Acne: Online Diagnosis and Treatment

Acne is a scourge of adolescence, affecting nearly 85% of teens,¹ causing anxiety, depression, and low self-esteem, but it can strike at any time. Approximately 50 million people in the U.S. are affected by acne, including 12% of adult women.^2,3,4 Because of its significant impact on all aspects of life, there is a wide range of treatment options available.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for acne diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat your acne. Telehealth for acne treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your acne quickly and easily, even if you don’t have insurance. Schedule an appointment today to uncover clearer, healthier skin in the future.

What Is Acne?

Acne vulgaris, or acne for short, is a chronic inflammatory skin condition that causes open or closed comedones (pimples) and inflammatory lesions such as papules, pustules, or cysts. It occurs when hair follicles become blocked with dead skin cells, bacteria, and sebum.²

What Are The Common Symptoms Of Acne?

Acne is a common skin condition that rarely causes any systemic effects. The skin lesions associated with acne can be divided into noninflammatory and inflammatory lesions.

Noninflammatory acne lesions:

• Closed comedones (whitehead): Small, raised white or skin-colored bumps from a blocked pore that remains below the skin surface. Since the follicle remains closed, its contents are not exposed to air.
• Open comedones (blackheads): Occur when a blocked pore opens to the skin’s surface. Exposing the plug of sebum and skin cells to oxygen causes it to turn brown or black. This is a chemical reaction called oxidation with melanin deposition.

Inflammatory acne lesions:

• Papules: When an inflamed pore begins to break down, it can become red and swollen when inflammatory cells and chemicals leak into the surrounding tissues. This is a papule.
• Pustules: An inflamed pimple with a white head filled with white, yellow, or cream-colored pus.
• Nodules; Larger, solid, inflamed nodes that are painful to the touch. The hair follicle has ruptured, and inflammatory chemicals have leaked into the surrounding tissue.

Can Acne Be Treated Through Telehealth?

Consulting a medical professional via telehealth makes getting acne diagnosed and treated easy. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your acne and call in your online prescription to a local pharmacy. Online doctors who prescribe acne treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Why Do You Get Acne?

Acne is a process that involves four factors that can be targeted by treatment:^5,6

• Sebum production: Sebum is a waxy substance that waterproofs and protects skin and hair. Androgen hormones influence sebum production and are linked to the increased prevalence of acne during the teen years.
• Increased keratin production: Keratinocytes are a type of skin cell that lines the hair follicle. Keratinocytes are constantly being produced in the skin, and older ones rise to the surface and are shed. Excess keratin clogs hair follicles and expands them, causing a microcomedone to expand to a comedone.
• Bacterial colonization with Cutibacterium acnes (formerly Propionibacterium acnes): This anaerobic bacteria infects clogged hair follicles, increasing inflammation and irritation around acne lesions.
• Inflammation: Bacteria trigger increased inflammation, bringing specialized immune cells to the area, which causes redness, swelling, and pain.

Acne is typically found in areas of the body with the densest concentration of sebaceous hair follicles, such as the face, upper chest, and back.

When keratinocytes do not move to the surface of a hair follicle, they can cause a clog of sebum and keratin inside a pore. The clogged pore is a great breeding ground for bacteria to grow. Bacterial growth causes inflammation, and the plugged hair follicle breaks down and leaks its contents into the surrounding tissue.

Are Some People at Increased Risk for Acne?

Factors associated with increased acne include the following:^7,8

• Androgen hormones: Increased androgen hormones or increased sensitivity to androgens causes increased sebum production. Sebum overproduction can clog pores and lead to acne.
• Genetics: Acne seems to run in families, suggesting there is a genetic component to it.
• Medications: Certain medications can cause acne, including hormones, corticosteroids, some anti-seizure medications, iodides, and lithium.
• Diet: Foods with a high glycemic index, such as sugary, starchy, highly processed foods and skim milk, seem to worsen acne severity. Diets high in fatty acids, fruits, and vegetables seem to improve acne.
• Endocrine disorders: Endocrine disorders such as polycystic ovary syndrome are associated with excess androgen production and increased acne risk.
• Mechanical factors: Occlusive clothing and sports equipment can increase acne.
• Emotional stress: Increased stress and elevated cortisol levels are associated with more severe acne.

How Do You Diagnose Acne?

Acne is a clinical diagnosis based on visually inspecting skin lesions. It is commonly classified as mild, moderate, or severe.

• Mild acne: Mild acne is characterized by having open and closed comedones and very few, if any, pimples. Limited skin area is involved, and there are no papules.
• Moderate acne: Moderate acne is characterized by having more pimples. Some pimples may be inflamed and, therefore, papules or pustules.
• Severe acne: Severe acne is characterized by having many papules, pustules, and nodules. These lesions may scar.

How Do You Treat Acne?

Many oral, topical, and procedural treatments are available to heal acne, leading to clearer, more blemish-free skin.

Non-antibiotic topical agents: These non-antibiotic medications reduce Cutibacterium acnes growth and inflammation. These medications are typically used to treat mild-to-moderate acne.

• Azelaic acid
• Benzoyl peroxide
• Salicylic acid

Topical antibiotics: These medications reduce Cutibacterium acnes growth and inflammation.

• Clindamycin
• Erythromycin
• Dapsone

Topical retinoids: These medications reduce inflammation and decrease keratin production. They reduce comedones and inflammatory lesions. These medications are used as a first-line treatment and are continued for maintenance.

• Adapalene
• Tretinoin
• Tazarotene
• Isotretinoin

Oral antibiotics: These medications reduce Cutibacterium acnes growth and are used to treat moderate-to-severe acne.

• Tetracycline
• Minocycline
• Doxycycline
• Sarecycline
• Trimethoprim/sulfamethoxazole
• Clindamycin

Other treatment options

• Clascoterone: androgen receptor inhibitor
• Spironolactone: selective aldosterone antagonist
• Oral contraceptives: estrogens can decrease androgen production

First-Line Treatment Options for Acne²

Mild Acne	Moderate Acne	Severe Acne
Benzoyl peroxide	Benzoyl peroxide + antibiotic	Oral antibiotic + topical antibiotic + benzoyl peroxide
Topical Retinoid	Retinoid + benzoyl peroxide	Oral antibiotic + topical retinoid + benzoyl peroxide
Benzoyl peroxide + antibiotic	Benzoyl peroxide + retinoid + antibiotic	Oral antibiotic + topical retinoid + benzoyl peroxide + topical antibiotic
Retinoid + benzoyl peroxide	Oral antibiotic + topical retinoid + benzoyl peroxide	Oral isotretinoin
Benzoyl peroxide + retinoid + antibiotic	Oral antibiotic + topical retinoid + benzoyl peroxide + topical antibiotic

Other steps you can take to improve your skin health include the following:

• Use gentle skin cleansers instead of harsh cleaners or perfumed soaps
• Avoid scrubbing or traumatizing skin
• Select non-comedogenic cosmetics and skin care products

When Should You See a Doctor for Acne?

See a doctor for acne as soon as possible. The sooner you start treatment, the less likely you are to develop hard-to-treat nodules and cystic lesions that may lead to scarring. In addition to its physical manifestations, acne is associated with depression, anxiety, and poor self-esteem. The sooner acne is effectively treated — the better.

Telehealth for acne is the perfect option. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis based on acne severity. Your virtual doctor can give you tips on preventing further acne lesions and call in a prescription to a local pharmacy. Online doctors who treat acne provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining an acne treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for acne treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your acne treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for acne, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013 Mar;168(3):474-85. doi: 10.1111/bjd.12149. PMID: 23210645.

2. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33. doi: 10.1016/j.jaad.2015.12.037. Epub 2016 Feb 17. Erratum in: J Am Acad Dermatol. 2020 Jun;82(6):1576. PMID: 26897386.

3. White GM. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. J Am Acad Dermatol. 1998 Aug;39(2 Pt 3):S34-7. doi: 10.1016/s0190-9622(98)70442-6. PMID: 9703121.

4. Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999 Oct;41(4):577-80. PMID: 10495379.

5. Titus S, Hodge J. Diagnosis and treatment of acne. Am Fam Physician. 2012 Oct 15;86(8):734-40. PMID: 23062156.

6. Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(5 suppl):S1-S50.

7. Oge’ LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019 Oct 15;100(8):475-484. PMID: 31613567.

8. Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10:2021-8-6. https://doi.org/10.7573/dic.2021-8-6