How Acne Forms

Acne lesions are created by plugged follicles. When a follicle is blocked, sebum (oil) gets trapped below the skin’s surface. With the sebum trapped, bacteria begins to grow, causing the follicle to appear as a whitehead or blackhead. Papules or pustules may form if the follicle walls break under the pressure of the trapped sebum, resulting in inflammation. In more severe cases of acne, a nodule or cyst may form. Scars are created when a nodule or cyst ruptures, resulting in an “ice pick” mark. Most forms of acne vulgaris can be effectively cleared up using at-home acne treatments; however some cases require oral medication, antibiotics or in-office procedures performed by a dermatologist. Before attempting to treat acne at home, visit your dermatologist to determine the best acne products for your skin.

• Noninflammatory whiteheads are formed when sebum and bacteria remain blocked below the skin’s surface due to a completely closed pore. This causes a white appearance at the surface of the pore, hence the name. Whiteheads usually clear up faster than blackheads.

• Noninflammatory blackheads are formed when the pore is partially opened at the surface, allowing sebum, bacteria and skin cells to become exposed to the air, which results in oxidization. Because sebum and skin cells contain melanin (the skin’s pigment), oxidization creates the brown or black color that the blackhead is named for.
• Inflammatory papules are formed when there is a break in the follicle wall of a noninflammatory lesion, allowing white blood cells to pour in and create inflammation. Papules are red, tender and do not have head. Do not try to squeeze or pop a papule! It will not release any of the built up sebum, bacteria or skin cells and can cause pain or even scarring.
• Inflammatory pustules are formed from papules when the white blood cells appear at the surface of the skin, creating what most people call a “pimple”. Pustules have a red base and a white or yellow center. It is best to allow pustules to heal on their own. However, because they can be quite unattractive, you may wish to gently release the built up pus. Before you attempt to pop a pustule, research the safest and most effective ways to release the built up debris in order to minimize discomfort, pigmentation issues and scarring.
• Inflammatory nodules are formed when a papule or pustule collapses, creating a large, hard lump that is often tender and sore to the touch. Nodules can last for weeks or months and often leave scars. Nodules can also leave an impaction behind which is likely to flare again and again, creating an embarrassing cycle. Never, ever attempt to squeeze a nodule. If a nodule becomes extremely painful or you wish to seek relief from the redness and inflammation, visit your dermatologist.
• Inflammatory cysts are formed when severe inflammation occurs, resulting in a large and tender pus-filled lesion. Although nodules and cysts are similar in appearance, cysts are full of pus and typically measure 5mm or more across. Like nodules, pain and scarring are common with cysts, and it is very unwise to try to pop a cyst. If you are affected by cystic acne, visit your dermatologist.
• Acne Rosacea is a skin condition which is often mistaken for common Acne Vulgaris. Acne Rosacea appears as a red rash that often has bumps, blemishes and pimples. It generally affects the “T-zone” which consists of the forehead, nose, chin and cheeks. Rosacea is best treated by a dermatologist, although home acne treatments do exist.

Rare Forms of Acne

• Acne Conglobata is the most severe form of Acne Vulgaris. Those affected by Acne Conglobata experience large, widespread and sometimes interconnected lesions, as well as many blackheads. It often results in disfiguring skin damage and scarring. Acne Conglobata is generally found on the face, back, chest, arms, buttocks and upper thighs. Although it is very difficult to treat Acne Conglobata, aggresive forms of treatment may provide some relief from this physically and emotionally painful form of acne.
• Acne Fulminans is the abrupt onset of Acne Conglobata. It features the same characteristics of Acne Conglobata, as well as fever and aching of the joints.
• Gram-Negative Folliculitis is a bacterial infection that causes pustules and cysts. Because it is quite rare, not much is known about Gram-Negative Folliculitis, although it may be caused by long-term use of antibiotics for the treatment of acne vulgaris.
• Pyoderma Faciale (Rosacea Fulminans) is a form of severe facial acne characterized by sores, pustules and nodules. It affects only females, generally between the ages of 20 and 40, and usually clears up in under a year. Although it has a relatively short lifespan, Pyoderma Faciale can cause severe scarring and damage that often remains a reminder of the condition for a lifetime if left untouched by an acne scar treatment.

Photos courtesy of the National Institute of Health and Photobucket.com users solarvirga and stereonation71.