The 8 types of acne and their characteristics

Acne is an extremely common event in general society. It is estimated that more than 90% of adolescents in the world have acne at some stage of their development, in 20% of cases of a moderate or severe nature. In any case, this pathology is not conceived only in young people: 10% of those affected are between 35 and 44 years old. Without a doubt, pimples on the face are a problem that affects all age groups and sexes, to a greater or lesser extent.

However, there is a big step between a pimple or blackhead and the condition known as acne vulgaris. In the following lines, we explore the different stages and types of acne and other clinical entities that can be confused with it.

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How does acne appear?

First of all, it is necessary to be clear about the mechanism of appearance of the pimples. It all starts in the hair follicle, which contains sebaceous glands, responsible for secreting an oily substance of a lipid nature (sebum) that protects and lubricates hair and skin. Skin fat is not negative as such, as long as it is found on the epidermal surface in the right concentration.

Either by hyperkeratosis (overproduction of keratin and dead epidermal cells) or fostered by excessive sebum production, the pore of the hair follicle can become clogged. This causes blackheads (closed pores) and blackheads (open pores). The blackened color of the black dot corresponds to the oxidation of the lipid material when it comes into contact with the environment, not to the accumulation of dirt.

Unfortunately, the bacteria Cutibacterium acnes, eminently commensal on the surface of the epidermis, can find an ideal growth medium in an obstructed hair follicle. It is a saprophytic bacterium that feeds on decomposing organic matter (such as sebum), so an isolated medium such as a pimple encourages its exponential multiplication. This is when inflammatory acne begins.

What are the types of acne?

Acne vulgaris (the typical one) is divided clinically into 4 different stages, depending on the severity of the lesions presented. Below we show you, in addition to other clinical pictures that do not fall into the category of acne vulgaris but are presented in a similar way.

1. Mild acne (grade 1)

The main lesions are microcomedones, that is, pimples and non-inflamed blackheads. Some inflammatory events can also occur, but there are fewer than 5 inflammatory lesions on each half of the face. Due to the mildness of the condition, the patient is not expected to have lifelong scars.

2. Moderate acne (grade 2)

In addition to pimples and blackheads, there are between 6 and 20 inflammatory-type lesions in the middle of the face of the patient. At this point, we must stop for a moment to explore what these damages are and why they occur. We don't take long.

A comedo (clogged hair follicle) can develop into a papule when inflammatory activity begins, promoted by the invasion of C. acnes in the epidermal environment. This bacterium has been shown to possess enzymes that degrade some components of the dermis and epidermis, as well as substances (antigens) that promote the activation of the immune system. Local inflammation and tissue damage promote the appearance of the papule.

Papules and pustules are two sides of the same coin, although the second indicates a slightly more severe inflammatory stage. However, both are noticeable, painful, circular lumps that appear as part of a more obvious acne pattern.

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3. Severe acne (grade 3)

There are between 21 and 50 inflammatory lesions on the middle of the face. There are between 40 and 100 papules and pustules in the entire epidermal environment of the patient, and it is also common for the affected areas to extend from the face to the torso and back. Because the lesions are deep (due to the inflammatory effect and infection), in these cases permanent scars are usually left, despite the fact that the main stressors are eliminated.

4. Very severe acne (grade 4)

More than 50 inflammatory lesions are counted in the middle of the face. In addition to papules and pustules, here appear the most serious formations of all within this picture: the nodule and the cyst (hence it is also known as nodulocystic acne). Nodules are painful, hard, and highly inflamed lumps that reach deep layers of the skin. They are like papules, but larger and without an obvious pus center. Cysts are similar formations, but even deeper and difficult to treat.

5. Iatrogenic acne

Iatrogenic acne is not driven by genetic causes, infections and natural hormonal problems (as is the case with vulgaris), but its cause is in the administration of certain medications.

Steroids, anabolics, testosterone and androgens can lead to the appearance of comedones on the skin, whether of greater or lesser severity.

As you can see, the drugs mentioned here are associated with hormonal imbalances, especially those related to androgen overproduction. These hormones could cause the stimulation of the pilosebaceous glands, hence the condition is propitiated.

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6. Keloid acne

Also known as sclerosing folliculitis of the neck, this acne-like condition is caused by poor healing after an inflammatory event. In this case, epidermal stress occurs in the occipital region, which leads to the formation of fibrous plaques, papules and alopecia, something similar to a cystic acne.

Interestingly, these formations have an important genetic load, since they are much more common in people of African descent. The incidence in people with a black skin color is 5 to 16%, much higher during different hormonal phases, such as pregnancy or puberty. Lesions appear in 3 different phases: inflammatory, fibroblastic, and maturation.

7. Acne neonatorum

As its name indicates, this type of acne is the one that occurs in newborn children. The lesions are comedogenic, papular, and pustular and are almost always limited to the facial environment. It appears in 20% of male newborns, but it is also common for it to develop from 3-6 months of age, with a highly variable duration.

In the newborn, acne occurs due to hormonal stimulation of the pilosebaceous glands, which have not yet evolved to a mature stage. Therefore, it is conceived as a normal clinical event and within what is expected. However, children with acne neonatorum are more likely than others to develop severe acne vulgaris later in life.

8. Rosacea

Until a while ago, rosacea was considered a type of acne, although its pathological characteristics have led to it being categorized as a clinical entity of its own. The prevalence of this condition is up to 10% of the population and it is especially common in white-skinned people of Northern European descent.

The etiology of rosacea is unknown, but it should be noted that its pathogenesis mechanism has nothing to do with that of classic acne. Severe sunburn, stress, anxiety, eating some foods, and other environmental factors are believed to cause it.

Summary

As you have seen, acne goes far beyond its vulgar variant, although this is the most prevalent in society and the one that reports the most aesthetic problems. While mild acne can be treated with home skin care, more severe forms require the use of antibiotics (tetracycline, amoxicillin and doxycycline, among others), in order to end the infection in the environment of the epidermis.

In any case, if you have any doubts or concerns, the best option will always be to visit the dermatologist and have him or her establish a diagnosis. Other more serious infectious pictures in the skin environment can be confused with acne, so in these cases, it is always better to be safe than sorry.