Types of Acne

Acne vulgaris is the most common form of acne. Acne vulgaris is a common skin disease that affects 35-90% of people at some time during their lives. Acne vulgaris is a condition of the sebaceous glands of the skin. The sebaceous glands surround each hair follicle and produce sebum, an oily substance, to lubricate the hair. Acne vulgaris is characterized by non-inflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne usually appears on the face, back and chest. Acne vulgaris includes several types of lesions, these individual acne lesions usually last less than two weeks but the deeper papules and nodules may persist for months. This is a skin condition that mainly affects adolescents but may persist or even become more severe in adulthood. Oily skin is common in many acne patients.

There are four main components involved in the development of acne:

1)Follicular epidermal hyperproliferation which clogs the pore causing excess skin oil to accumulate providing the right environment for pimples. Acne bacteria and accompanying inflammation to occur. Persons with acne frequently have excess sebum (skin oil) production and oily skin. This excess sebum may affect the normal pH balance of the skin and initiates comedone formation.

2)Excess sebum is another component in the development of acne vulgaris. Sebum production and excretion are regulated by a number of different hormones and mediators. Androgen hormones promote sebum production and release but are not the only regulators of sebaceous gland function.

3)Propionibacterium acnes otherwise known as "P-acnes" this is a microaerophilic organism present in many acne lesions. The presence of P-acnes promotes inflammation by producing pro-inflammatory mediators that diffuse through the follicle wall. Hypersensitivity to P-acnes may also explain why some individuals develop inflammatory acne vulgaris while others do not.

4)Inflammation may be a primary component of or a secondary component. Most of the evidence to date suggests a secondary inflammatory response to P acnes. Although inflammation is not apparent microscopically or clinically in early lesions of acne, it may still play a pivotal role in the development of acne vulgaris and the comedones.

Mild to Moderate acne vulgaris consists of:

Comedonal acne: non-inflammatory lesions such as blackheads and whiteheads, although some pustules and papules may be present.

Mild acne: with blackheads and whiteheads but also with papules and pustules.

Moderate acne: characterized by more painful, deep-rooted inflamed lesions, which can result in scarring. It is important to treat early to avoid this.

Whiteheads: Whiteheads result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface.

Blackheads: Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum (oil), bacteria, and dead skin cells to slowly drain to the surface. The black color is not caused by dirt. Rather, it is a reaction of the skin's own pigment, melanin, reacting with the oxygen in the air.

Papules: Papules are small, red, tender bumps with no head. Do not squeeze a papule. It will do no good, and may exacerbate scarring.

Pustules: Pustules are similar to whiteheads, but are inflamed, and appear as a red circle with a white or yellow center.

Severe acne vulgaris consists of:

Severe acne: deep-rooted inflammatory lesions featuring cysts and nodules which are painful and produce scarring. If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin tissues rather than onto the surface. Swelling and pain take place as the body's activated defense mechanism sends bacteria-fighting white cells to the area. This deep-rooted inflammation and infection results in cyst formation.

Nodules: As opposed to the lesions mentioned above, nodules are much larger, can be quite painful, and can sometimes last for months. Nodules are large, hard bumps under the skin's surface. Scarring is common. Absolutely do not attempt to squeeze such a lesion. You may cause severe trauma to the skin and the lesion may last for months longer than it normally would.

Cysts: Cysts can appear similar to nodules, but are pus-filled, and have been described as having a diameter of 3/16 of an inch (5mm) or more across. They can be painful. Again, scarring is common. Squeezing a cyst may cause a deeper infection and more painful inflammation that will last much longer than if you had left it alone.

Types of cyst include:

  1. Localized cystic: a few cysts on face, chest and back
  2. 2)Diffuse cystic: wide areas of face, chest and back involved
  3. 3)Pyoderma faciale: inflamed cysts localized on the face of females
  4. 4)Acne conglobata: highly inflammatory, with cysts that communicate under the skin with abscesses and burrowing sinus tracts.