the acne basics

Acne is a disease involving the oil glands and hair follicles of the skin, which is manifested by blackheads, whiteheads, acne pimples and acne blemishes. On some individuals, cysts and nodules (deeper skin lesions) may appear. Acne is one of the most common skin diseases in the U.S.

While acne can affect anyone at any age, it usually begins at puberty and worsens during adolescence. 67% of people who have had acne report having experienced their first breakout by 13 years of age (deKadt Facial Skin Care Market Study, Acne Sufferers, 2006).

how acne begins

 

	FIGURE 1.a  A normal pilosebaceous unit consisting of sebaceous glands and a small hair follicle. In each pore or sebaceous hair follicle, sebaceous glands are working to produce sebum, oil from your body that it needs to keep skin moist. At puberty, the level of androgens (male hormones, which women also have) increases, causing the sebaceous glands to go into overdrive and produce excess sebum. This excess sebum combined with dead, sticky skin cells and/or bacteria creates the perfect set-up for breakouts.
FIGURE 1.b  Blockage of follicle opening leads to the formation of a microcomedone, which is below the skin surface and thus known as the invisible origin of acne. It’s important to note that an acne breakout begins two to six weeks before you actually see it appear on your skin, which is why sticking to a regular acne care routine is important for treating the acne you can already see and for helping prevent acne from occurring.
While all breakouts start off the same way, they can take on many forms and be present in different proportions depending on each individual and her or his unique skin condition. For example, some people tend to get pimples frequently, while others have mostly blackheads and whiteheads with only occasional pimples. That’s why it’s important to get the right treatment for your acne.

types of acne

FIGURE 2.  Stages of acne. (A) Normal follicle; (B) open comedo (blackhead); (C) closed comedo (whitehead); (D) papule; (E) pustule. More severe forms of acne lesions such as cysts and nodules are not shown.

There are two types of acne: non-inflammatory acne and inflammatory acne.

Non-Inflammatory Acne

Whitehead or closed comedo: a clogged follicle that usually appears on the skin as a small, whitish bump
 
Blackhead or open comedo: a clogged follicle that usually appears on the skin with a dark tip due to the buildup of melanin (the skin’s dark pigment)
 

Inflammatory Acne

Papule:
• First sign of inflammatory acne
• Small, firm pink bump raised to varying degrees
• Can be tender to the touch
 
Pustule:
• Like papules but with visible pus (red at base with yellowish or white center)
 
Nodule or cyst:
• Large, usually very painful
• Inflamed, pus-filled lesions deep within skin
• Contents have spilled into the surrounding skin infecting the area
• Most severe form of acne lesion
• May persist for weeks or months
• Often leaves deep scars
 
Acne conglobata:
• Rare but serious form of inflammatory acne
• Primarily occurs on back, buttocks and chest
• Exists in the presence of papules and pustules
• May also have severe bacterial infection