Understanding and Treating the Most Common Types of Acne
All acne types are not created equal, and all acne types do not cause the same degree of damage to the skin. Nearly everyone has mild to moderate common acne, or acne vulgaris, at some point in life, usually between the ages of 8 to 18. Some other kinds of acne, however, are not just a cosmetic burden. They can be even be a threat to life itself.
- Not everything that looks like acne is actually acne.
- Nearly everyone has the most common form of acne, acne vulgaris, between the ages of 8 and 18.
- People who have fair skin get acne earlier. Fair skin acne is primarily caused by stress hormones.
- People who have dark skin acne get acne later. Dark skin acne is primarily caused by fluctuations in testosterone.
- Pimples that suddenly appear on the back and shoulders after an infection may be psoriatric acne, also known as guttate psoriasis.
- Pimples that pop up on the nose and cheeks after changes in temperature are usually rosacea.
- Steroid abuse can cause a potentially deadly form of acne known as acne fulminans.
- Shaving the head can cause a kind of acne that leaves permanent scars, especially in young men who have dark brown or black skin.
Acne vulgaris is the medical term for “common acne.” People all over the world get this kind of acne in late childhood or adolescence. In people of European descent, it usually first occurs as the adrenal glands mature to the point they can make the a chemical called DHEA, which is turned into the stress hormone cortisol. In people of African descent, it usually first occurs when the body starts making the sex hormone testosterone, which occurs, in different amounts, in both males and females at puberty. In people of Asian, Middle Eastern, and Hispanic descent, common acne is not quite as common. People who have golden skin tones tend either not to get acne or to get another, more severe form later in life.
Common acne usually goes away on its own, no matter how many mistakes you make in skin care. This process, however, can take 5 to 10 years, which is a long time to be bothered with blemishes. If there is any single principle of skin care that everyone who has acne vulgaris needs to know, it is this:
Never try to scrub acne away.
The things people who have this the most common of acne types do to get rid of blemishes often make them worse. Vigorous scrubbing with a cloth or a brush (acne “scrubs” applied to the skin without mechanical force are OK), picking at pimples, steaming away pimples, applying ice, or even worse, dry ice to pimples, and products that are too harsh for the skin type can leave permanent blemishes that last long after whiteheads and blackheads have fallen out of pores and pimples have healed.
Always use gentle skin care. And if you don’t know what to use, start with a treatment system like Exposed Skin Care.
Nodular and Cystic Acne
Nodules and cysts are common acne gone bad. They are usually caused by picking at, probing, needling, mashing, smashing, or lancing pimples. Bacteria get forced into the skin. Pink skin grows over the infection, locking it inside, where it gets bigger and bigger, more embarrassing and more painful.
It’s a bad idea to open pimples on your own. It’s a worse idea to dry to drain your own cysts or lance your own nodules. These kinds of acne do not respond to surface level treatments. Short of surgery, the only thing to be done for them is treatment with Accutane (isotretinoin) or Retin-A (tretinoin), which stimulate the skin to grow so fast it literally opens up over these deep skin infections. Treatment with these medications, however, has a side effect: It usually triggers even worse acne vulgaris, requiring even more diligent attention to cleansing, exfoliation, moisturizing, and antiseptics.
Psoriatic acne, also known as guttate psoriasis, really is not acne at all. It is not caused by excessive oil solidifying in a pore, like whiteheads or blackheads, or by the immune system’s attack on acne bacteria, like a pimple. Psoriatic acne is a collection of small, painless, salmon-colored pimples that appear on the back and chest, then the legs and thighs, and sometimes on the face, ears, and scalp. Children often get psoriatic acne around the anus, causing intense itching.
This form of acne usually occurs after an infection. The microorganism can be a fungus, such as yeast (Candida) or Malassezia (the fungus that causes seborrheic dermatitis) or a bacterium, especially Staphylococcus aureus. It can also be caused by HPV, the human papillomavirus, the same family of viruses that causes genital warts. The immune system becomes over-activated after the infection and causes the formation of tiny acne-like pimples.
Treatment of psoriatic acne usually involves treatment with steroids or UV-B light—which is not the same as the blue light used to treat common acne.
Rosacea is a highly reactive condition of the skin that causes tiny red spots to break out over the cheeks and on the nose. These red spots are due to a breakdown of blood vessels in the skin, causing them to leak. The leakage of blood turns the skin red, unless the blood vessel is large enough to leave a purple blotch.
This leaking of blood vessels is caused by an overreaction to signals from the nervous system to relax the walls of the blood vessel to cool off the blood. That is why rosacea breaks out after drinking a cup of hot coffee, or coming in to a warm room on a cold day, or after eating spicy foods. Rosacea does not involve acne bacteria, but certain stomach infections and skin mites can increase the risk of the disease. Treatments that work for common acne do not work for rosacea.
Other Forms of Inflammatory Acne
There are other rare forms of acne that can cause problems far below the skin.
- Acne conglobata causes areas of infection that grow together under the skin. Most common in women and in men who have a condition known as Klinefelter’s syndrome (two X chromosomes with one Y chromosome), acne conglobata can occur anywhere on the body from the thighs up. Cysts fill with a foul-smelling fluid that returns even after they are drained, and the condition can also enter the joints and cause kidney damage.
- Acne fulminans is a bacterial infection that usually strikes the joints first and then causes severe breakouts on the skin all over the body. It strikes suddenly, most commonly in men who use anabolic steroids and injected testosterone. Even though it is caused by the same species of bacteria that causes common acne, antibiotics have little effect on this disease.
- Acne keloidalis nuchae is an acne that occurs in hair shafts rather than in skin pores. Most common in young Black and Hispanic men, it most commonly occurs on the scalp after shaving the head. It is essential to stop using pomades and shampoos, and preventing permanent scars to the scalp usually requires a combination of Accutane, benzoyl peroxide, antibiotics, and steroids.
- Acneiform eruptions are blemishes that look like acne but that are caused by something other than acne bacteria. Dozens of different microorganisms can cause pimples on the skin, but they usually also cause other symptoms.