The 8 types of acne and their characteristics

These are the types of acne that appear on the skin, described according to their severity and characteristics.

Acne is an extremely common event in general society. It is estimated that more than 90% of adolescents in the world present acne at some stage of their development, in 20% of the cases of moderate or severe nature. However, this pathology is not conceived only in young people: 10% of those affected are between 35 and 44 years of age. Undoubtedly, facial pimples are a problem that affects all age groups and sexes, to a greater or lesser extent.

However, there is a big step between a pimple or blackhead and the condition known as acne vulgaris. In the following lines, we explore the different stages and types of acne and other clinical and other clinical entities that can be confused with it.

How does acne appear?

First of all, it is necessary to be clear about the mechanism of appearance of pimples. It all starts in the hair follicle, which contains sebaceous glands, responsible for secreting an oily substance of lipid nature (sebum) that protects and lubricates the hair.These glands are responsible for secreting an oily substance of a lipidic nature (sebum) that protects and lubricates the hair and skin. Cutaneous grease is not negative as such, as long as it is present on the epidermal surface in the right concentration.

Whether due to hyperkeratosis (overproduction of keratin and dead epidermal cells) or encouraged by excessive sebum production, the hair follicle pore can become clogged. This causes blackheads (closed pores) and blackheads (open pores). The blackened color of the blackhead corresponds to oxidation of the lipid material on contact with the environment, not to the accumulation of dirt.

Unfortunately, the bacterium Cutibacterium acnes. eminently commensal on the surface of the epidermis, can find an ideal growth medium in a clogged hair follicle.. It is a saprophytic bacterium that feeds on decaying organic matter (such as sebum), so an isolated medium such as a pimple is conducive to its exponential multiplication. This is when inflammatory acne begins.

What are the types of acne?

Acne vulgaris (the typical one) is clinically divided into 4 different stages, depending on the severity of the lesions presented. These are shown below, as well as other clinical pictures that do not fall into the category of acne vulgaris but present in a similar way.

1. Mild acne (grade 1)

The main lesions are microcomedones, i.e. non-inflamed blackheads and blackheads.. Some inflammatory events may also occur, but there are less than 5 inflammatory lesions on each half of the face. Due to the mildness of the condition, the patient is not expected to be scarred for life.

2. Moderate acne (grade 2)

In addition to the blackheads and blackheads, there are between 6 and 20 inflammatory-type lesions on half of the patient's face. of the patient's face. At this point, we should pause for a moment to explore what this damage is and why it occurs. We do not linger long.

A comedo (clogged hair follicle) can develop into a papule when inflammatory activity begins.promoted by the invasion of C. acnes into the epidermal environment. This bacterium has been shown to possess enzymes that degrade some components of the dermis and epidermis, as well as substances (antigens) that promote activation of the immune system. Local inflammation and tissue damage promote the appearance of the papule.

Papules and pustules are two sides of the same coin, although the latter indicates a slightly more severe inflammatory stage. In any case, both are circular, painful and noticeable bumps that arise as part of a more evident acne picture.

3. Severe acne (grade 3)

There are between 21 and 50 inflammatory lesions on half of the face.. Between 40 and 100 papules and pustules are counted throughout the patient's epidermal environment, and it is also common for the affected areas to extend from the face to the torso and back. Because the lesions are deep (due to the inflammatory effect and infection), permanent scars are usually left in these cases, even if the main stressors are removed.

4. Very severe acne (grade 4)

There are more than 50 inflammatory lesions on half of the face.. In addition to papules and pustules, the most serious formations of all within this picture appear here: the nodule and the cyst (hence also known as nodulocystic acne). Nodules are painful, hard and very inflamed lumps that reach deep layers of the skin. They are like papules, but larger and without an obvious pus center. Cysts are similar formations, but even deeper and more difficult to treat.

5. Iatrogenic acne

Iatrogenic acne is not driven by genetic causes, infections and natural hormonal problems (as is the case with acne vulgaris), but is instead is caused by the administration of certain medications..

Steroids, anabolic steroids, testosterone and androgens can cause the appearance of comedones on the skin, whether of greater or lesser severity.

As you can see, the drugs mentioned here are associated with hormonal imbalancesespecially those related to the overproduction of androgens. These hormones could lead to stimulation of the pilosebaceous glands, thus promoting the condition.

6. Keloid acne

Also known as sclerosing folliculitis of the nape of the neck, this acne-like condition is due to poor healing after an inflammatory event. In this case epidermal stress occurs in the occipital region, leading to the formation of fibrous plaques, papules and alopecia, similar to an acne keloid.similar to cystic acne.

Interestingly, these formations have an important genetic burden, as they are much more common in people of African descent. The incidence in people with a black skin color is 5 to 16%, much higher during disparate hormonal phases, such as pregnancy or puberty. Lesions appear in 3 different phases: inflammatory, fibroblastic and maturation.

7. Acne neonatorum

As its name suggests this type of acne is the one that occurs in newborn children.. The lesions are comedogenic, papular and pustular and are almost always confined to the facial environment. It appears in 20% of male newborns, but it is also common to develop from 3-6 months of age, with a very variable duration.

In the newborn, acne occurs due to hormonal stimulation of the pilosebaceous glands, which have not yet evolved to a mature stage. Therefore, it is conceived as a normal and expected clinical event. However, children who experience acne neonatorum are more likely than others to develop severe acne vulgaris later in life.

8. Rosacea

Until some time ago, rosacea was considered a type of acne, although its anatomopathologic features have led to its categorization as a clinical entity of its own. The prevalence of this condition is up to 10% of the population and is especially common in people of white skin color with northern European ancestry.

The etiology of rosacea is unknown, but it should be noted that its mechanism of pathogenesis is not known. its mechanism of pathogenesis has nothing to do with that of classical acne.. It is believed that severe sunburn, stress, anxiety, consumption of certain foods and other environmental factors may promote it.

Summary

As you have been able to see, acne goes far beyond its vulgar variant, although this is the most prevalent in society and the one that causes the most aesthetic problems. While mild acne can be treated with skin care at home, more severe forms require the use of Antibiotics (tetracycline, amoxicillin and doxycycline, among others) in order to kill the infection in the epidermal environment.

In any case, if you have any doubts or concerns, the best option is always to visit a dermatologist who will establish a diagnosis. Other more serious infectious conditions in the skin environment may be mistaken for acne, so in these cases, prevention is always better than cure.