Often, when we hear the word acne we automatically think pimple, but in actuality the word is used to describe an assortment of skin conditions. These conditions can affect an individual with a mild case or even severely, each person is different. If you want to be sure to treat your acne the right way, you must first identify the type of acne from which you are suffering.
Identifying Your Acne
The most recognizable type of acne is known as Acne Vulgaris. Under this category you may identify the following:
- Papules – These are inflamed, solid elevations of the skin. There is no visible fluid and they vary in size.
- Pustules – These are also inflamed elevations of the skin but are often filled with pus. They have a white or yellowish appearance but are red underneath. Breaking the whites of these can result in permanent acne scarring.
- Whiteheads – A clogged hair follicle that appears as a white bump on the skin. The oil within has not had contact with the surrounding air.
- Blackheads – A clogged hair follicle that has a small black appearance on the skin. They are uninfected but the clogged oil has come in contact with the air and therefore appears black.
- Nodules – These forms of severe acne develop under the skin and are firm to the touch; they frequently don’t contain pus.
- Cysts – Much like the nodules, these are also a severe form of acne, but will appear inflamed and will contain pus.
Outside of Acne Vulgaris, there are two different conditions; they are Acne Mechanica and Acne Fulminans.
- Acne Mechanica – This is a common affliction of active people, such as those who play sports and experience frequent friction from the equipment they wear. This can also affect women whose bra straps rub their shoulders and backs. You may recognize it as small bumps, blackheads (also known as comedones) or severe lesions that have become irritated and red.
- Acne Fulminans – This form of acne, also known as Acne Maligna, is a skin condition or disease which can be the result of elevated levels of testosterone and therefore typically effects males. Further to the inflamed nodules that develop, the male may also experience scarring, pain in the joints, fever, and arthritis.
Acne – The Different Types
There are two ways we can catalog acne, that which causes inflammation and that which doesn’t; otherwise known as inflammatory acne and non-inflammatory acne. Let’s take a closer look at the former, first.
When acne becomes inflamed it is due to the bacteria, specifically known as Propionibacterium Acnes, that causes the pore to become infected. Further to this infection, the acne can then be broken up into four different types which we will examine in more detail.
These are firm elevations of the skin; there is no visible fluid, the size can vary, as can the appearance and color. They don’t contain any pus and there is no noticeable pore; they are sensitive to the touch.
As the name suggests, a pustule is a small bump that contains pus within, this pus can be recognized as a white or yellowish dot in the middle. Pustules differ from papules in that they contain white blood cells due to the fact that your body is trying to remove the bacteria that have gained access.
When your body works to remove a foreign substance, pus is the result much in the same way as your body creates pus when healing a bad scratch or an eye infection. These are also tender to the touch.
Nodules are also elevated areas of the skin, they too are firm and tend to occur in more severe acne cases as they form deeper in the epidermis layer of the skin. They too develop due to bacteria building up in the follicles and the sebaceous glands on the skin.
When these nodules form, the immune system reacts and causes them to become inflamed. Although they don’t contain any pus they can persist and irritate the skin for long periods of time. It is best to avoid rupturing them in order to prevent severe outbreaks and cause further infections as well as prevent scarring.
Similar to their nodule counterpart they form deep below the skin, but comparatively don’t always come to the surface. They are described as a closed sac and can become quite swollen. They are recognizable as a large red lump and can appear as individual bumps or within a group of other cysts.
Sufferers of cysts are lower overall compared to those who suffer from other forms of acne, about 0.002 percent of the population to 0.07 percent. Ultimately, acne that becomes inflamed often needs help from a dermatologist and proper skin care. These four types require a longer time to heal compared to the non-inflammatory type that we will discuss next.
To better understand what non-inflammatory acne is, we must first become familiar with the term comedo, or comedones, a name that is used to describe a blackhead. Essentially, a comedo is a clogged hair follicle in the skin.
These comedones can be open or closed, when open we use the term blackhead, when closed we refer to it as a whitehead.
A blackhead occurs when the clogged pore remains open to the exposed air; the sebum (oily matter) inside becomes oxidized as a result and the sebum becomes hardened causing a dark pigment to appear.
Typically, blackheads form in the T-zone area of the face (forehead, nose, and chin) but can pop up on other parts of the body as well. An individual will notice their appearance more during puberty or during other hormonal changes of the body.
What can sometimes have a similar appearance to blackheads and therefore be confused with them, are actually sebaceous filaments. They appear as small dark, gray-colored dots, also in the T-zone, they become quite visible in oily skin and when they are filled with sebum.
Filaments originate in the same manner, but when the pore then becomes plugged with dead cells on top of the sebum that is present, they then become known as blackheads.
To distinguish between the two, you will notice the sebum color differs when extracted, so a blackhead will have a dark appearance that is harder, whereas the sebaceous filaments will come out as a lighter extraction of sebum that has a wax-like texture.
Despite extraction of a sebaceous filament, it won’t stay unclogged for very long and will fill up again within a month. Proper skin care maintenance will help to lower the development of these filaments.
As previously mentioned, this non-inflammatory form of acne develops in an unopen pore. A thin layer of skin covers it preventing it from being exposed to the surrounding air. In the same way that sebum and dead skin cells collect in a blackhead, in this case, they remain trapped under the skin and can’t get out. They tend to last on a person’s face for about a week.
Grades of Acne
There are four different grades that are accessed by their severity.
Grade Level I
The lowest severity of acne; the appearance on the skin will come in the form of blackheads, whiteheads, and possibly pimples, papules or pustules. This mild level does not typically display inflammation acne, it typically occurs within the T-zone and during the pubescent time-frame.
Grade Level II
The frequency of acne will be more intense, as will the tenderness of the present acne; this is also known as moderate acne.
Grade Level III
The severity of this acne will mean that the individual suffers from inflammation and more frequency with the outbreaks. There will also be more variety of pustules, comedones, and papules.
Grade Level IV
The sufferer at this extreme level will face breakouts of all forms of acne, including nodules and cysts. They will also develop acne on other parts of the body, including the back and chest. Due to the severity of this acne scarring can occur and a visit to a dermatologist is in order to properly treat this acne with medication and preventative prescriptions.
It should be advised that to self-extract any form of comedones can also cause scarring of the skin and lead to a rupture of the acne.
Different Forms of Acne
While most acne falls under the term Acne Vulgaris, there are a few other variations that do not. Although they can display the same appearance and have similar symptoms to Acne Vulgaris, they are often not easy to get rid of and therefore a visit to a dermatologist to clarify the type of acne the individual is suffering from is important.
In actuality, this is an inflammatory disease, it exhibits comedones, nodules, forms of acne, as well as abscesses and even draining sinus tracts. The cause for the development of this disease is undetermined yet is believed to be connected with the release of testosterone and therefore is more present in males.
Males can exhibit symptoms of this form of acne from around the age of 18 well into their 40’s. It is not restrictive to the face as it can also develop in other parts of the body. It often begins to develop as blackheads within a group while pimples will also move in around the blackheads and fill with pus. Ruptures of these pimples and nodules are frequent and as a result, they can fuse together creating larger ones with scabs between them.
If an individual is suffering from a tumor, and thus is releasing a large quantity of androgen, or that individual is in remission from leukemia, they can suffer from this form of acne.
Another form of skin disease, what is often the result of unsuccessful treatment of acne conglobata. It is believed to develop due to the elevated level of testosterone which in turn, causes the levels of sebum to increase as well as the Propionibacterium acnes bacteria.
These increased levels activate the immunologic reaction which causes the development of acne fulminans. Much like acne conglobate, this acne typically occurs in males, although it is rare today. It is also known as Acne Maligna, its occurrence can be rapid and quite painful.
The individual may first experience pain in the joints followed by the development of nodular acne and ulcerative lesions. These lesions can bleed and develop scars on top of them. In severe cases, the sufferer may lose weight and could develop an enlarged spleen or liver.
If an individual has suffered from moderate inflamed acne for a long stretch of time and has been treated with antibiotics, then the result may actually be gram-negative folliculitis. It is a bacterial infection that appears much like acne does, with similar appearance and symptoms but can actually be a pustular rash.
When antibiotics are used to treat acne, the body builds up an immunity to the medicine, and the acne can become more severe. This condition is rare and is difficult to treat.
Another skin disease, which is caused by friction, pressure or heat on the skin. It is typically more prevalent in athletes due to the equipment such as chinstraps, shoulder pads, or other materials that rub up against parts of the body.
Ways to prevent the development of this acne-like condition are by wearing a layer in between the clothing, lubrication of the skin, sweat-absorbent clothing, or showering off the sweat following the activity.
Also called rosacea fulminans because it mimics rosacea yet it is not associated with oily skin or is not developed from comedones and is specific to females between the age of a young adult into her 40’s. It flairs up quickly and can coincide with acne such as pustules or cysts. A rarer condition that is often treated with a prescription, is restricted to the face, and it often doesn’t last very long.