Which Form of Acne Do You Have?
There are so many kinds of acne that you practically need a scorecard to keep up. Understanding your personal form of acne, however, is essential to choosing the right acne treatment. Different kinds of acne require different kinds of treatment1, and what is helpful for one acne form may be harmful for another.
- Acne vulgaris, a term that literally means “common acne,” is the most common form of acne.
- Not all kinds of acne are caused by infection, and not all acne infections stay on the face.
- Rosacea is a form of acne that has very little to do with sebum accumulation and a great deal to do with hyperactivity of the peripheral nervous system. The detergents that sometimes are successful for treating common acne on oily skin can have a devastating effect on rosacea.
- Different ethnic groups tend to get different kinds of acne.
Understanding Acne Vulgaris
Acne vulgaris is the common acne that nearly all people experience during adolescence2. This form of acne occurs when pores are clogged with wicks of solid sebum, the normally liquid oil that helps lubricate the face to prevent wrinkling. The tightness of the pores may be a reaction to pain or to sex hormones, and this form of acne may or may not cause inflammation.
Whiteheads and blackheads are known as non-inflammatory comedones. A whitehead is just a plug of waxy sebum that is stuck in a pore. A blackhead is a plug of waxy sebum that has oxidized. Pimples, pustules, and papules are red, itchy, tingly, tender, and sometimes painful because of inflammation. This inflammation may be caused by the release of peroxides by acne bacteria trapped in the pore, or by the action of the immune system trying to contain the infection.
Acne vulgaris is most common on the nose and around the eyes3. It rarely is found on the neck and back or elsewhere on the body. It can occur at any time of life, but is most common beginning about the age of 8 and 18, when the adrenal glands begin to mature, until the age of 18, when sex organs completely mature.
Another common form of acne, affecting up to 1 in 10 people of Scandinavian or British descent4, is rosacea. This form of acne usually is limited to the nose and cheeks5. It causes tiny pimples rather than big pimples, but it can change the structure of tissues beneath the skin.
Hypersensitivity to cold, heat, fumes, and spices trigger a reaction in the nerves of the face that sends blood rushing to the skin and reddens the face. The reaction may be so intense that tiny bumps that look like pimples break out in minutes. These bumps, however, are not caused by bacteria.
Most of the “heavy duty” treatments that work for some cases of acne vulgaris actually make rosacea worse. Any kind of irritation to the face, nose, or mouth, drinking a cup of hot coffee, for instance, or stepping outside into cold wind or dry desert heat, can make the condition quickly worse. A variation of rosacea known as acne graminata occurs in up to 1 in 10 people of African heritage, causing a thickening of the skin across the nose and cheeks without obvious redness.
Understanding Acne Conglobata
Acne congoblata is a severely disfiguring6“burrowing” form of acne in which bacterial infection spreads from pimple to pimple underneath the skin. Most common in men who have an extra X chromosome, acne conglobata usually strikes between the ages of 15 and 18, but can even occur in infants. There is also a hereditary white blood cell abnormality that can cause the disease.
The presence of acne conglobata does not necessarily mean someone has an extra X chromosome. An even worse form of this disease, known as acne fulminans, sometimes occurs in women as well as men in their teens and early 20’s. Acne fulminans can spread to bone. Fortunately, both of these conditions are rare.
Treatment of acne conglobata and acne fulminans always requires medical supervision. A variety of potent medications including retinoids (such as Accutane or Retin-A) and dapsone (also used to treat a kind of gluten sensitivity that causes skin problems) along with laser treatment is usually required.
Understanding Staph Infections of the Skin
Staph infections of the skin are not really acne7, but they are often confused with acne. A staph infection can cause a tiny raised pimple with a round yellow center. If you were to pop this pimple (which is something you should not do) it would squirt out clear or yellow pus. Staph infections of the skin occur when a different microorganism, Staphylococcus aureus, gets trapped in pores.
This much more aggressive bacterium can spread from the skin to other parts of the body. Common acne bacteria only infect the inner organs when the immune system is weakened by chemotherapy, radiation, or HIV.
If you notice pimples with yellow centers, standard acne treatments won’t work. In fact, most of them will just spread the infection to other parts of your skin. Treat staph infections of the skin from the inside out, either with natural immunostimulants, such as echinacea, or appropriate antibiotic therapy.
Understanding Acne Keloidalis Nuchae (AKN)
Acne keloidalis nuchae8, also known by its acronym AKN, is a particularly disfiguring form of acne that most often strikes people with very dark skin tones, typically people of African or South Asian descent. This form of acne usually starts in a hair shaft rather than in a skin pore. It is itchy, then painful. It triggers the formation of a dense mat of tough collagen that makes hair fall out and stands out as a pink raised scar.
The most common trigger for this form of acne is shaving the head or getting “bald fades.” Hairs get bent over and trapped in their follicles. Various kinds of bacteria may accumulate in the follicle, but the damage to skin is done by the immune system, not bacteria. The lesion may drain, but the fluid is not pus.
Understanding Acneiform Eruptions
Acneiform eruptions10 are skin outbreaks that look like acne but are not acne. They may be caused by chemical exposure, tumors in hair follicles, steroid use, or syphilis. Usually there are other symptoms that make the nature of the outbreak obvious.
If you have a condition that looks like mild to moderate acne, chances are that it really is mild to moderate acne. Awareness of other possibilities, however, can keep you from pursuing acne treatments that will not work for you.
- Tailored acne treatments help women address adult acne with the added benefit of improving aging skin | American Academy of Dermatology. Aad.org. 2019.
- Aydemir EH. Acne vulgaris. Turk Pediatri Ars. 2014 Mar 1;49(1):13-6.
- Purdy S, de Berker D. Acne vulgaris. BMJ Clin Evid. 2011 Jan 5;2011:1714.
- Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018 Dec 3;7:F1000 Faculty Rev-1885. PMC6281021
- Picardo M, Eichenfield LF, Tan J. Acne and Rosacea. Dermatol Ther (Heidelb). 7(Suppl 1):43-52.
- Hafsi W, Badri T. Acne Conglobata. [Updated 2019 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.
- Totté JE, van der Feltz WT, Bode LG, van Belkum A, van Zuuren EJ, Pasmans SG. A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea. Eur J Clin Microbiol Infect Dis. 2016;35(7):1069-77.
- Al Aboud DM, Badri T. Acne Keloidalis Nuchae. Treasure Island (FL): StatPearls Publishing; 2019 Jan.
- Ogunbiyi A. Acne keloidalis nuchae: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2016 Dec 14;9:483-489.
- Nair PA, Salazar FJ. Acneiform Eruptions. [Updated 2018 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.
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