Acne and Its Types

Acne in Singapore is an inflammatory condition of hair follicles and oil glands present on the skin. It is an unpleasant and socially unacceptable skin condition that has clear signs and symptoms visible on the facial skin. Usually starting at the age of 12 for boys and 10-11 for girls, this skin condition affects an both teens and adults. The actual cause in teenagers is hormonal changes secondary to the onset of puberty that leads to the production of more hair follicles and oil glands. Besides hormonal changes, improper skin cleansing, microbial infections and dietary triggers are also known to cause acne.

Types of Acne

Acne can present itself in various types ranging from mild to severe form. For effectively treating the condition and taking necessary preventive measures, you need to determine the exact type of acne you are suffering from. Depending on the cause, acne can be divided into following types.

Non-inflamed Acne (Blackheads and Whiteheads)

As its name suggests, this type of acne is not due to any inflammatory process rather it appears as non-inflammatory pebbles under the skin. These pebbles are formed due to clogging of the hair follicle and can be further classified as whiteheads and blackheads; depending on their respective colour.

Blackheads – Also called “open comedones”, blackheads are the non-inflammatory skin lesions that are formed due to the accumulation of dead skin cells and sebum under the skin. When this pebble bursts and expose to the oxygen in the environment, it darkens and changes its color to black.

Whiteheads – These are actually blackheads that are still immature and not exposed to the environmental oxygen, therefore retain their original white colour. As they remain closed before turning into blackheads, they look like bumps under the skin and are also called “closed comedones”. A whitehead will eventually open up due to many environmental triggers and become exposed to oxygen to turn into a blackhead.

If your face is filled with comedones, you might have a high number of hormone receptors. As a result, you will get more whiteheads and blackheads whenever there will be a gush of androgen hormones in your blood. The characteristic features of non-inflamed acne include;

• Strong genetic predisposition
• Usually affects teenagers and young adults
• Sluggish and dull appearance of the skin
• Congestion of the tissue
• Prominent blackheads and whiteheads
• Few or no inflamed papules
• Triggered by stress, hormonal drugs and other environmental factors

These comedones start fading when there is no more clogging of hair follicles or decreased hormone sensitivity towards high levels of androgens. They usually disappear after a certain age (when you achieve a steady state level of androgens in your blood) or after treatment with hormone receptor blocker medications that block hormone receptors and help you get rid of acne breakouts. Aggressive skin care that involves washing and exfoliating your skin with special skin care products can also help reduce comedones.

Inflamed Acne

Clogged skin pores are the hallmark of any type of acne, however, it is the underlying cause and clogged substances that differentiate one type of acne from the other. The main difference between inflamed and non-inflamed acne is the presence of bacteria and active inflammation. Out of several acne-causing bacteria, Propionibacterium acnes (P. acnes) is the most notorious one and causes severe inflamed acne. Besides bacterial infection, genetics, hormonal changes, high levels of humidity and sweating, greasy cosmetics and certain drugs and chemicals seem to play an important role in causing or triggering inflamed acne.

Non-inflamed acne has no deeper roots and causes superficial bumps on the skin, while inflamed acne always has a bacterial basis and causes inflamed, red-coloured and painful bumps. In the beginning, these bumps are smaller in size and called pimples and pustules. If left untreated, it can progress into more severe form, leading to pus-filled cysts that are usually larger in size and extremely painful when touched. Inflamed acne is therefore also called ‘cystic acne.” The characteristic features of cystic acne include;

• Red and swollen skin
• Skin filled with inflamed pimples, pustules and crusts
• Vesicles are extremely painful when touched
• Skin becomes sensitive and reactive to products

Contrary to popular beliefs, inflamed acne is not caused by most dietary choices like chocolate, greasy foods and nuts. It can, however, be triggered by low immunity and certain drugs like lithium, phenytoin, isoniazid, and corticosteroids.

The good news about inflamed acne is that it is quite reactive to home remedies and prescription medications. It usually responds quickly to anti-bacterial and anti-inflammatory drugs like benzoyl peroxide.

Combined Acne

As its name suggests, combination acne involves both types of acne at the same time. In most cases, non-inflamed acne progresses into inflamed acne over time and causes pebbles (whiteheads and blackheads) under the skin to become inflamed and turn into pimples, pustules or cysts. It is a severe form of acne that usually affects adult males after mid-30s and females after menopause.  A majority of people usually experience a single type of acne, however, poor hygiene, self-neglect and failure to get effective treatment usually result in combined acne. It can be characterized by;

• Blackheads, whiteheads, pimples, pustules and cysts at the same time
• Hot and inflamed skin
• Skin may contain scars (the remnants of healed cysts)
• Skin is usually sensitive and reactive to products

Combined acne usually involves greater personal care and strict follow up of most effective medication. The first visible sign that combined acne is going away is the reduction in comedones and formation of acne scars. These nodules and lesions usually leave a scar behind when they start fading after aggressive skin care and combined medical treatment.