Non-inflammatory acne is very common and can be solved with certain home care, while inflammatory variants require controlled pharmacological treatment.
Acne, known medically as Acne vulgaris, is a chronic, multifactorial disease that occurs whenhair follicles are clogged by dead cells and oils produced by specialized glands in the skin. It is estimated that this pathology of the pilosebaceous unit affects 40 million people worldwide, including girls from the age of 11 and boys from the age of 12.
It is a typical skin disease of adolescents, since more than 90% of young people suffer at some point in their development some type of acne, being serious in approximately 20% of cases. In any case, 10% of patients are between 35 and 44 years old, which is why acne in adults should also be taken into account.
Genetics is one of the most important factors in its development, since it is estimated that more than 50% of acne patients have a first-order relative who suffers from it. The IGF-1 gene has been associated in multiple cases with this picture, estimating that the general heritability rate is 50 to 90%.
Other factors such as diet, stress, infections and hormonal activity can favor the appearance of acne or that it becomes more aggressive. Based on these premises, we present the 6 types of acne and their characteristics in the following lines. Don’t miss it.
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How is acne classified?
Acne is a pathology of sequential appearance that takes place in the hair follicles (pilosebaceous unit), in which there are sebaceous glands producing oils, which lubricate and keep the hair healthy and strong. These glands pour their contents into the skin through the “pores”, whose dysfunctionality marks the beginning of the clinical picture.
At the beginning of the pathology, there is an overgrowth of superficial epidermal cells (corneocytes), which causes the exit of the hair follicle to be blocked. The patient’s sebaceous glands are also hyperreactive, so they produce more sebum than they should and, on top of that, this substance is trapped inside the follicle.
This is when bacterial microorganisms come into play, specifically,the bacterium Cutibacterium acnes. This usually commensal agent feeds on fatty acids secreted by the sebaceous glands, so this plugged and isolated medium is a true paradise for it. Unfortunately, as they proliferate, these colonies synthesize enzymes that degrade some components of the epidermis and, in addition, put the immune system on notice.
This results in local tissue degradation, pus formation and inflammatory responses by our white blood cells. This is how the most severe acne symptoms develop, which correspond to 20% of the total clinical pictures and leave marks even after their resolution.
Now, we know what acne is in general. We are ready to introduce you to the 6 types of this condition in the following lines, so don’t miss it.
1. Non-inflammatory acne
This group includes the pimples and blackheads of a lifetime, those that do not have to be associated with a serious picture. This clinical picture does not generate an inflammatory response and, therefore, the patient does not have a red and inflamed face or back.
1.1 Pimples
Pimples are the primary efflorescences of acne, andarise when the follicle becomes clogged due to an event of hyperkeratosis, as we have said in previous lines. Circulating androgens promote the release of sebum at the epidermal level and, therefore, it is common for pimples to appear especially in adolescence, at which time a very pronounced hormonal dance occurs.
In pimples, Cutibacterium acneshas not yet proliferated in the hair follicle environment, so immune-mediated inflammatory responses and tissue damage do not arise. Therefore, when they disappear, these formations do not leave a scar. In any case, it should be noted that you should never exploit a pimple: the only thing that is achieved is to leave the area exposed to pathogenic organisms.
1.2 Blackheads
Blackheads and pimples are two sides of the same coin. While a pimple is a “closed” comedo (below the surface of a pore that does not open to the outside), a black dot is in contact with the medium. As a curiosity, it should be noted that this formation acquires a black color due to its oxidation, not due to the accumulation of dirt.
Solar comedones are a very striking form of black dot that appears with age, but are not directly related to acne. They affect areas that have been exposed to sunlight for a long time, these being usually the areas surrounding the nose and cheekbones.
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2. Inflammatory acne
As you may suspect, in this category we include the clinical pictures that go “a little further”, that is, we begin to take into account bacterial infections and immune responses. We dissect each of the variants included here.
2.1 Papules
A papule is defined as asuperficial lesion on the skin of circumscribed, elevated shape, with well-defined edges and a solid internal content. It is a solid cystic point of raised nature less than one centimeter in diameter, which in this case appears due to the rupture of the walls surrounding the hair follicle, due to severe inflammation.
Inflammation, as we have already said, is caused by the infestation ofC. acnesin the affected follicle. When the patient has a high number of epidermal papules, acne begins to be considered moderate or severe.
2.2 Pustules
The biggest difference between a papule and a pustule is that, in this case,the internal content of the lesion is liquid. Therefore, it usually occurs in the form of a kind of “pimple” larger and striking, in the form of a small and inflamed sore. They have a reddened and inflamed color.
2.3 Nodules
Nodular acne or cystic nodule is part of severe acne, as itaffects more internalized layers of the skin (dermis). Nodules arise when hair follicles suffer prolonged irritation and, in addition, have inflammatory infiltrations composed primarily of lymphocytes and giant cells (in the case of pustules, the infiltration is neutrophilic in nature).
When we talk about nodular acne, the chances of developing scars multiply. Also, due to the internalized nature of the injury, it cannot be treated from home. In this variant, going to a dermatologist quickly becomes essential, as it must be treated with specific medications.
2.4 Cysts
Cystic acne appears whenthe action of stored sebum, bacteria, immune inflammation, and dead epidermal cells is chronically combined. It affects layers of the skin even more internalized than the nodules, so in these cases it is always expected that the lesion undergoes a healing process.
It is the most severe type of acne on the entire list and, although it is not life-threatening, it requires immediate dermatological treatment. Unfortunately, the consequences of this type of acne are the alterations of the facial features and the appearance of scars that are difficult to approach, which generally translates into diminished confidence on the part of the patient.
Summary
As you can see, pimples and blackheads are not considered pathological pictures. Despite being the primary efflorescences in acne (everything starts with them), they do not require urgent pharmacological treatment, since there is no infection or inflammatory response.
On the other hand, papular, pustular, nodular and cystic acne are variants of the disease that worsen at different scales, depending on the extent of the infection and the layers of the skin that are affected. Finally, with the nodular and cystic variant, the patient can end up with a picture of difficult treatment and thesubsequent almost assured manifestation of facial scars. Therefore, pharmacologically treating these conditions is essential.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.