Acne, formally known as acne vulgaris, is a very misunderstood skin condition that most people experience at some stage in their life. It is often used as a vague word to describe anything from red marks and hormonal breakouts to having scars from older pimples, but actually acne is much more than that. I’m going to explain the different types of acne, to help you determine which treatment options are right for you.
Acne is divided into mild, moderate and severe subtypes which are based on presence of certain characteristics as well as the amount and duration of symptoms. Although it is often observed on the face, it is also very common to find acne on the chest, shoulders and back.
Non-inflammatory acne is the mildest form, which most of us see at some point. Whilst pores might be blocked, there is no inflammatory response from the body. Non-inflammatory acne is shown in the form of comedones.
A comedo (plural comedones) is the name given to a hair follicle within the skin that has become clogged up. Comedones are what we see as whiteheads and blackheads and are a common characteristic of early acne. The hair follicle shows as a pore, and can be clogged by excess oil, dead skin cells and other impurities.
Open comedones are prone to oxidisation, which discolours all the impurities clogging the pore, and are known as blackheads. Whiteheads on the other hand are closed comedones and display themselves as small white spots.
Inflammatory acne is a moderate form of acne, which occurs when comedones become inflamed and irritated.
These are the most common type of inflamed acne. They show as small, pink bumps on the skin, which may feel tender to the touch. Your skin might look a little rough in texture and these are usually present on the face rather than the body.
Papules are usually formed after a comedone becomes irritated and swells up. The inflammation is caused by white blood cells rushing to the area. Papules tend to be what most of us think of as ‘under the skin spots’.
Pustules are what we usually think of as spots; a raised, sore spot, with a yellow or white centre that shows on the skin.
The visible centre is caused by the white blood cells rising to the surface and showing as pus. These tend to be similar in size to the papules and can be quite red and painful.
Macules come after papules and pustules. They are that red, puffy mark that is left by a healing spot. Left alone, they should disappear, but if they are picked at it can cause scarring, or even more acne.
This is the least common form of acne, and it can be very painful. It tends to take 2 different forms.
These are the most developed and severe form of acne. Cysts are formed from a build up of oils, fluids and white blood cells under the skin’s surface, showing as large, pus filled lesions.
Cysts, especially on the body, resemble boils. They can be very painful to touch and can last for weeks at a time. They can be on the chest, back, shoulder and arms as well as on the face.
Nodules are much larger in size and develop inside the skin layer. They are quite firm and can be very painful to touch. Unlike cysts, they don’t tend to show any pus; they feel like spherical objects under the skin, without an obvious opening and can last for many days.
Both nodules and cysts tend to extend fairly deeply into the layers of the skin, meaning they can take a long time to heal and leave unpleasant scars. It is especially important to seek treatment for these, to minimise the impact.
What Type of Acne do you Have?
Whilst all acne can feel debilitating, from a medical perspective, we consider different types of acne to be mild, moderate or severe.
- Mild Acne: This tends to mean you have fewer than 15 inflamed spots and under 30 non-inflammatory spots at any one time.
- Moderate Acne: This usually means you have under 50 inflamed spots and under 100 non-inflammatory spots at any one time.
- Severe Acne: If you are suffering from large numbers of inflamed spots, cysts and nodules, then your acne would usually be considered severe.
All acne can feel severe, regardless of the medical opinion, so it is important to try to treat it in the best way possible and to ask for medical advice.
This is especially true for severe acne, as nodules and cysts, left untreated, can develop into the most severe form of acne known as conglobata. This is when multiple nodules merge together to form much larger irregularly shaped lesions which often stay within your skin for weeks and cause severe scarring. Very often this type of acne will require prescription medication in order to achieve effective treatment.