Types and Subtypes of Acne

Sebaceous glands (oil glands) in our skin that connect the hair follicles or pores are responsible for producing sebum (oily substance that lubricates the skin). While sebum is being distributed unto the surface of the skin, dead cells are getting driven out; however, if too much sebum is being produced some of the pores get blocked, preventing the dead skin cells from leaving these pores. To a further complication, as bacteria get built-up the result is acne. I will elaborate more on the latter in the paragraphs to come.

Unfortunately, we do not know what the exact cause of acne is, but some elements that are thought to have an effect in its development include: heredity, oily skin or hair, hormonal imbalances (especially in women during menstruation and sometimes pregnancy), stress, oily and highly chemical cosmetics, etc.

Types of Acne

1. Acne Vulgaris

Acne Vulgaris is considered to be the most common type of acne. Acne Vulgaris includes mild to moderate (blackheads, whiteheads, papules, pustules) to severe (nodules and cysts) lesions.

Mild to Moderate Acne Vulgaris

- Blackheads (open comedo): they are the result of partially clogged pores. The black color that appears is not because of trapped dirt, it's the reaction of Sebum and Melanin (skin pigments) with oxygen.

- Whiteheads (closed comedo): they are the result of the complete blockage of the pores. Once the partial blockage becomes complete the excess Sebum cannot get out at all, and together with bacteria called "Proprionibacterium Acnes" or "P. Acnes" that are normally present on the skin get trapped in the pores; an enzyme is produced and causes the Sebum to break down into "free fatty acids", which causes irritation, swelling, redness, and pus formation that we call whiteheads.

- Papules: they are inflamed, red, and tender bumps that do not have heads. It's important not to squeeze or press a papule to get rid of it, because as a result scarring may occur.

- Pustules: they are inflamed red circles with a whitish or yellowish center. Again we should not mess with a pustule, since possible scarring is likely.

Severe Acne Vulgaris

- Nodules: contrary to the aforementioned lesions, nodules are much larger, more painful, and last longer (it might take months to heal). Nodules are characterized as hard bumps under the skin. We must absolutely resist the temptation to squeeze nodules, because pressing them causes severe trauma to the skin, causing the lesion to take an even longer time to heal, and scar.

- Cysts: they are somewhat similar in appearance to nodules, but are pus-filled and a bit bigger (5mm in diameter or more). Do not squeeze cysts as this causes deeper infection and therefore a more painful inflammation will result, and will take longer to heal.

2. Acne Rosacea

This type of acne is very similar to Acne Vulgaris, which makes it confusing for us to distinguish them from one another. It affects mostly women (but when found in men it's usually more severe) and those aged 30 and above. It appears as red rashes on the nose, cheeks, forehead, and chin. People with Acne Rosacea end up having pimples, bumps, and skin blemishes, but blackheads are unlikely with this type of acne. It can also cause Rhinophyma (bulbous nose) if not treated.

3. Acne Conglobata

This is considered to be the most severe type of acne, and it is more common in males. It appears as multiple large lesions, which seem to be interconnected across the face (found also on the back, chest, upper arms, and thighs); also a large number of blackheads are common with this type of acne. Acne Conglobata causes harmful damage to the skin along with extreme scarring.

4. Acne Fulminans

This type of acne is usually found in young men. It is associated with severe cysts and ulcer-like acne. It could cause extreme and disfiguring scars.

5. Gram-Negative Folliculitis

This type of acne is considered to be a bacterial infection associated with pustules and cysts, believed to be the result of complications from longtime antibiotic treatment for Acne Vulgaris.

6. Pyoderma Faciale (or Rosacea Fulminans)

This type of acne is usually found in females (between the ages of 20 to 40), and is associated to large painful nodules, and pustules that may leave scars. Also it may take place on the skin of a woman who has never had an acne condition before.

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