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Acne vul­garis (or sim­ply acne) is a chron­ic skin con­di­tion char­ac­ter­ized by areas of black­heads, white­heads, pim­ples, greasy skin, and pos­si­bly scar­ring. The result­ing appear­ance may lead to anx­i­ety, reduced self-esteem, and in extreme cas­es, depres­sion or thoughts of sui­cide. Genet­ics is esti­mat­ed to be the cause of 80% of cas­es. The role of diet as a cause is unclear. Nei­ther clean­li­ness nor sun­light appear to be involved. How­ev­er, cig­a­rette smok­ing does increase the risk of devel­op­ing acne and wors­ens its sever­i­ty. Acne most­ly affects skin with a greater num­ber of oil glands; includ­ing the face, upper part of the chest, and back. Dur­ing puber­ty in both sex­es, acne is often brought on by an increase in andro­gens such as testos­terone. Many treat­ment options are avail­able to improve the appear­ance of acne includ­ing lifestyle changes, pro­ce­dures, and med­ica­tions. Eat­ing few­er sim­ple car­bo­hy­drates like sug­ar may help. Top­i­cal ben­zoyl per­ox­ide, sal­i­cylic acid, and aze­la­ic acid are com­mon­ly used treat­ments. Antibi­otics and retinoids are avail­able top­i­cal­ly and by mouth to treat acne. Resis­tance, how­ev­er, may devel­op to antibi­otics. A num­ber of birth con­trol pills may be use­ful in women. Oral isotretinoin is usu­al­ly reserved for severe acne due to greater poten­tial side effects. Ear­ly and aggres­sive treat­ment is advo­cat­ed by some to lessen the over­all long-term impact to indi­vid­u­als. Acne occurs most com­mon­ly dur­ing ado­les­cence, affect­ing an esti­mat­ed 80–90% of teenagers in the West­ern world. Low­er rates are report­ed in some rur­al soci­eties. In 2010, acne was esti­mat­ed to affect 650 mil­lion peo­ple glob­al­ly mak­ing it the 8th most com­mon dis­ease world­wide. Peo­ple may also be affect­ed before and after puber­ty. Though it becomes less com­mon in adult­hood than in ado­les­cence, near­ly half of peo­ple in their twen­ties and thir­ties con­tin­ue to have acne. About 4% con­tin­ue to have dif­fi­cul­ties into their forties.