your face has many macules present together, it can produce an inflamed look.


A nodule is similar in appearance to a papule. However, nodules are usually inflamed and they extend deeper into the skin. Nodules can potentially result in permanent tissue damage known as acne scarring. They may also be quite painful.


A cyst is the most severe form of acne lesion. An acne cyst is a sac-like blemish that is filled with pus (white blood cells, dead skin cells, and bacteria). Cysts often occur in conjunction with nodules. A cyst is generally larger than a pustule, and it can be very painful. Cysts may be very inflamed, and they generally extend deep into the skin. Acne cysts often lead to permanent scars.

What Causes Acne Vulgaris?

There are several common factors that can produce acne vulgaris. Here is an overview of the main causes for acne:


Acne vulgaris is usually associated with adolescence, as hormonal shifts during the teen years are a prime factor in the formation of acne. The hormones released during puberty called androgens, stimulate the over production of skin oils from the sebaceous glands. This excess production of oils continues through the teen years, and in some cases into adulthood.

Oil Production

When too much oil is produced in the sebaceous gland, it must find a way of escape. If the opening of the gland is plugged by dead skin cells, bacteria, and other skin debris, the gland will begin to swell under the skin’s surface. This leads to acne lesions.


The bacterium Propionibacterium acnes is very common to our skin. Its presence is normal on healthy skin. However, when a sebaceous gland becomes blocked and oil accumulates under the skin, it often leads to a bacterial infection involving Propionibacterium acnes. This causes inflammation and often produces acne blemishes.


When excess bacteria is present, the immune system responds by sending out an army of white blood cells to battle the invaders. This process is known as chemotaxis, sometimes called “the inflammatory response.” The result is that surrounding tissues become red, swollen, and painful.

About the Author

Loretta Lanphier, ND, CN, HHP, CH is a Doctor of Naturopath, Clinical Nutritionist, Holistic Health Practitioner and Clinical Herbalist in Houston, TX and Founder / CEO of Oasis Advanced Wellness. Under her leadership, Oasis Advanced Wellness is known and respected as one of the leading companies in providing safe and clean hi-tech natural health and wellness solutions. Because of the need for high-end natural and organic skin care products, Dr. Lanphier has developed Lanique Organics, an all-natural skin-care line which promotes natural health for the skin.