Tag Archives: types of acne

What are Different Types of Acne?

 

Skin Care Tips From Dermatologist
Different Types of Acne
Acne Types

Acne treatment depends upon the clinical type and severity of the pimples. There are many different types of acne classifications available, depending upon the morphology, severity and pathophysiology of the acne.

Why Learn about Different Types of Acne?

 Most people think that all types of acne require same treatment. Nothing can be far from the truth. Each type of acne has to be managed according to its own merit. Most acne natural or home remedies are not effective because they do not pay attention to this important factor.

Your dermatologist will take into account a number of factors while deciding on the best pimple treatment suitable for you; like the type and severity of acne, your age, gender, profession, and; if you are a female, whether you are expecting or breast feeding or have chances of getting pregnant.

Knowing your acne type will also help you decide when to get expert help so as to avoid complications like acne scars and acne skin blemishes.

The most useful and common classifications of acne are as follows:

Morphological Types of Acne

Morphological Types of Acne include

  1. Acne Comedones: Primary lesions during the development of acne; non inflammatory type of acne. Two types: Closed comedone (whitehead) and open comedone (blackhead).
  2. Acne Papules: Papular acne shows minimal inflammation with skin colored or red bumps.
  3. Acne Pustules: Moderate to severe inflammation and pus filled bumps are seen in pustular acne.
  4. Acne Nodules: Deep seated, red, severely inflamed nodules characterise nodular acne. Acne nodules are the result of repeated inflammatory rupture and encapsulation of the hair follicle and sebaceous gland with abscess formation and foreign body reaction.
  5. Acne Cysts: Fluctuant cystic acne lesions are abscesses formed by the breakdown and necrosis of the nodules and contain the debris from infected sebaceous gland, hair duct, inflammatory cells and surrounding dermal tissue.
  6. Acne Conglobata: In very severe acne, the nodules and cysts connect together to form deep, painful sinus like tracts. These are prone for deep scars.

Types of Acne Depending Upon the Severity

The following classification, a very useful one for the patients as well as the treating dermatologist, is modified from “Acne therapy: A methodological review” by Lehmann HP et al. in the August 2002 issue of the Journal of American Academy of Dermatology.

  1. Mild Acne: Up to 20 comedones and less than 15 papules, total acne lesions less than 30 in number.
  2. Moderate Acne: 20-100 comedones and/or 15-50 inflamed papules or pustules, total count of 30-125 acne bumps.
  3. Severe Acne: More than 5 cysts/nodules, more than 100 comedones or inflammatory acne lesions more than 50 with a total acne bumps’ count more than 125
  4. Very Severe Acne: Disfiguring severe nodulocystic acne, covering the major portion of the face, chest and back.

Acne Types Based on the Pathophysiology of Pimples

  1. Inflammatory Acne: Includes acne with papules, pustules, nodules and cysts.
  2. Non-inflammatory acne: Includes comedonal acne.

Acne Grading System

 This grading of acne includes a combination of above classifications.

  1. Grade 1. Mild, comedonal acne; non inflammatory type.
  2. Grade 2: Moderate, papular acne; inflammation is minimal
  3. Grade 3: Severe, pustular acne with moderate to severe inflammation. Chances of acne scar formation present.
  4. Grade 4: Very severe, nodulocystic acne. Deep acne scars possible if not treated promptly.

These different classifications of acne are useful not only in choosing the appropriate treatment modalities for the pimples, but also for conducting acne clinical research and disease surveys. The mild acne is the only type of acne where OTC products and acne home remedy may be tried without much risk of acne complications.

Published by Dr Hanish Babu, MD on 25th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

What are the causes of Acne?

How does Acne occur?

Acne vulgaris or common acne (also known as pimple and zits) is actually a disease of the hair follicle and its associated oil producing

Acne Cause: Hair Follicle
Acne Cause: Hair Follicle

sebaceous gland, as we have already discussed. The oily liquid produced by the sebaceous gland is known as sebum.

The sebaceous glands remain relatively small during infancy and childhood. At puberty due to the action of hormones known as androgens (which include testosterone and dihydrotestosterone), increase the size and activity of the glands. As a result, there is increased sebum production from the sebaceous glands.

How Acne Occurs
How Does Acne Occur?

A bacteria known as Propionibacterium acnes(P.acnes), which is a normal resident of the hair follicle and which thrives on a fatty food, increases in number during puberty due to the increased ‘food supply’ in the form of sebum!

The combined effects of activities of the increased sebum secretion and the P.acnes is the cause for the disease we commonly recognise as acne.

Let us examine how these two conspire together to disturb the normal milieu interior of the skin and damage the clear complexion of millions of teenagers around the globe.

How Acne Develops
Stages of Acne Development

Depending upon severity, there are 4 types of acne.

Grade 1: Mild (Comedonal) Acne

We have already seen that the combined effects of activities of the increased sebum secretion and the bacteria Propionibacterium acnes(P.acnes) is the cause for acne.

Comedonal Acne
Acne Grade 1: Comedone

Certain enzymes produced by the bacteria cause chemical changes in the composition of sebum, converting the triglycerides into free fatty acids.

These free fatty acids are potentially irritating to the epidermal cells lining the inside of the hair follicle. Some chemotactic factors are also released due to the action of the P.acnes on the sebum. These in turn attract certain white blood cells known as neutrophils to the vicinity of the hair follicle. This starts another chain of chemical and physiological reactions that results in what we know as inflammation.

The net result of all those changes are these:

How Acne Develops
How Acne Develops
  • The lining of the hair follicle above the sebaceous gland become thickened.
  • Because of changes in the keratinization of the follicular cells, there is accumulation of abnormal cornified cells inside the follicular lumen.
  • This sticky cells become adherent to the top of the sebaceous gland to form a plug known as microcomedone.
  • When this plug enlarges just beneath the small hair follicle(pore) opening on the surface of the skin, it become visible to our eyes. This is nothing but the (in)famous whitehead or the closed comedone!
  • An open comedone or blackhead occurs when, because of the pressure from the plug beneath, the hair orifice enlarge to reveal the black “dirty looking” plug. This black color is not due to dirt, but due to the action of atmospheric oxygen on the free fatty acids, the after products of sebum.

This, then, is how the comedones come into existence during puberty.

Some comedones are not as innocuous as they look. For many unfortunate teens, they are time bombs ticking, with impending catastrophe in later years to break into scar forming nodules and cysts.

Grade 2: Moderate(Papular)Acne

As the sebum continues to accumulate, the hair follicular wall become stretched and larger skin colored papules become evident on the skin surface. There is minimal inflammatory reaction due to the neutrophils attracted to the area in this moderate type of papular acne.

What is Grade 2 Moderate Acne?
Grade 2 Moderate Acne

The lesions are more pronounced and more in number than in the comedonal acne.

Grade 3: Severe(Pustular) Acne
Severe Inflammed Acne
Grade 3 Pustular Acne

When the sebum secretion is increased and the chemical breakdown of the sebum occurs due to the action of the bacteria P.acnes, neutrophils are attracted to the area. Neutrophils are the white cells involved in inflammatory reaction. These release certain chemical mediators and enzymes which further weaken the follicular walls. The wall and the sheath of the sebaceous gland thins and become inflamed leading to pustule formation.

These are numerous red, tender, pus filled lesions on the affected areas.

This is the severe grade 3 acne or pustular acne.

Grade 4: Very Severe (Nodulo-cystic) Acne

Acne Cyst
Acne Cyst Formation

When the follicular walls further weaken and get inflamed gradually the walls expand and become deep seated nodules. Further action of inflammatory mediators cause rupture of the wall and sebum, part of the wall and cornified cells and bacteria are released into the dermis. This causes an intense reaction known as foreign body reaction within the dermis resulting in the formation of deep seated cysts.

Nodulocystic Acne
Very Severe Grade 4 Acne: Acne Conglobata

This is known as the very severe scarring type of nodulocystic variety of acne.

Note: The grading is only facilitatory. There may be more than one or two kinds of lesions (comedone, papule, pustule, nodule) present at any time in acne patients. The grading is done when a particular type of lesion out numbers others.

Published by Dr Hanish Babu, MD on 23rd May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis

should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD