Types of Acne

There are different types of acne. They can be categorized based on severity of the outbreak, what causes them, where they occur or even who gets affected. Here we will see each type in detail.

Mild Acne Vulgaris

Whiteheads: These occur when pores get blocked by sebum (skin oil produced by the sebaceous glands). The blocked pores contain dead skin cells and bacteria. They appear on the skin’s surface as tiny white spots. They are the first in the life cycle of acne vulgaris and this type of acne occurs before blackheads.  This is called a closed comedone as it stays just under the surface and forms a white bump. Comedone refers to a basic acne lesion. 

Blackheads: These occur when the pore is partially blocked. The trapped sebum, dead skin cells and bacteria are given a passage way to the surface. They drain on to the skin’s surface as black marks (not due to dirt). The black color is due to melanin – the skin’s pigment – reacting to oxygen and to the excess oil. Blackheads are stable structures and do not clear very easily and are called open comedones. 

Papules: These are inflamed types of acne. They are red and tender bumps that do not have a head. They are solid and raised. The redness is caused due to inflammation. It is usually has a circumference of less than a centimeter and does not have pus. It occurs when dead skin cells on the surface are not cleansed properly. They can combine with sebum and blog follicles. The blocked hair follicles prevent oxygen from escaping, and create a good environment for bacteria to dwell. It is the bacteria which appears on the skin’s surface as red bumps. Papules heal quickly and do not leave scars unless they are squeezed or pinched. 

Pustules: These are inflamed acne lesions with a white or yellow head. Pustules are also known as zits. They contain pus and have a red base.   When hair follicles get clogged and infected by P.acnes bacteria, they can sometimes burst from the pressure. The infection then spreads to surround tissues. Pus builds up because of white blood cells that try to fight the bacteria.

Macules: Macules are atrophic scars that are round, flat and pink or red in color. They can be indented and a few millimeters wide. acne vulgarisMacules may last for a few days or few weeks. If you leave your pimples alone, the scars are less noticeable and disappear quickly. If they are pricked will they spread and become permanent. 

Severe Acne Vulgaris

Nodules and cysts are severe types of acne vulgaris.

Nodules: These are larger than the smaller pustules or papules. They are painful to the touch and can last for months. Nodules appear as large bumps that are hard. They are deep seated under the skin’s surface. Scarring is common with nodules. Unresolved nodules can flare up several times if they leave an impaction behind. Squeezing nodules can cause severe skin trauma and extend the healing process. Dermatologists often treat such scarring by injecting each nodule with cortisone. 

Cysts: These are pus-filled nodules that are painful and cause scarring. These cysts take long to heal and usually leave scars behind. It usually occurs if pimples are not treated properly and they leave scars. The infection remains and turns into cysts. There are several effective treatments for acne cysts. Pinching cysts can cause deep seated infection that will last for months. 

More Acne Types

There are even more severe types of acne. These occur rarely but cause immense hardship and emotional trauma to those who suffer from them. 

Acne Conglobata: This is a severe and chronic type of acne vulgaris. It is characterized by deep abscesses, inflammation, and types of acnescarring and very severe skin damage. Open comedones (blackheads) are very widespread and prominent. Acne conglobata occurs usually on the neck, face, upper arms, trunks and buttocks. Multiple comedones are surrounded by several inflammatory nodules. Keloid-type (keloids are large scars which are raised and spread over a wide area beyond the original wound) scars occur with crusts on top under which lie deeply ulcerated nodules.

Burrowing lesions cause deep and irregular scars. An outbreak of acne conglobata can be preceded by papules, cysts or pustules. These may not heal completely but worsen quickly. Sometimes, acne conglobata can occur over acne lesions that have lain dormant for several years. Males (18 – 30 years) are more prone to this type of acne than females. 

Acne Rosacea : Acne Rosacea looks similar to acne vulgaris and both are usually confused for the other. Acne rosacea usually occurs in people over 30 years. It is confined mostly to the nose, cheeks, chin and forehead. It appears as a red rash together with pimples, bumps and skin blemishes. Those with acne rosacea have prominent blood vessels. While acne rosacea occurs more in women, men suffer severe outbreaks. Blackheads do not form part of acne rosacea. If this condition is not treated, it can lead to rhinophyma – that causes a bulging nose and excess growth of tissues.

Acne Fulminans: This occurs very suddenly and can cause lot of trouble. It is characterized by fever, severe inflammation, aching joints of the knees and hips. The symptoms are severe and the acne is ulcerative. Those who had unsuccessful treatment for acne conglobata could develop acne fulminans.   Young Caucasian men are often affected by acne fulminans and they suffer from disfiguring scarring. Since symptoms are so severe, patients may require 3-5 weeks of hospitalization. This type of acne may not respond easily to a course of antibiotics and will require stronger medication like isotretinoin or oral steroids.

Nodulocystic Acne : This is characterized by very large cysts with a diameter of several centimeters. The cysts maybe singular or spread all over the face, scalp, neck, chest, back and shoulders. It is very severe and not similar to an ordinary cyst. The origin of this type of acne could be nodular or papular lesions. The cysts will be filled with pus-like thick, yellow fluid and be inflamed and infected. A physician must drain such cysts. If nodulocystic acne occurs close together, the lesions may coalesce and form soft areas with tunnels. This can result in cell destruction and lead to acne conglobata.

Gram-negative folliculitis: This very severe type of acne affects the hair follicles on the skin. Hair follicles get infected by bacteria. One cause could be long term treatment with antibiotic. ‘Gram’ is a blue stain that a technician uses in laboratories to spot microscopic organisms. Since these bacteria that causes acne do not stain blue, the condition is called ‘gram negative folliculitis’. 

Pyoderma Faciale: This is also called Rosacea Fulminans. It occurs only women in the age group of 20 – 40 years and it is very severe facial acne. Patients suffer from large pustules or nodules that are extremely painful and sore that will leave scars. It can even affect women with no prior acne attacks. It usually disappears within a year but in that time, it wreaks havoc on the skin and psychology of the sufferers.