Acne basics contain all the information that you should know about Acne. It covers what Acne really is, what causes it and how many different types of acne there are.
What is Acne?
Acne is the commonest skin problem that dermatologists see. They are recognized as the ugly red bumps and blemishes that appear usually on the face. It is a disorder due to inflammation of the oil glands (also known as pilosebaceous units).
What causes Acne?
Acne arises because of many reasons.
The below tells the story of the steps that lead to the formation of Acne.
- Increased activity of the oil-producing glands (or sebaceous glands).
- Narrowing of the lining of the oil-producing glands (due to roughness of the lining, medically termed as hyperkeratosis).
- The increased oil (sebum) production, coupled with slower drainage due to narrowing result in accumulation of oil (sebum) within the glands. This situation then promotes the growth of the bacteria, Propionebacterium acnes (P.acnes), within the glands. P. acnes is a bacteria that grows well in an environment which is deficient in oxygen. When the lining of the oil gland narrows, the environment within the oil gland becomes less oxygenated and allows the bacteria to multiply. Furthermore, the accumulated oil within the gland becomes food for the bacteria, allowing them to multiply further.
- The breakdown product of the sebum by the bacteria causes inflammation of the oil glands and result in the bumps and swellings that we see in a patient with active acne.
The other question one may have is what determines whether a person has the tendency to develop Acne or not?
There are 2 main factors that contribute to the development of Acne.
- Genetic factors.
It is known that a person with family history of severe acne is more prone to development of severe acne. - Hormonal factors.
The androgens (hormones), which in males are derived from testosterones and their derivatives and in females are converted from hormones at the ovaries and adrenal glands, play significant role in the formation of acne. The androgens have stimulatory effect on the sebocytes and are also important in causing narrowing of the lining of the oil glands ducts and openings.
What makes Acne worse?
- Greasy makeup and cosmetics. Using makeup or skincare products that are greasy may block up the oil glands and cause or aggravate the acne condition. Fortunately, high quality, oil-free makeup and skincare products are widely available now.
- Dusty or oily environment.
- Pre-menstrual flare.
- Stress.
- Occlusive factors. Repeated occlusive factors over certain areas on face may lead to blockage of oil glands and resulting in localized acne, for examples, habitual holding of chin causing localized acne on chin, wearing of tight fitting cap resulting in localized acne on forehead.
What are the different types of Acne?
Acne appears in different forms, from small little skin colour white bumps which may not look obvious, to angry looking painful red bumps. Here, we bring you through the different types of acne. The doctor will choose the appropriate treatments for the different types of acne.
- Comedonal acne lesions
These represent early stages in the development of acne. They result from blockage of the pore (pilosebaceous unit) with mild accumulation of sebum (oil). Closed comedones (also known as white heads) are formed when the blocked content is found beneath the skin and they appear as tiny, 1-2mm, whitish or skin coloured bumps on the skin. Occasionally, bigger closed comedones, 2-5mm in diameter, known as macrocomedones are also found. Open comedones (also known as black heads) are formed when the blocked content is exposed above the skin and appear as tiny, blackish dots at centre of oil gland openings.
Small white and black heads (comedones) on the cheek.
- Inflammatory acne lesions
These are more advanced development of acne and indicate inflammation within the oil gland. They may appear as reddish bumps, boils containing pus or even big cysts. These lesions maybe painful and can leave behind reddish or brownish marks when the inflammation subsides. If the condition is severe and untreated or poorly treated, patients may end up with acne scarring when the acne subsided.
Special Forms of Acne:
- Truncal acne: Acne is also quite commonly found on the chest and back. Truncal acne may be aggravated by heat and sweat and tend to be more resistant to treatment. In humid and hot weather, it is always better to take a shower after exercise and keep yourself cool and dry after that. When medications are needed, some patients may require higher dosing for better control of truncal acne.
- Preadolescent acne
- Neonatal acne: this is more common among baby boys and develops a few days after birth. The baby develops transient red bumps and yellowish pus on the face which usually resolve in a few days or weeks.
- Infantile acne: this form of acne have an onset after the first 4 weeks of life and may extend to childhood or adulthood.
- Childhood acne: this may be a continuation from infantile acne or begin only after 2 years old. Besides the comedones (black and white heads), red bumps, yellowish pus, some of the children may even develop big cysts on the face. This condition may last for months to years and some may extend into more severe form of adolescent acne. It is also more common to find family history of severe acne amont this group of children.
Pimples on right cheek of an infant.
- Acne fulminans: severe inflamed form of acne where patients may have associated fever, joints pain and raised white blood count.
- Acne due to drugs: this form of acne usually present with multiple red bumps and pustules with absence of white and black heads. Topical and oral steroids are the most common cause of drug-induced acne; other medications include phenytoin, lithium, bromides, iodides and androgens.
Rather uniform red bumps and pustules on the chest.
These developed after usage of topical steroid.
- Acne cosmetica: this is a form of acne due to use of cosmetics containing chemicals which may cause blockage of oil glands. However, this form of acne is probably very rare as most modern cosmetics are formulated with ingredients that do not block oil glands.
- Acne mechanica: this occurs from physical trauma such as rubbing, it is most common under chin straps of helmets.
- Acne detergents: this occurs in some patients who are compulsive face-washers.
- Gram-negative folliculitis: this is a rare form of acne due to superimposed gram-negative infection of the skin as a result of chronic antibiotic treatment. The gram negative bacteria most likely come from the nose.
