Acne is an inflammatory disease of the sebaceous glands and hair follicles.

The cause is unknown, but factors that may be predisposing are hereditary tendencies, and problems with the androgen-estrogen balance. Acne begins at puberty because androgen secretion is increased in males and females and, in turn, the pilosebaceous glands increase in size and activity. Other factors that may stimulate acne include:

• food allergies,

• vitamin deficiencies,

• endocrine disorders,

• corticosteroid therapy,

• contact with chemicals, and

• psychogenic factors.

The face, neck, and shoulders are the usual sites for acne. Papules, pustules, and comedones (blackheads and whiteheads) are visible with inflamed cysts and nodules causing scarring. Acne is worse in the winter, and improves in the summer possibly due to more sunlight. Menses precipitates outbreaks, and pregnancy may improve or worsen the condition.

Most skin diseases can be diagnosed by physical examination alone. History and lesion distribution also provide clues.

The severity of the lesions determines whether the treatment will be local or systemic. Superficial pustular acne benefits from topical treatments. Occasionally oral antibiotics are needed. If antibiotics are unsuccessful, deep cystic acne may respond well to oral isotretinoin agents; however, there are contraindications to its use (see residuals). Corticosteroid injection into an abscess may be helpful. Surgical incision and drainage may be necessary, but will result in scarring. Dermabrasion for scars has been helpful and, occasionally for women, an oral contraceptive may be tried for at least six months. Before treatment, complete blood count (CBC), cholesterol, triglyceride, and liver function tests should be done, and reassessed every month, except for the CBC.

Many of the oral broad-spectrum antibiotics have side effects related to photosensitivity, candidal vaginitis, esophageal erosion, dizziness, and dryness of the genital mucosa and conjunctiva. There are risks for women associated with taking isotretinoin and pregnancy. The drug is teratogenic and, before therapy is begun, methods of contraception must be in place for at least a month prior to use and for a month after discontinuation. Extensive facial scarring will alter a person's body image concept, and counseling may be needed.

• In the most severe cases, extensive facial scarring may be the predominant residual. If so, consider disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability.

• Consider acne vulgaris pursuant to 38 CFR 4.27 and 38 CFR 4.20, when applicable. Analogous ratings are utilized when a specific disability is not listed in 38 CFR Part 4. Certain hyphenated codes do not necessarily denote analogous ratings – a hyphenated DC may also be used to identify the proper evaluation of a disability or a residual from disease. Diagnostic Codes (DCs) must be carefully selected as a condition specifically listed in the rating schedule may not be rated by analogy, unless otherwise directed (e.g., amyotrophic lateral sclerosis, multiple sclerosis).  When multiple DCs apply to a given disability, consider whether separate evaluations are warranted, and/or which DC will result in the most advantageous outcome for the claimant.

• Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.