WHAT IS ACNE?
Acne? Sure, it’s not life-threatening. However, for some, acne might be life-altering. We’ve all had acne. None of us want it. Acne is mild for some, harsh for others. Some people experience acne in adolescence and for some, it continues into their adult life. But what is Acne?
Acne occurs in many forms. Most popularly, acne refers to clogged pores turning into whiteheads and blackheads. Acne is the ever dreaded pimple. Acne can even be the deeper lumps that appear as nodules or cysts. All of these can lead to scarring if not treated correctly. Acne can occur anywhere. Although most prominent on the face, it can also show up on the neck, shoulders, chest, back, and arms.
There are many different types of acne. The most common, of course, is Acne Vulgaris. The common offender to most of these acne types is: BACTERIA!
ACNE TYPES AND DEFINITIONS:
Many different words describe an acne problem. Therefore, it’s important to note and understand what each word means. We will start with the most general and get more specific.
- Lesion- An infected or diseased patch of skin (can accompany acne, skin cancer, a knife cut, etc.) When we read about lesions, we recognize that it has to do with an infected sebaceous gland. Some lesions are more severe than others.
- Comedo (plural Comedones)- when a sebaceous follicle is plugged with dirt, other cells, tiny hairs, or bacteria. There are two types of comedones. Blackheads are open comedones because the surface appears black. Closed comedones appear as a slightly inflamed, skin colored bump and are called Whiteheads.
- Macule- a temporary red spot left from a healed lesion. They are generally light red or pink and they can last from anywhere between a day to a few weeks.
- Pustule- Something likened to an inflamed, pus-filled lesion: a small inflamed elevation of the skin that is filled with pus; a pimple.
- Papule- A small, solid, usually inflammatory elevation of the skin that does not contain pus.
- Nodule- Like a papule in that it is white and dome-shaped. Characterized by inflammation. Nodular acne is very severe and doesn’t respond well to many forms of therapy.
- Cyst- an abnormal membranous sac containing a liquid or semi-liquid substance consisting of white blood cells, dead cells, and bacteria. Often very painful and they extend to deeper layers of skin. Nodulocystic acne is when nodules and cysts appear together.
Some of the more common types of acne include:
Acne vulgaris is the most common form of acne. It includes several types of lesion. Individual acne lesions usually last less than two weeks but the deeper papules and nodules may persist for months. It is a condition that mainly affects adolescents but may persist or even become more severe in adulthood. Most, but not all, acne patients have oily skin (seborrhoea). Acne vulgaris may occur on the face, chest, back and sometimes even more extensively. Several types of acne spots occur, often at the same time.
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: characterised 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. These types of acne lesions sometimes seem to be begging to be popped. Whiteheads are normally quicker in life cycle than blackheads.
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. Blackheads tend to be stable structures, and often take a long time to clear.
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. They are your garden variety "zit".
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 defence 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. Dermatologists often have ways of lessening swelling and preventing scarring.
Cysts: Cysts can appear similar to nodules, but are pus-filled, and have been described as having a diameter of 5mm or more across. They can be painful. Again, scarring is common. Squeezing a cyst may cause a deeper infection and more painful inflammation which will last much longer than if you had left it alone. Dermatologists often have ways of lessening swelling and preventing scarring. Types of cyst include:
Localized cystic: a few cysts on face, chest and back
Diffuse cystic: wide areas of face, chest and back involved
Pyoderma faciale: inflamed cysts localized on the face of females
Acne conglobata: highly inflammatory, with cysts that communicate under the skin with abscesses and burrowing sinus tracts.
Acne rosacea: is not true acne. Rosacea, previously called acne rosacea, is a chronic skin disease that affects both the skin and the eyes. The disorder is characterized by redness, bumps, pimples, and, in advanced stages, thickened skin on the nose. Rosacea usually occurs on the face, although the neck and upper chest are also sometimes involved. A mild degree of eye (ocular) involvement occurs in more than 50 percent of people with rosacea.
Adult Acne: acne in adults can be a result of fluctuating hormones that occur naturally as we mature. Certainly pregnancy can sometimes worsen or improve adult acne because it profoundly affects hormones.
Comedonal acne: acne in which most lesions are comedones (blackheads and whiteheads). Most often affecting the forehead and chin, this type of acne may be agravated by humidity, hormones, oily products such aspomades, sunscreens and petroleum-based moisturisers.
Perioral Dermatitis: tiny papules (red bumps), pustules (pus-filled yellowish bumps) and scaling with intense itching. It is usually localized to the surrounding area of the mouth and on the chin, or extend to involve the eyelids and the forehead. Generally exclusive to young women, perioral dermatitis may be caused by the use of fluorinated toothpaste, facial creams, or irritants such as strong benzoyl peroxide or cinnamon in the area.
Corticosteroid Acne: caused by the use of steroids. It results in pustular acne on the face, chest, back, arms and thighs.
Baby Acne: Newborn babies, not infrequently, get mild acne on their faces - sometimes it is even present at birth. Infantile acne generally affects the cheeks, and sometimes the forehead and chin. It is more common in boys and is usually mild. In most children it settles down within a few months.
Acne cosmetica: acne caused by cosmetics, characterized by small pink bumps, acne cosmetica is usually quite mild, with little chance of scarring.
Acne excoriée: is simply scratched or picked pimples. Minimal acne lesions on the face are exacerbated by neurotic squeezing and pressing of the pimples, trying to rid the contents with the fingers. As a result, hyperpigmentation and stellate contracted scars occur, while often the original underlying acne has healed. Acne excoriée is more common in females than males, and can be a sign of stress or depression. Sometimes it is just a bad habit that's hard to break; the acne may not actually be all that severe.
Medication induced acne: Acne can occasionally be caused by, or aggravated by, medications (drugs)such as Oral steroids may cause steroid acne; Contraceptive agents: medroxyprogesterone injection (Depo-Provera) and oral contraceptives which reduce circulating sex hormone binding globulin (SHBG), can aggravate acne in females, Testosterone, Anabolic steroids such as danazol, stanozolol can cause severe acne including acne conglobata and acne fulminans. Athletes and body-builders sometimes abuse anabolic steroids because they result in increased muscle bulk - severe acne is one of the undesirable results.
It is not known why some other medicines cause or aggravate acne; theories include effects on white blood cells and direct effects on the hair follicle. Medications known to aggravate acne include: Halogens (iodides, chlorides, bromides, halothane), Antiepileptics (carbamazepine, phenytoin, phenobarbital), Antituberculous drugs (ethionamide, isoniazid, rifampicin), Antidepressants (lithium, amoxapine), Cyclosporin, B vitamins (B12, cyanocobalamin).
Acne in Pregnancy: During pregnancy, acne can both clear and get worse. In early pregnancy, acne often gets a bit worse but as pregnancy progresses, acne can often improve, possibly because of increased levels of estrogen.
Severe Forms of Acne are rare, but they are a great hardship to the people who experience them, and can be disfiguring--and, like all forms of acne, can have psychological effects on the sufferer.
Acne conglobata: the most severe form of acne vulgaris and is more common in males. It is a form of nodulocystic acne in which there are interconnecting abscesses and sinuses, which result in unsightly hypertrophic (thick) and atrophic (thin) scars. There are groups of large "macrocomedones" and cysts that are filled with smelly pus. It can cause severe, irrevocable damage to the skin, and disfiguring scarring. It is found on the face, chest, back, buttocks, upper arms, and thighs. The age of onset for acne conglobata is usually between 18 and 30 years, and the condition can stay active for many years.
Acne fulminans: an abrupt onset of acne conglobata which normally afflicts young men. Symptoms of severe nodulocystic, often ulcerating acne are apparent. As with acne conglobata, extreme, disfiguring scarring is common. Acne fulminans is unique in that it also includes a fever and aching of the joints.
Pyoderma faciale: This type affects only females, usually between the ages of 20 to 40 years old, and is characterized by painful large nodules, pustules and sores which may leave scarring. It begins abruptly, and may occur on the skin of a woman who has never had acne before. It is confined to the face, and usually does not last longer than one year, but can wreak havoc in a very short time.
Gram-negative folliculitis: a bacterial infection characterized by pustules and cysts, possibly occurring as a complication resulting from a long term antibiotic treatment of acne vulgaris. It is a rare condition, and we do not know if it is more common in males or females at this time.
Nodulocystic acne: a severe form of acne affecting the face, chest and back. Nodulocystic acne is characterised by multiple inflamed and uninflamed nodules and frequently, scars. It is more common in males.
Types of Acne Scars
The term "scarring" refers to a fibrous process in which new collagen is laid down to heal an injury. It affects 30% of those with moderate or severe acne vulgaris. Most people will have acne scars that are mild. However, some will have scars that look significant even to others. There are a number of different looking scars caused by acne. They can be classified as follows:
- Ice pick scars: Deep pits, that are the most common and a classic sign of acne scarring.
- Boxcar scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep. These are similar to chickenpox scars.
- Hypertrophic scars: Thickened, or keloid scars.
- Rolling scars: Scars that give the skin a wave-like appearance.
OTHER SOURCES OF INFORMATION
Rosacea is sometimes called "acne rosacea" because it often occurs with acne. When rosacea is present, small, red, solid bumps (called papules) and pus-filled pimples (called pustules) may appear on the skin. These can easily be confused with acne pimples, but unlike acne, rosacea papules and pustules have no blackheads. Rosacea is sometimes called "adult acne," and it can be caused by harsh or aggressive acne treatments.
Acne Facts:1) Acne appears as white or red bumps that are painful to touch.
2) Whiteheads are formed due to trapped oil and debris within the hair follicles of the skin.
3) If whiteheads are formed in the deeper layers, a soft, fluctuant mass called a cyst appears.
4) Blackheads are open and dark in color. This is due to melanin pigment and not dirt.
5) The plugged wall of the follicle ruptures on to the skin surface, and can get infected by bacteria and form pimples or "zits".
6) Small red bumps are called papules. Larger red bumps are called nodules.
7) A pustule is a whitish yellow squeezable spot due to the accumulation of pus inside. After the lesions heal, they leave behind scars that form permanent marks on the skin.
