From pesky pimples that pop up before a big event to the persistent breakouts that seems to linger no matter what you do, acne is a common skincare concern that affects people of all ages and skin types. But did you know there are different types of acne, and understanding these types is the first step towards effective treatment? In this article we explore the different types of acne and explain how you can leverage this in your skincare routine and get a healthier, clearer complexion.
What is Acne & What Causes it?
Acne is a chronic inflammatory skin condition that involves the sebaceous glands and hair follicles of the skin. It is caused by a combination of factors, including:
- Overproduction of oil: The sebaceous glands in the skin produce oil, which helps to keep the skin moist and reduce trans-epidermal water loss. However, if the sebaceous glands produce too much oil, it can clog the hair follicles.
- Dead skin cells: If dead skin cells do not shed properly from the skin, they can build up and clog the hair follicles.
- Bacteria: The bacterium Propionibacterium acnes (P. acnes) lives on the skin of most people. However, in people with acne, P. acnes can multiply and cause inflammation of the hair follicles.
- Hormones: Androgens and related hormones can increase the production of oil by the sebaceous glands. This is why acne is more common in teenagers and young adults, when hormone levels are higher.
- Stress: This can trigger the release of hormones that can lead to acne.
- Diet: Some foods, such as dairy products and sugary foods, may trigger acne in some people.
- Medications: Some medications, such as steroids and lithium, can cause acne as a side effect.
- Skin care products: Some skincare products, such as oil-based makeup and moisturisers, can clog the hair follicles and cause acne.
In general, acne is characterised by the appearance of spots/pimples or blemishes on the skin. These terms are often used interchangeably with ‘breakouts’ to describe how acne presents. Spots and pimples largely refer to the same thing. Blemishes refer to any type of spot, mark, or colour irregularity that appears on the skin. It’s important to note that whilst acne is a type of blemish, not all blemishes are acne.
Types of Acne Lesions
There are different types of acne lesions, each with its own characteristic appearance. It is important to understand these as the will determine the severity of your condition and the best treatment for you.
Blackheads and Whiteheads (Comedones)
This is a form of non-inflammatory acne occurs. It occurs when pores become clogged with excess sebum and dead skin cells. The clogged pore can remain open in which case it is called a blackhead or closed which is known as a whitehead. These are usually the least severe form of acne.
Papules and Pustules
These are probably what most people are familiar with as typical features of acne. Papules and pustules are forms of inflammatory acne that occur when bacteria, sebum, and dead skin cells push deeper into the skin. This causes redness and swelling. Papules are small, red and tender bumps. Pustules are similar but contain a pus-filled centre.
Nodules and Cysts
These lesions are felt under the skin and typically look like an enlarged raised area of skin with diffuse borders. They are not distinct superficial lesions but not easily sign like comedones, papules or pustules. They occur when a pore becomes clogged and bacteria continue to multiply, causing an infection deep in the skin. Nodules are hard and painful lumps. Meanwhile, cysts contain pus and can lead to permanent scarring. Nodules and cysts are the most severe forms of acne.
In addition to these key features of active acne, there is often a secondary set of features that present after a breakout clears. Post-inflammatory hyperpigmentation (PIH) and scarring are two common blemishes that occur in the aftermath of acne. PIH leaves dark spots on the skin after whilst acne scars are textural irregularities or indentations.
Different Types of Acne
To add to the confusion, acne is also often split into different types based on the cause or trigger of the breakouts. I haven’t included acne rosacea because even though it has similar features, rosacea treatment is a little different as a lot of skincare care we use for acne can worsen rosacea.
The medical name for the most common type of acne is acne vulgaris. This includes a variety of lesion types, including blackheads, whiteheads, papules, pustules, nodules and cysts.
All acne is to some extent “hormonal”. However, hormonal acne is specifically linked to fluctuations in hormones. It is most common in women. It usually occurs in a characteristic pattern along the lower face, jawline and neck. Hormonal acne typically flares up in sync with the menstrual cycles.
This is a rare and severe type of acne. Acne conglobata involves many inflamed nodules. These connect under the skin to other nodules. It often leaves deep, prominent scars.
Excess heat, pressure, friction or rubbing of the skin trigger this type of acne. As such, acne mechanica is common among athletes and those who sweat heavily or wear tight clothing.
The Acne Severity Spectrum
To make treatment planning and monitoring easier, it is useful to categorise diseases. Broadly speaking, acne can be classified into three broad categories based on severity:
- Mild Acne: Few to several papules and pustules, but with little to no nodules.
- Moderate Acne: Several to many papules and pustules, plus few to several nodules.
- Severe Acne: Extensive or very painful papules, pustules, or nodules.
Treating Different Types of Acne
Both the severity and type of acne affect the treatment for acne. Its important to bear this in mind when considering skincare and also medical treatments for acne.
Blackheads and Whiteheads
These are in many ways the easiest to treat. Over-the-counter treatments containing salicylic acid, azelaic acid, and benzoyl peroxide are commonly used and very effective. Retinoids can prevent pore blockages by increasing skin cell turnover.
Papules and Pustules
Benzoyl peroxide is a great spot treatment to reduce size and redness of these lesions when they first start and clear them faster. Salicylic acid, Retinol and sulfur can reduce the number of breakouts when used regularly in your skincare routine. For stubborn acne, prescription topical or oral antibiotics or retinoids like Tretinoin, Adapalene or Isotretinoin will help clear and prevent breakouts.
Nodules, Cysts & Acne Conglobata
Due to their severity, nodular and cystic acne often require prescription treatment. As such, you should see a Dermatologist for these types of acne. The mainstay of treatment is usually oral isotretinoin but may also involve in-office treatments including deep peels, lasers and even surgery (if there is scarring). This is also applies for acne conglobata which requires aggressive treatment under the care of a dermatologist.
Acne Vulgaris & Hormonal Acne
This condition typically requires a multi-pronged approach. Good options will involve a skincare routine for acne-prone skin as well as prescription treatments like Tretinoin cream or oral antibiotics. It may also need in-office treatments like chemical peels. Hormonal acne is usually treated like acne vulgaris. In addition, women are often offered hormonal treatments such as oral contraceptives or spironolactone.
You can manage this type of acne with good skincare habits, like cleansing after sweating, wearing loose-fitting clothing and avoiding friction on the skin. Depending on where the acne is, cleansers and toners containing benzoyl peroxide can help acute breakouts. Using a regular salicylic acid wash will also help keep this condition at bay.
Acne can feel like an uphill battle, but understanding the different types of acne and their appropriate treatments is a significant step towards winning the fight. It’s essential to remember that everyone’s skin is unique and different products have different effects on different people. If you’re finding it hard to manage your own acne or suspect you have severe acne, it’s important to consult with a dermatologist or other skin doctor to help et you on the right path. Remember, patience is key when treating acne. It may take at least 6-8 weeks to see an improvement, so consistency is key!
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