ACNE AND ACNE TYPES
What is acne?
Acne is a skin disorder that affects 85-100% of people sometime in their lives, most frequently during their teen-age years but it can continue for years after. It affects the areas of skin with the greatest concentration of sebaceous follicles; these areas include the face, the upper part of the chest, and the back.
What are the causes of acne?
There are many factors that can cause acne, but most commonly the pilosebaceous unit, the pores and hair follicles, become clogged with sebum and keratin debris causing irritation and inflammation of the area, allowing the proliferation of bacteria, manifesting in what we commonly know as ACNE.
What are the most common types of acne?
Acne vulgaris
This is the most common type of acne. It can range from mild to severe and in very severe cases there is a greater risk of permanent scarring. Acne vulgaris is caused by increased production of sebum (oily substance), which is secreted by the sebaceous glands in the skin. (insert picture acne_2). It is released on to the surface of the skin through the hair follicles however, when sebum is overproduced the hair follicles become blocked and the sebum may become infected with bacteria beneath the skin's surface. This then causes the inflammation commonly associated with the condition. Acne vulgaris may also be influenced by genetic factors.
Occupational acne
There are people whose jobs requires them to handle and use different types of chemicals that may irritate their skin. Some of these substances have been shown experimentally to provoke the development of comedones (whiteheads) when applied to healthy skin. Some of the worst cases occur in people exposed to halogenated hydrocarbons, for example chlor-napthalene, which cause a severe and persistent form of acne known as chloracne. There are other substances capable of causing occupational acne, including tar, which causes comedones, and mineral oil, which causes both comedones and folliculitis (inflammation of the hair follicles), which is superficial and often widely dispersed.
Acne induced by drugs or medications
Some of the most common types of medications causing acne are: androgens, ACTH, steroids, Dilantin, Lithium and Isoniazide.
Frictional Acne
Can occur from headbands, football helmets, hats, tight bras, etc.
Acne Cosmetica
Oil-based cosmetics and hair products can also be responsible for predominantly comedonal acne.
Acne Caused by Endocrine Disorders
Congenital adrenal hyperplasia, polycystic ovary syndrome, and other endocrine disorders with excess androgens may trigger the development of acne vulgaris.
What are the clinical manifestations of acne?
Acne is seen most frequently in people with oily skin. The lesions are characterized by comedones, papules, pustules, and nodules.
A comedone is a whitehead, also known as a closed comedone or a blackhead (open comedone) without any clinical signs of inflammation.
Papules and pustules are raised bumps with obvious inflammation.
The face may be the only involved skin surface, but the chest, the back, and the upper arms are often involved.
In comedonal acne, no inflammatory lesions are present. Comedonal lesions are the earliest lesions of acne, and closed comedones are the precursor lesion of inflammatory lesions.
Mild inflammatory acne is characterized by inflammatory papules and comedones.
Moderate inflammatory acne has comedones, inflammatory papules, and pustules. Greater numbers of lesions are present than in milder inflammatory acne.
Nodulocystic acne is characterized by comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter. Scarring is often evident.
Acne can cause physical pain and psychosocial suffering. Acne can lead to scarring primarily in nodulocystic acne and also with frequent manipulation of the acne lesions. A severe inflammatory variant of acne, acne fulminans, can be associated with fever, arthritis, and other systemic symptoms.
Diagnostic Tests for Acne
No diagnostic test is generally required and the diagnosis is based on the clinical appearance of the lesions. However, because acne may be due to other clinical conditions, as we have seen, those patients may need specific laboratory or radiologic testing to identify the cause.
