Acne is a disorder of the hair follicles and sebaceous glands of the skin, manifested by skin lesions; comedones (blackheads or lesions within a dilated opening of a hair follicle), papules, and pustules. This inflammatory condition is usually associated with seborrhea. 

The cause of the condition is unknown. There may be predisposing factors that include hereditary tendencies and possible disturbances in the androgen-estrogen balance. Acne begins at puberty when the oil glands in the skin increase in size. Some additional factors in acne formation include:

• stress;

• endocrine disorders;

• adrenal corticosteroid medications;

• oral contraceptives;

• food allergies;

• vitamin deficiencies;

• contact with certain chemicals; and

• ingestion of halogens.

The face, neck and shoulders are the common sites for the development of comedones. These lesions may be deep and frequently contain bacteria. Symptoms of acne may become worse for females just prior to the onset of their menstrual period. Cystic acne causes scarring.

Observation of the affected sites reveals lesions at various stages of development along with comedones. This manifestation differs from other skin diseases. In other skin diseases, skin lesions at the same stage of development are not seen simultaneously. Biopsy, and bacterial smear or culture may be done to distinguish the condition from folliculitis.

There are misconceptions related to the incidence of the condition and to aspects such as diet, sex and athletics. Treatment depends upon the severity of the condition. Severe, cystic acne generally responds well to orally administered isotretinoin agents; however, there are contraindications to its use (see residuals). Severe, deep lesions of acne do not respond favorably to broad-spectrum oral or topical antibiotic therapy. Cysts and pustules are incised and drained, and extraction of comedones is performed carefully. Avoiding the causes of cyst formation may prevent their occurrence.

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. Visible scarring, especially of the face may cause a self-esteem disturbance and require supportive counseling.

• In the most severe cases, extensive facial scarring may be the predominant residual. If so, consider evaluation under Diagnostic Code: 7800.

• When 38 CFR 4.118 offers variable methods to evaluate a skin condition, assign a single evaluation using the criteria that results in the highest rating. 

• Consider this condition 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.