Acne in Germany: Symptoms, Causes & Treatment

Acne in Germany: Symptoms, Causes & Treatment | aihealz

§ 02

How you might notice it

Clinical photograph of severe nodulocystic acne with deep painful cysts and scarring on the cheek and jawline — Severe nodulocystic acne with deep cysts and early scarring, an isotretinoin indication. · Credit: James Heilman, MD / Wikimedia Commons · CC BY-SA 4.0

01Open comedones (blackheads) are small dilated follicular openings filled with oxidized keratin and melanin, most often across the nose, forehead, and chin.

02Closed 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.

03Inflammatory papules present as red, tender, raised bumps 2-5 mm in diameter without a visible pus head, lasting 4-10 days each.

04Pustules are superficial papules topped with a yellow-white pus collection, classically on the forehead and cheeks, that drain or crust within a few days.

05Nodules 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.

06Cysts 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.

07Post-inflammatory hyperpigmentation produces flat brown or grey-brown marks lingering for months after lesions resolve, more prominent and longer lasting in skin of colour.

08Post-inflammatory erythema causes flat pink to red marks that follow inflammatory lesions, more visible in lighter skin types and typically fading over 3-6 months.

09Scarring takes atrophic (ice-pick, boxcar, rolling), hypertrophic, or keloidal forms that appear after nodules and cysts and persist long after the active disease.

10Greasy or shiny skin (seborrhoea) reflects high sebum output, which is both a driver and an outward sign of active acne, often concentrated in the T-zone.

11Distribution along the central face, jawline, neck, upper chest, shoulders, and upper back marks out the regions richest in sebaceous follicles.

12Emotional and psychosocial distress is measurable on validated quality-of-life scales (Cardiff Acne Disability Index, Acne-QoL), with severity often disproportionate to the visible burden.

early warning signs

•Persistent oiliness across the forehead, nose, and chin in a child aged 7-10 may signal premature adrenarche and predict moderate-to-severe acne in adolescence
•First crops of closed comedones along the lateral cheeks and forehead in early puberty
•A new ring of inflammatory papules along the jawline and chin in an adult woman, especially with premenstrual flares
•Worsening lesions after starting anabolic steroids, high-dose corticosteroids, lithium, isoniazid, or certain progestin-only contraceptives
•Acne accompanied by hirsutism, irregular menstrual cycles, scalp hair thinning, or rapid weight gain, which warrants workup for PCOS or other androgen excess

● emergency signs

•Sudden ulcerative crusted acne with fever, joint pain, and malaise within 4-8 weeks of starting isotretinoin, suggesting acne fulminans, which requires halting isotretinoin and adding systemic corticosteroids
•Severe rash, mouth or eye sores, peeling skin, or facial swelling on minocycline or doxycycline, which may indicate DRESS or Stevens-Johnson syndrome and requires stopping the drug and emergency care
•Sudden onset of severe headache, vision change, or pulsatile tinnitus while on isotretinoin or tetracycline antibiotics, which may reflect idiopathic intracranial hypertension and requires urgent neurology review
•Right upper quadrant pain, jaundice, or dark urine on oral isotretinoin or oral antibiotics, which suggests possible drug-induced hepatitis warranting same-day liver function tests

§ 03

How it’s diagnosed

diagnosis

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).

Key tests

Clinical examination with lesion count and severity gradingConfirms the diagnosis based on lesion morphology and distribution, grades severity, and selects the appropriate therapy ladder. The Investigator's Global Assessment and Comprehensive Acne Severity Scale are the most widely used scales in clinics and trials.

Standardized photographyTracks response objectively over weeks to months, since patients often perceive less improvement than the photographs reveal. Particularly useful in adult women on hormonal therapy and patients on isotretinoin.

Hormonal panel (total/free testosterone, DHEAS, 17-OH-progesterone, prolactin, LH/FSH)Indicated in women with acne plus hirsutism, irregular cycles, scalp hair thinning, or rapid virilization, and in any pre-pubertal child with acne, to identify PCOS, late-onset congenital adrenal hyperplasia, or androgen-secreting tumour.

Pelvic ultrasoundAdded when PCOS is suspected, to assess ovarian morphology (Rotterdam criteria require two of three: oligo-ovulation, clinical or biochemical hyperandrogenism, polycystic ovaries on imaging).

Bacterial swab and cultureReserved for treatment failure or atypical pustular eruptions to identify gram-negative folliculitis (Klebsiella, Enterobacter, Proteus) that can complicate long-term antibiotic therapy.

Baseline laboratory testing before isotretinoinBefore starting oral isotretinoin, AAD 2024 recommends baseline complete blood count, fasting lipid panel, and liver function tests, with repeat lipids and LFTs at 2-month intervals while on therapy. Routine creatine kinase and inflammatory markers are not required.

Pregnancy testing (women of reproductive potential on isotretinoin)Mandatory monthly serum or urine pregnancy testing throughout isotretinoin therapy plus 1 month after, with two reliable contraceptive methods, under the US iPLEDGE risk-management programme.

Skin biopsyPerformed only when the diagnosis is uncertain, when treatment-resistant lesions look atypical, or when conditions such as sarcoidosis, lupus miliaris disseminatus faciei, or cutaneous tuberculosis are being considered.

Outlook

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.

§ 05

Causes & risk factors

known causes

Androgen-driven sebum overproduction: Testosterone is converted to the more potent dihydrotestosterone by 5-alpha-reductase inside the sebaceous gland. DHT stimulates sebocyte proliferation and lipid output. Sebum quantity correlates with disease severity, and patients with complete androgen insensitivity do not develop acne.
Follicular hyperkeratinization and microcomedo formation: Keratinocytes lining the infundibulum fail to shed normally, clumping with corneocytes and sebum to form the microcomedo, the universal precursor of every acne lesion. Retinoids correct this step, which is why they form the backbone of nearly all treatment regimens.
Cutibacterium acnes biofilm and inflammatory phylotypes: Cutibacterium acnes is part of the normal skin microbiome, but specific virulent phylotypes (notably IA1) form biofilms inside the obstructed follicle, secrete lipases and porphyrins, and activate innate immunity through Toll-like receptor 2 and the NLRP3 inflammasome (Dreno JEADV 2018).
Innate and adaptive inflammation (IL-1 beta, IL-17, TNF): Inflammation begins before the visible lesion appears, with peri-follicular IL-1 beta and CD4 T-cell infiltrates detectable around clinically normal-looking skin in acne patients. IL-17-mediated Th17 responses drive the chronicity that distinguishes acne from a transient follicular infection.
Insulin and IGF-1 signalling and dietary factors: Hyperinsulinaemia and elevated insulin-like growth factor 1 stimulate the mammalian target of rapamycin complex 1 (mTORC1), increasing sebocyte lipogenesis and follicular keratinocyte proliferation. High-glycaemic-load diets and skim-milk intake have been linked in cohort studies to acne severity, though effect sizes are modest.
Hormonal disorders and exogenous hormones: Polycystic ovary syndrome, congenital adrenal hyperplasia, Cushing syndrome, and androgen-secreting tumours can all present with acne. Anabolic steroids, high-dose corticosteroids, danazol, and certain progestin-only contraceptives also precipitate or worsen disease.
Medications and external triggers: Lithium, isoniazid, phenytoin, EGFR inhibitors (acneiform eruption), high-dose B vitamins, and certain Chinese herbal supplements containing exogenous corticosteroids can mimic or exacerbate acne. Pomades, comedogenic cosmetics, and chronic occlusion from helmets, masks, or sports gear cause acne mechanica.
Genetic predisposition: Twin studies estimate heritability for acne at around 80%. Family history in a first-degree relative roughly doubles personal risk and predicts more severe and persistent disease. Specific susceptibility loci identified in genome-wide association studies map to inflammatory and androgen-pathway genes.

risk factors

Adolescence (ages 12-24)non-modifiable: Puberty triggers a 10-fold rise in adrenal and gonadal androgens; nearly 85% of adolescents are affected to some degree, and severity peaks at ages 14-19.
Family history of moderate-to-severe acnegenetic: Heritability is approximately 80% in twin studies. A parent or sibling with severe or scarring acne roughly doubles personal risk and predicts more severe and persistent disease.
Female sex in adulthoodnon-modifiable: Adult-onset and persistent acne affect women three to four times more often than men, with jawline distribution and premenstrual flares characteristic.
Polycystic ovary syndrome and hyperandrogenismmodifiable: Up to 50% of women with PCOS have acne; screening for PCOS is warranted in women with acne plus hirsutism, irregular cycles, or scalp hair thinning, because treating the underlying disorder improves the skin.
High-glycaemic-load diet and skim milkmodifiable: Randomized trials of low-glycaemic-load diets show modest improvements in lesion counts. Observational data link skim-milk and whey-protein intake to higher acne prevalence, likely via insulin and IGF-1 signalling.
Anabolic steroids, corticosteroids, and certain medicationsmodifiable

§ 06

Living with it

01Start a topical retinoid plus benzoyl peroxide at the first sign of comedones in early adolescence, since earlier treatment prevents progression to inflammatory and scarring disease

02Switch comedogenic cosmetics, pomades, and hair products to non-comedogenic, oil-free formulations and avoid heavy occlusive sunscreens on acne-prone areas

03Reduce dietary glycaemic load and skim-milk intake where appetite and culture allow, a modest evidence base but reasonable for patients motivated to try

04Review prescription and over-the-counter medications for known acne-inducing agents (lithium, isoniazid, anabolic steroids, high-dose corticosteroids, certain progestin-only contraceptives) and substitute where clinically appropriate

05Limit unnecessary face-touching and skin-picking and resist DIY extraction of inflammatory lesions, which deepens lesions and worsens scarring

06Wash twice daily with a gentle non-soap cleanser and lukewarm water, since over-washing and scrubbing strip the barrier and worsen acne

07Use a broad-spectrum non-comedogenic sunscreen (SPF 30+) daily, especially while on retinoids and tetracyclines, both of which raise photosensitivity

recommended foods

•Low-glycaemic-load eating pattern with wholegrains, legumes, vegetables, and lean protein, which lowers insulin and IGF-1, with modest improvement in lesion counts
•Mediterranean-style diet rich in olive oil, vegetables, fish, and nuts, associated with lower acne severity in cohort studies
•Oily fish and other sources of omega-3 fatty acids, with small randomized trials showing modest reductions in inflammatory lesions
•Green tea and other polyphenol-rich beverages, anti-inflammatory and weakly anti-androgenic in small trials
•Adequate water intake to support healthy skin barrier function

foods to avoid

•High-glycaemic-index foods consumed in large quantities, such as white bread, sugary drinks, and refined snacks, linked to higher acne severity in randomized trials
•Skim milk and whey-protein supplements in motivated patients with persistent acne, given an observational link to higher prevalence
•Excessive intake of B12 and B6 supplements, which can trigger acneiform eruptions in susceptible patients
•Crash diets and ketogenic diets that paradoxically raise IGF-1 and worsen acne in some patients
•Anabolic steroids, SARMs, and unregulated bodybuilding supplements, where frequent and severe acne is a hallmark side effect

Living with Acne

Timeline

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.

Lifestyle

01Apply the prescribed regimen consistently, since at least 8-12 weeks of daily use are needed before judging response and stopping early is the leading reason for treatment failure
02Build the topical regimen up slowly: start retinoids every other night for 2 weeks before going nightly, and pair with a fragrance-free moisturizer to manage retinoid dermatitis
03Use a fragrance-free, ceramide-rich moisturizer in the morning and evening, especially while on retinoids, benzoyl peroxide, and isotretinoin, which all dry the skin
04Wear broad-spectrum sunscreen daily; retinoids and tetracyclines both increase photosensitivity, and sun exposure worsens post-inflammatory hyperpigmentation in skin of colour
05Shower and change out of sweaty clothing promptly after exercise to limit acne mechanica on the chest, shoulders, and back
06Manage stress and protect sleep, since both reduce cortisol-driven sebum output and break the stress-flare cycle documented in adolescents and adults
07Track flares in a simple diary with diet, products, menstrual cycle, and medication entries; personal triggers often emerge within a few months
08Discuss vaccination plans, blood donation, and elective surgery timing with the prescribing clinician before starting isotretinoin

Daily management

01Cleanse twice daily with a gentle non-soap cleanser, pat dry, then apply prescribed topicals to the whole affected area, not just to visible lesions
02Apply a fragrance-free non-comedogenic moisturizer in the morning and evening to manage retinoid- and benzoyl-peroxide-induced dryness
03Use a broad-spectrum SPF 30+ sunscreen every morning, especially on retinoids, tetracyclines, and isotretinoin
04Take oral medications at consistent times: tetracyclines with a full glass of water and avoiding lying down for 30 minutes, isotretinoin with a fatty meal to maximize absorption
05Track flares, side effects, and missed doses in a brief diary and bring it to follow-up visits to refine the regimen
06Keep a short-course intralesional steroid or oral antibiotic plan agreed with the clinician for early treatment of new painful nodules

Exercise

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.

§ 08

Frequently asked

Is acne curable?

Acne is not curable in the strict sense because the underlying tendency to oily skin and follicular plugging persists, but it is highly controllable. Mild and moderate acne usually clears or near-clears within 3-6 months of consistent topical therapy. A 5-7 month course of oral isotretinoin produces durable remission in roughly 70% of severe patients at 2 years, with about a quarter needing a second course. Most adolescents see active disease decline through their early twenties.

What causes acne?

Acne is caused by four interacting processes inside the hair follicle: excess sebum production driven by androgens, abnormal shedding of keratinocytes that plugs the follicle, overgrowth of Cutibacterium acnes biofilms, and inflammation through Toll-like receptor 2 and the NLRP3 inflammasome. Genetics set susceptibility (heritability around 80%), and hormones, certain medications, diet, and mechanical occlusion modify expression.

What does the early stage of acne look like?

Early acne presents as small skin-coloured or whitish bumps (closed comedones) and dark-tipped pores (open comedones, or blackheads) across the forehead, nose, and chin in early adolescence. Visible inflammation, red papules and pus-tipped pustules, usually follows within months. Early treatment with a topical retinoid plus benzoyl peroxide at this stage prevents progression to inflammatory and scarring disease.

How is acne diagnosed?

Acne is diagnosed clinically. A dermatologist or primary-care clinician examines the face, chest, and back, counts lesion types, and grades severity using scales such as the Investigator's Global Assessment. Blood tests are reserved for women with sudden-onset or treatment-resistant acne plus hirsutism, irregular cycles, or hair thinning, where polycystic ovary syndrome or other androgen excess is suspected, and for children with acne before age 7.

What is the best treatment for acne?

There is no single best treatment; the right regimen depends on severity and lesion type. Mild comedonal acne responds to a topical retinoid plus benzoyl peroxide. Moderate inflammatory disease usually adds a topical antibiotic in a fixed combination and, when needed, an oral tetracycline for 3-4 months. Adult women often benefit from spironolactone or a combined oral contraceptive. Severe nodulocystic or scarring acne is treated with oral isotretinoin under close monitoring.

How long does acne treatment take to work?

Most topical and oral regimens take 8-12 weeks of consistent daily use before meaningful improvement, and full benefit at 4-6 months. The first 2-4 weeks can actually look worse as deeper lesions surface, and pushing through this period is essential. Isotretinoin courses run 5-7 months, with continued improvement for up to 4 months after the last dose.

Are topical retinoids safe long-term?

Yes. Adapalene, tretinoin, tazarotene, and trifarotene are safe for years of nightly use when paired with sunscreen and moisturizer. Mild redness and peeling are common in the first 4-6 weeks and ease with a slower titration. Tazarotene is contraindicated in pregnancy and pregnancy planning; adapalene is the preferred retinoid for women trying to conceive.

What is isotretinoin and who needs it?

Isotretinoin is an oral retinoid (Accutane, Roaccutane, Absorica, Claravis) that reduces sebum output by 80-90% and addresses all four pathogenic steps of acne. It is indicated for severe nodulocystic acne, scarring acne, treatment-resistant moderate acne, and acne with major psychosocial impact. Typical dosing is 0.5-1.0 mg/kg/day to a cumulative dose of 120-150 mg/kg over 5-7 months. It is a category X teratogen managed under iPLEDGE in the United States.

What is iPLEDGE?

iPLEDGE is the US FDA risk-management programme for isotretinoin, designed to prevent in-utero exposure. Women of reproductive potential need monthly pregnancy tests, two reliable contraceptive methods, and monthly clinic visits to obtain each 30-day prescription. Men and women of non-reproductive potential have a lighter monitoring schedule but still require monthly visits.

Does isotretinoin cause depression?

A causal link has not been established. Large meta-analyses, including population-level pharmaco-epidemiologic studies, have not shown a consistent increase in depression or suicide risk among patients on isotretinoin, and treatment of severe acne typically improves mood scores. Pre-existing mental-health conditions should be monitored throughout the course and any change in mood reported promptly.

Can adults get acne?

Yes. Persistent or late-onset acne affects roughly 12% of women and 3% of men over age 25. Adult female acne is typically distributed along the jawline and chin with premenstrual flares. Hormonal therapy with combined oral contraceptives and spironolactone works particularly well in this group, with the SAFA trial confirming spironolactone's effectiveness at 24 weeks.

Does diet really affect acne?

Diet has a modest but real effect in some patients. Low-glycaemic-load eating patterns reduce lesion counts by 20-30% in randomized trials, and observational data link skim-milk and whey-protein intake to higher acne prevalence. Chocolate, oily food, and individual culprits beyond glycaemic load have weaker evidence. Diet is an adjunct, not a substitute for guideline-directed therapy.

What is hormonal acne and how is it treated?

Hormonal acne is the term used for adult female acne distributed along the jawline, chin, and lower face with premenstrual flares. Treatment options endorsed by the AAD 2024 guideline include combined oral contraceptives with a low-androgenic progestin and spironolactone 50-200 mg daily. Both take 3-6 months to reach peak effect and are often used alongside a topical retinoid.

Can I pop or squeeze my pimples?

No. Squeezing inflammatory papules, pustules, and nodules deepens the lesion, increases the chance of scarring, and prolongs healing. Painful nodules and cysts can be flattened in 48-72 hours with an in-office intralesional steroid injection, which is far safer than self-extraction. Comedone extraction with a sterile loop is performed by clinicians where appropriate.

How do I prevent acne scars?

The single best way to prevent scarring is early effective treatment of inflammatory and nodulocystic acne, escalating to systemic therapy when topical regimens fail rather than waiting for visible scars to appear. Avoid squeezing lesions, treat post-inflammatory hyperpigmentation actively in skin of colour, and use daily sunscreen to prevent darkening. Scar revision lasers and microneedling are used once active acne has been controlled for at least 6-12 months.

Does acne go away on its own?

Most adolescent acne improves through the early twenties as androgen output stabilizes, but waiting it out risks permanent scarring and prolonged post-inflammatory pigmentation, especially in skin of colour. Roughly 12% of women and 3% of men carry persistent or recurrent acne into adulthood. Effective treatment shortens the active phase and prevents long-term complications.

Is acne caused by dirty skin?

No. Acne is driven by hormones, follicular plugging, bacteria, and inflammation, not by surface dirt. Over-washing, scrubbing, and harsh cleansers strip the skin barrier and can worsen acne. Gentle non-soap cleansing twice daily plus a fragrance-free moisturizer is the right cleansing routine for nearly every patient.

Can stress cause acne?

Stress does not cause acne but is a recognized trigger for flares. Cortisol-driven sebum output, sleep disruption, and skin-picking during stressful periods all contribute. Adolescents commonly flare around exam periods. Sleep hygiene, regular exercise, and where indicated cognitive-behavioural support reduce flare frequency in chronic disease.

How much does acne treatment cost?

Generic topical retinoids, benzoyl peroxide, and clindamycin together cost roughly USD 30-80 per month in the US and similar in the UK; in India and other emerging markets, generic topical regimens are widely affordable. Oral antibiotics and isotretinoin generics cost USD 20-150 per month. Brand-name and newer agents (clascoterone, trifarotene, sarecycline, the fixed triple-combination gel) run several hundred dollars per month at US list price, with insurance coverage variable.

Can pregnant women treat acne safely?

Yes, with care. Safe options in pregnancy include topical azelaic acid, topical erythromycin or clindamycin (combined with benzoyl peroxide), and oral erythromycin for severe inflammatory disease. Topical retinoids and tazarotene, oral tetracyclines, isotretinoin, hormonal therapy, and spironolactone are contraindicated. Discuss any regimen with the prescribing clinician early in pregnancy or pregnancy planning.

When should I see a dermatologist for acne?

See a dermatologist for moderate-to-severe inflammatory or nodulocystic acne, any scarring or significant pigmentation, treatment failure after 12 weeks of consistent first-line therapy, suspected hormonal disease, and acne with significant psychosocial impact. Adolescent boys with rapidly progressive severe disease and adult women with sudden-onset persistent acne especially benefit from early specialist review to prevent permanent scarring.

Acne.Care & specialists in Germany

What it is

How you might notice it

How it’s diagnosed

Treatment & cost

Causes & risk factors

Living with it

When to seek help

Related conditions

Easily confused with

Often appears alongside

Types and stages

Living with Acne

Complementary approaches

Patient support resources

Frequently asked

Sources & references

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