Types of Acne

There are various types of acne that commonly affect people. They are mildly differentiated by the differences in appearance that have been clinically established. Based on the type, the severity, spreading tendency, location of appearance and medication for treatment may vary accordingly. Some of the commonly seen types of Acne and their specific characteristics are discussed here. This can also prove to be a guide for those who could use some help to identify the specific condition they are facing with respect to their acne problems.

1. Mild acne

Acne vulgaris is the most common type of acne which includes blackheads, whiteheads, papules, pustules, nodules and cysts.

2.   Whiteheads: Whiteheads are the result of a pore being completely blocked, trapping oil, bacteria and dead skin, causing the skin surface to appear white. Whiteheads are also quicker to erupt and burst than blackheads though whiteheads are non-inflammatory in nature.

Blackheads

3.   Blackheads: Blackheads are the most commonly found type of acne that is commonly seen in teenagers and affects both girls and boys alike. Blackheads result when a pore is partially blocked, allowing some of the oil, bacteria and dead skin to gradually drain to the surface. The black color should not be mistaken for dirt; rather, it is the color or pigment of the skin, melanin, reacting with the air outside. They might also appear as a result of tampering with boils and other types of acne cysts and trying to break them. Blackheads take a long time to clear and blackheads are also non-inflammatory.

Papules

4.   Papules: These are inflamed red bumps without a head. It is better not to squeeze or touch a papule as it may worsen scarring. These are inflammatory in nature hence can cause greater pain than blackheads and whiteheads.

Pustules

5.   Pustules: Pustules that are otherwise commonly known as zits are a common occurrence in men and especially teenage men. They are characterized by a pus-filled, white or yellow center that is surrounded by a red circle. They are inflammatory in nature and can spread easily on the event of puncture or irritation. Care must be taken not to burst them or infect them when they are formed.

Nodules

6.   Nodular acne is much larger in size than other kinds of acne mentioned above. It is quite painful and sometimes lasts for months together.

  • Nodules are large, hard bumps under the skin’s surface.
  • They also have the potential to leave behind several scars. Some nodules that are left untreated carry the risk of flaring up repeatedly. Dermatologists usually treat these breakouts with cortisone.
  • A nodule is a solid dome-shaped inflamed lesion and is much bigger than papules and may be very painful. As explained before, nodules reach deeper in the skin and cause scars.
  • Nodules should not be treated with OTC medication. If you have the third stage of acne with large nodules and cysts, you should consult a doctor about the treatment.

7.   Cyst is a kind of acne that is pus filled, large and also causes a lot of pain for the sufferer.

  • Cysts invariably cause a scar. Squeezing a cyst may result in it spreading and leaving behind severe scars.
  • A cyst is a severe form of pustule that is filled with bacteria, white blood cells, sebum and dead skin cells.
  • Cysts can be very painful and extend inside the skin damaging the skin tissue.
  • Cysts may need to be drained before treatment.

Rosacea

8.   Acne rosacea affects millions of people over the age of 30.

  • It looks like a red rash primarily on the cheeks, nose, forehead and skin.
  • The redness comes with bumps, pimples and skin blemishes.
  • Due to rosacea, blood vessels become more visible on the skin.
  • There is a greater occurrence of rosacea in women but men face comparatively severe rosacea than women.
  • If rosacea is left untreated, it can cause swelling of the nose and the growth of excess tissue, called rhinopyma.

9. Scalp folliculitis is also a type of acne that develops in the scalp. Lack of hygienic practices and maintaining the scalp area clean in addition with oily hair type can accumulate bacteria in the scalp to form acne. This type of acne can be treated with acne-fighting shampoos.

Acne conglobata

10.   Acne Conglobata:

  • Conglobata is the most severe form of acne vulgaris and is more common in males.
  • It is characterized by numerous large lesions, which are sometimes interconnected, along with a lot of blackheads.
  • Deep abscesses, inflammation, severe damage to the skin, scarring and blackheads are other characteristics of conglobata.
  • It can cause severe, irreversible damage to the skin, and disfiguring scarring.
  • Conglobata is found on the face, chest, back, buttocks, upper arms, and thighs of males. Conglobata usually appears between 18 to 30 years, and may stay active for many years.
  • Dermatologists treat conglobata with isotretinoin (Accutane), and although acne conglobata is sometimes resistant to treatment, it can often be controlled through aggressive treatment over time.

As is the case with all forms of acne, the cause of acne conglobata is unknown.

Acne Fulminans

11.   Acne Fulminans: When conglobata erupts abruptly, it’s called acne fulminans, which normally afflicts young men.

  • Symptoms of severe nodulocystic acne that appear like ulcers are visible in those suffering from acne fulminans.
  • As with acne conglobata, fulminans also produces disfiguring scarring.
  • Acne fulminans is also accompanied by fever and aching of the joints. Its symptoms include severe and often ulcerating acne, fever, inflammation and aching of joints, especially hips and knees.
  • Antibiotics are mostly unable to cure acne fulminans hence Isotretinoin (Accutane) and oral steroids are normally prescribed by dermatologists.

12.   Gram-Negative Folliculitis: Folliculitis is a bacterial infection characterized by pustules and cysts and occurs as a complication from long term antibiotic treatment of acne vulgaris. It is a rare condition and presently it is not known if it is more common in males or females. Fortunately, isotretinoin (Accutane) is often effective in combating gram-negative folliculitis.

Rosacea Fulminans

13.   Rosacea Fulminans:

  • This type of severe facial acne affects mostly females, usually between the ages of 20 to 40 years old.
  • Rosacea is characterized by large painful nodules, pustules, and sores, all of which may produce scars.
  • Rosacea begins abruptly and may occur on the skin of women who have never had acne before.
  • It appears mostly on the face, and usually does not last longer than one year, but can be very difficult for victims.
  • Dermatologists often prescribe isotretinoin (Accutane) and systemic corticosteroids are sometimes prescribed in addition.

14.   Acne Mechanica

Acne Mechanica is the acne that develops when skin is subjected one or more of the following risk factors:

  • under stress
  • undergoing friction
  • covered tightly
  • exposed to heat

Some situations when Acne Mechanica may form are-

  • Tight clothing that rubs against the skin
  • Synthetic clothing that does not allow skin to breathe
  • Pressure of backpacks

Any situation during which the skin is tightly covered with cloth, rubbed and pressurized makes it vulnerable to acne mechanica. Hence, those who are under the risk of developing skin acne and are generally prone to skin problems must think twice before they might subject themselves to these situations.

Some examples of pressures or physical stress that may cause acne mechanica are-

  • Soldiers carrying heavy loads on the back
  • people carrying backpacks
  • athletes wearing a tight headband
  • women wearing bras with tight straps

Who are more prone to acne mechanica?

Those who have a tendency to develop body acne are more prone to acne mechanica. Those with very small comedones are prone to acne mechanica too. When these small comedones are subjected to mechanical pressure and friction, they flare up as acne mechanica.

To Avoid Acne Mechanica-

  • Wear loose fitting cotton clothing.
  • Avoid headbands.
  • Avoid constant pressure on the skin from any object.
  • Keep skin clean of perspiration.
  • Wear cotton clothes that breathe ensure air circulation beneath your regular clothes.
  • Wash yourself thoroughly after removing the irritating baggage/object.

15.   Chemical based acne and other types of acne:

  • Medication induced acne, halogen acne, pregnancy induced acne, chloracne, polycystic ovarian syndrome related acne are curable acne.
  • Halogen acne is an acne eruption caused by bromides or iodides.
  • Chlor acne are acne like eruptions caused due to occupational contact, by inhalation or ingestion of certain chlorinated compounds (naphthalenes and diphenyls) used as insulators, insecticides, fungicides, and herbicides. Some times, skin contact with these compounds may also cause Chlor acne.

Causes of acne

Scientific organizations have studied and examined all possible causes of acne.

  • These studies show that acne develops as a result of follicular blockages. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) are the earliest symptoms.
  • The sebaceous glands get enlarged and an increase in sebum production occurs with increased androgen (a male hormone) production.
  • The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands becoming blocked with sebum, a physically occurring oil, and dead skin cells.
  • In these conditions, the naturally occurring, largely commensal Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the lower skin layer around the microcomedo or comedone that in turn results in redness and may finally result in scarring or hyperpigmentation.

A. Check your hormones:

  • Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne.
  • During puberty, an increase in male sex hormones called androgens causes the follicular glands to grow larger and make more sebum.
  • Use of anabolic steroids may have a similar effect.
  • Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).
  • Development of acne vulgaris in later years is uncommon, although this is the age group for rosacea, which may have similar appearances.
  • Pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing’s syndrome may be the causes for acne in adult women.
  • Menopause-associated acne occurs as the production of natural anti-acne ovarian hormone – estradiol fails during menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

B. Your genetic disposition matters: The tendency to develop acne runs in your genes. For example, school aged boys with acne often have other members in their family with acne too. A family history of acne is usually associated with earlier incidence of acne and an increased number of retentional acne lesions.

C.   Stress, the killer: While the connection between acne and stress has been debated, scientific research indicates that “increased acne severity” is “significantly associated with increased stress levels.” The National Institutes of Health (USA) list stress as a factor that “can cause an acne flare.” A study of adolescents in Singapore “observed a statistically significant positive correlation between stress levels and severity of acne.”

D. Infectious bacteria in the pores: Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. The fear is that it is now getting more and more resistant to commonly used antibiotics.

E. Watch your diet: A high glycemic index diet and cow’s milk have been associated with worsening acne. Other foods such as chocolate and salt are not supported by the evidence.

F. Watch you cosmetics (Comedogenicity)

You may have observed that when you begin using a particular skin care product, you begin getting whiteheads and blackheads. Whiteheads and blackheads are called comedones and hence a product that gives rise to comedones is called comedogenic.

If a product has five ingredients out of which one is comedogenic, the product will be labeled comedogenic. In other words, for a product to be labeled as non-comedogenic all the ingredients must be non-comedogenic. Every product to be used on the body can be tested in this manner and labeled.

Only use products labled non-comedogenic to prevent formation of whiteheads and blackheads.

Stages of Acne

Acne Vulgaris occurs in various stages. Acne begins as whiteheads and blackheads followed by Pimples as the second stage and finally, the third stage is the severe form of acne characterized by cysts and nodules.

1. The first stage of acne:

  • Blackhead:
    A blackhead forms if air oxidizes the sebum. Oxidized sebum looks black. This is the reason behind the name blackhead. As the pore is open at the top in blackheads, they are also known as open comedones.
  • Whitehead:
    Whiteheads are also known as closed comedones. In whiteheads the skin covers the sebum. That is also the reason why sebum does not turn black in whiteheads.

2. The second stage of acne is:

  • Papule:

A papule is a slightly elevated solid lesion that is generally less than 5 mm in diameter and is not infected. Papules grow to nodular acne.

  • Pustule:

Pustules are filled with liquid mass containing dead skin cells, white blood cells and bacteria. They are fragile, rupture easily and progress to cysts.

3. The third stage of acne:

Nodule:

  • A nodule is an inflamed lesion that extends to deeper layers of the skin.
  • A nodule is like a papule in the sense of being a solid dome-shaped lesion.
  • Yet, nodules are more painful and cause scars as they damage the inner tissues of the skin.
  • They also take time to cure.

Cyst:

  • A cyst is a severe form of pustule that is filled with bacteria, pus, sebum and dead skin cells.
  • Cysts cause pain and extend inside the skin damaging the skin tissue.
  • Cysts invariably cause a scar.
  • Commonly a cyst is drained and then treated.
  • Those who have tendency to form nodular or cystic acne are advised to take Isotertinoin.