Healthy Living Solutions

There are many types of acne. Acne usually appears on the face, back or chest as blackheads, spots or pustules. Most people think of acne as a skin affliction limited to those in their teen years. However, it is not just teenagers who have acne. It affects between 25 to 50 percent of all adults at some time in their lives. Acne can also be much more severe than oily skin and whiteheads. Severe acne can even be disfiguring. Acne can be both physically and emotionally difficult for people of all ages with all severities.

There are two general types of Acne. They are Acne Vulgaris and Acne Rosacea.

Acne Vulgaris is characterized by blackheads, whiteheads, papules, pustules, nodules and cysts. Nodules and Cysts can both be quite severe, painful and even disfiguring.

Blackheads	A blackhead is defined as - A yellowish or blackish plug of material accumulated in the duct of a sebaceous gland. The material consists of keratin (horny cells of the epidermis) and modified sebum (oily secretions of the sebaceous gland). Blackheads are the primary lesions in acne. Treatment is the same as for acne, with frequent cleansing of the skin and a healthy diet. Blackheads result when a pore is only partially blocked, allowing some of the trapped sebum (oil), bacteria, and dead skin cells to slowly drain to the surface. The black color is not caused by dirt. Rather, it is a reaction of the skin's own pigment, melanin, reacting with the oxygen in the air.
Whiteheads	Whiteheads result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells, causing a white appearance on the surface. The bacterium in a whitehead turns the sebum to “free fatty acid” thereby causing the white color.
Papules	Papules are small, red, tender bumps or spots.
Pustules	Pustules or “Zits” are similar to whiteheads, but are inflamed, larger, red and puss-filled. A pustule will appear as a white or yellow center surrounded by a red or inflamed circle.
Nodules	Nodules are large, hard bumps under the skin's surface. Scarring is common. Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring. A nodule may be very painful. Nodular acne is a severe form of acne.
Cysts	A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic. Some acne investigators believe that true cysts rarely occur in acne, and that (1) the lesions called cysts are usually severely inflamed nodules, and (2) the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form of acne that is often resistant to treatment and likely to leave scars after healing.

Acne Rosacea is characterized by red blotches on areas of the face and forehead. It can sometimes be difficult to differentiate between Acne Rosacea and Acne Vulgaris.

Rosacea affects millions of people, most of whom are over the age of 30. It appears as a red rash which is normally confined to the cheeks, nose, forehead and chin. The redness is often accompanied by bumps and pimples. Blood vessels may also become more visible on the skin. Blackheads are not a part of rosacea. It is more prevalent in women, but often more severe when found in men. Left untreated, it can cause swelling of the nose and the growth of excess tissue, a condition called rhinophyma. Treatment is often different for rosacea than for acne, and it is important that you consult a doctor who can determine if what you are experiencing is acne vulgaris or rosacea.

Other severe types of acne include Acne Conglobata, Acne Fulminans, Gram-negative Folliculitis and Pyoderma Faciale.

Acne conglobata: This is the most severe form of acne vulgaris and is more common in males. It is characterized by numerous large lesions, which are sometimes interconnected, along with widespread blackheads. It can cause severe, irrevocable damage to the skin, and disfiguring scarring. It is found on the face, chest, back, buttocks, upper arms, and thighs. The age of onset for acne conglobata is usually between 18 and 30 years, and the condition can stay active for many years. As with all forms of acne, the cause of acne conglobata is unknown. Treatment usually includes isotretinoin (Accutane), and although acne conglobata is sometimes resistant to treatment, it can often be controlled through aggressive treatment over time.

Acne fulminans: This is an abrupt onset of acne conglobata which normally afflicts young men. Symptoms of severe nodulocystic, often ulcerating acne are apparent. As with acne conglobata, extreme, disfiguring scarring is common. Acne fulminans is unique in that it also includes a fever and aching of the joints. Acne fulminans does not respond well to antibiotics. Isotretinoin (Accutane) and oral steroids are normally prescribed.

Gram-negative folliculitis: This condition is a bacterial infection characterized by pustules and cysts, possibly occurring as a complication resulting from a long term antibiotic treatment of acne vulgaris. It is a rare condition, and we do not know if it is more common in males or females at this time. Fortunately, isotretinoin (Accutane) is often effective in combating gram-negative folliculitis.

Pyoderma faciale: This type of severe acne affects only females, usually between the ages of 20 to 40 years old, and is characterized by painful large nodules, pustules and sores which may leave scarring. It begins abruptly, and may occur on the skin of a woman who has never had acne before. It is confined to the face, and usually does not last longer than one year, but can wreak havoc in a very short time.