Acne Vulgaris

Pathophysiology

Hormonal trigger: Androgens (especially during puberty) stimulate sebaceous glands to produce excess sebum
Follicular hyperkeratinization: Keratinocytes proliferate excessively within the follicle, forming a plug (comedone)
Comedones: Closed (whiteheads) and open (blackheads — dark color from oxidized melanin, not dirt)
Bacterial involvement: C. acnes colonizes the plugged follicle, producing lipases that break down sebum into irritating free fatty acids
Inflammatory cascade: Bacterial byproducts trigger neutrophil infiltration and inflammatory mediator release
Acne conglobata: Severe cystic form with interconnecting abscesses and sinus tracts. Causes significant scarring

Non-inflammatory: Whiteheads (closed comedones) and blackheads (open comedones)
Inflammatory: Red papules, pustules, nodules, and cysts
Common sites: face, upper back, chest, shoulders (high sebaceous gland density)
Pain and tenderness with deep nodular or cystic lesions
Post-inflammatory hyperpigmentation (especially darker skin tones)
Scarring: ice-pick, boxcar, rolling, hypertrophic, or keloid

Acne is NOT contagious: No IPAC concerns beyond standard hygiene
Sudden severe acne in an adult: May indicate hormonal disorder (PCOS, Cushing syndrome) or medication side effect (corticosteroids, lithium)
Cystic acne with interconnecting abscesses: Acne conglobata — refer for dermatology management
Distinguish from rosacea: Rosacea has no comedones. Acne has comedones

Local contraindication: Avoid direct pressure over active inflamed acne (pustules, nodules, cysts) — risk of rupturing lesions and causing pain
Non-inflammatory acne (comedones only): Light massage generally acceptable. Avoid occlusive oils
Lubricant selection: Use non-comedogenic, fragrance-free products. Avoid mineral oil and heavy creams on acne-prone areas
Prone positioning: Use a clean face cradle cover. Consider disposable covers for clients with facial acne
Back acne: Common in athletes and young adults. Avoid deep pressure over active lesions
Scar management: Post-acne scarring may benefit from cross-fiber friction and myofascial techniques once fully healed and mature
Not contagious: No additional IPAC precautions needed

Most common skin condition therapists will encounter in adolescent and young adult clients
Distinguish non-inflammatory (comedones) from inflammatory (pustules, cysts) acne
Active pustular or cystic acne is a local contraindication
Acne is NOT contagious — inflammatory condition, not infection
Distinguish from rosacea (no comedones in rosacea)

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit, not an infection
Driven by excess sebum, follicular plugging, C. acnes colonization, and inflammation
Active inflammatory acne is a local contraindication. Avoid direct pressure over pustules, nodules, and cysts
Use non-comedogenic lubricants on acne-prone skin
Post-acne scarring may benefit from massage once fully healed and mature