In Switzerland, acne is managed by dermatologists. Acne vulgaris is the most common skin disease in humans, driven by four overlapping problems inside the pilosebaceous follicle: excess sebum production under androgen control, hyperkeratinization of the follicular lining, overgrowth of Cutibacterium acnes biofilms, and the inflammatory cascade that follows. It affects roughly 85% of people aged 12 to 24 and persists into adulthood for about 12% of women and 3% of men, with the Global Burden of Disease study ranking it the eighth most prevalent disease worldwide and the leading skin disease by years lived with disability.

Acne vulgaris (ICD-10: L70.0) is a chronic inflammatory disorder of the pilosebaceous unit, the follicular structure that bundles a hair shaft with a sebaceous gland. Four interacting mechanisms produce the clinical disease. First, androgens drive enlargement of the sebaceous gland and excess sebum output beginning at adrenarche, around age 7-8. Second, the lining of the follicle becomes hyperkeratinized, with keratinocytes failing to shed normally and plugging the duct, producing the microcomedo that is the precursor of every acne lesion.

The key symptoms of Acne are: Open comedones (blackheads) are small dilated follicular openings filled with oxidized keratin and melanin, most often across the nose, forehead, and chin., Closed comedones (whiteheads) are small flesh-coloured or whitish bumps roughly 1-2 mm wide that lack an opening to the skin surface and feel rough to the touch., Inflammatory papules present as red, tender, raised bumps 2-5 mm in diameter without a visible pus head, lasting 4-10 days each., Pustules are superficial papules topped with a yellow-white pus collection, classically on the forehead and cheeks, that drain or crust within a few days., Nodules are deep, firm, painful lesions larger than 5 mm that sit under the skin surface, last for weeks, and frequently leave atrophic or hypertrophic scars., Cysts and draining sinuses are fluctuant deeper collections that can interconnect under the skin, characteristic of severe nodulocystic acne and almost always scarring without systemic therapy., Post-inflammatory hyperpigmentation produces flat brown or grey-brown marks lingering for months after lesions resolve, more prominent and longer lasting in skin of colour..
Acne is a clinical diagnosis, with no blood or imaging test required to confirm it. A dermatologist or primary-care clinician examines the skin under good light and grades disease in three dimensions: lesion type (comedonal, papulopustular, nodulocystic), severity (mild, moderate, severe, using the Investigator's Global Assessment or Comprehensive Acne Severity Scale), and distribution (face, chest, back). Lesion counts of comedones, inflammatory papules and pustules, and nodules are recorded at baseline and on follow-up. Photographs taken under standardized lighting are useful for tracking response, since visible improvement often lags clinical change. Workup is reserved for atypical presentations. Hormonal evaluation, with serum total and free testosterone, DHEAS, 17-hydroxyprogesterone, prolactin, and LH/FSH, is indicated in women with sudden-onset or treatment-resistant acne accompanied by hirsutism, irregular menses, scalp hair loss, or rapid virilization, especially when polycystic ovary syndrome, late-onset congenital adrenal hyperplasia, or an androgen-secreting tumour is suspected. Pelvic ultrasound is added when PCOS is on the differential. In children under 7, an acne eruption is itself an indication for endocrine evaluation because adrenarche should not have occurred yet. Bacterial swabs are reserved for treatment failure or unusual presentations, mainly to identify gram-negative folliculitis after prolonged antibiotic therapy. Skin biopsy is rarely needed but is performed when the diagnosis is uncertain or when conditions such as acne rosacea, sarcoidosis, lupus miliaris disseminatus faciei, or cutaneous tuberculosis are being considered. The decisive differentials are rosacea (centrofacial flushing and telangiectasia without comedones), folliculitis (monomorphic pustules at follicular orifices, often after antibiotic use or hot-tub exposure), perioral dermatitis (small papules sparing the vermilion border), and hidradenitis suppurativa (recurrent painful nodules and sinuses in flexural areas).
With a guideline-directed regimen, the outlook is excellent for the large majority of patients. Mild and moderate acne typically achieves at least 50% reduction in lesion counts by 12 weeks of consistent topical therapy, and clear or almost-clear skin in 60-75% by 6 months. Combined oral contraceptives and spironolactone produce comparable rates in adult women, with the SAFA trial confirming durable response on spironolactone at 24 weeks. A standard 5-7 month course of oral isotretinoin clears 70-85% of severe nodulocystic patients, with durable remission in roughly 70% at 2 years; about 25-30% need a second course. Scarring is the main long-term complication and is largely preventable with early effective treatment. Most adolescents see active lesions decline through their early twenties, although roughly 12% of women and 3% of men carry persistent or recurrent disease into adulthood, and a smaller proportion experience late-onset disease. Acne carries a measurable psychosocial burden, with evidence linking moderate-to-severe acne to clinically significant depression, anxiety, and suicidal ideation independent of objective lesion counts, and effective skin clearance reliably improves these measures.
Refer to dermatology when moderate or severe inflammatory or nodulocystic acne is present, when scarring has already appeared, when first-line topical therapy has failed at 12 weeks, when isotretinoin is being considered, when hormonal evaluation suggests an underlying endocrinopathy, when post-inflammatory hyperpigmentation is disproportionate to active lesions in skin of colour, and when psychosocial impact is significant regardless of objective severity. Adolescent boys with rapid-onset severe inflammatory acne and adult women with sudden-onset persistent acne benefit from early dermatology review to prevent permanent scarring.
Find specialists →Topical retinoids and benzoyl peroxide produce visible improvement at 4-6 weeks and meaningful reduction in lesion counts by 12 weeks. Oral antibiotic plus topical regimens reduce inflammatory lesions by half in 8-12 weeks; antibiotics are limited to 3-4 months total to reduce resistance. Combined oral contraceptives and spironolactone take 3-6 months to reach peak effect, often with a transient worsening in the first 4-8 weeks. Isotretinoin courses run 5-7 months at 0.5-1.0 mg/kg/day to a cumulative dose of 120-150 mg/kg, with response continuing for up to 4 months after the last dose. Post-inflammatory erythema fades over 3-6 months and hyperpigmentation in skin of colour can take 6-18 months. Atrophic scars are permanent without procedural treatment, which is started only once active acne has been controlled for at least 6-12 months.
Regular exercise is encouraged for its mood, sleep, and metabolic benefits and does not need to be modified for acne. Shower or rinse promptly after sweating, change out of damp sportswear, and avoid leaning helmets, pads, and straps directly on the face for prolonged periods to limit acne mechanica. During isotretinoin therapy, avoid heavy weight-lifting in the first few weeks, when transient muscle aches and creatine-kinase elevations are most common, and stop strenuous exercise if you develop joint pain or unusual muscle weakness.
Look for a board-certified dermatologist with explicit experience prescribing isotretinoin under iPLEDGE (in the United States) or equivalent risk-management programmes, comfort with hormonal therapy in adult women (spironolactone, combined oral contraceptives), and access to in-office procedures such as intralesional steroid, comedone extraction, chemical peels, and scar revision lasers. Skin-of-colour expertise matters: ask whether the clinic stocks lower-strength retinoids and azelaic acid and whether they treat post-inflammatory hyperpigmentation actively. Continuity is high-yield, since acne is a 6-24 month treatment relationship at minimum.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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