Different types of acne

Acne is a common inflammatory condition of the skin characterized by both less severe non-inflammatory lesions, as well as the severe inflammatory type. It is mostly prevalent during adolescence and can aggravate a difficult period of physical and psycholsocial development in the life of the individual.

Although not life threatening, it has significant clinical, as well as psychological impact on the individual due to severe inflammation and permanent residual scarring that occurs on the face, chest and back. This can lead to feelings of low self esteem, social withdrawal, depression, anxiety and stress. Severity of this disorder thus causes both mental as well as physical discomfort.

Four main subtypes of severe acne can be diagnosed: acne conglobata, acne fulminans, gram-negative folliculitis and nodulocystic acne.

a) Acne vulgaris

Acne vulgaris is the most common type and involves the initial development of comedones which are blackheads and/or white heads. Blackheads are plugs of sebum that build up in affected hair follicles where the plug is open to the skin surface. Whiteheads are also plugs of sebum in hair follicle canals but in this case the hair canal is closed over by dead skin. These comedones are non-inflammatory. When comedones get bigger they rupture the follicular walls, causing an inflammatory response that result in papules, pustules and nodules. These inflamed spots are the classic presentation of acne vulgaris.

b) Acne Conglobata

Acne conglobata is a chronic and severe form which is characterized by deep abscesses, inflammation and widespread damage to the skin. Scarring blackheads or open comedones are found conspicuously and distributed thickly on the face, neck, trunk, upper arms and back. This form is unique in the formation of inflammatory nodules around multiple comedones that become bigger until they rupture and release pus. Ulcers formed after rupture result in deep uneven scars.

c) Acne Fulminans

Acne fulminans is characterized by a sudden occurrence of highly debilitating inflammation. This results in ulcerating acne, fever, inflammation and pain in the joints of hips and knees. Acne conglobata, when unsuccessfully treated, can give rise to this form of acne.

d) Nodulocystic Acne

Nodulocystic acne occus in isolation or in thick clusters on the face, neck, scalp, back, chest and shoulders. They measure several centimeters in diameter and are usually painful. The nodular cysts are inflammatory nodules arising from popular or nodular acne lesions or from cysts in outer epidermal layer. The inflamed and infected cysts can often coalescing and form acne conglobata.

Gram-negative folliculitis

Gram-negative folliculitis is an inflammation of follicles caused by gram negative bacteria. They usually result from prolonged antibiotic treatment that leads to resistance to gram negative bacteria leading to folliculitis.

Acne in females

Acne is also more common amongst women with the onset of menses. This occurs due to ovarian or adrenal hypersecretion of androgenic hormones resulting in severe sebum secretion. In adulthood they occur mostly before menstruation. Hormone therapy is considered to be effective.

Infantum or Pre-pubertal acne

Acne is sometimes found to occur in infants immediately after birth and present till they are 6 months of age. The cause of the acne is due to high levels of DHEA that has crossed the placenta from the mother into the baby shortly before birth. This type of acne is generally not treated as it clears up of its own accord as the mother’s DHEA is gradually metabolized and cleared from the infants blood.

Treatment of acne types

Isotretinoin and antibiotics are the usual treatment of choice for acne conglobata, nodulocystic acne and gram-negative folliculitis. Prolonged courses of treatment may be necessary over a period of years. Corticosteroids or non-steroidal anti-inflammatory medications may help reduce inflammation in acne fulminans. Some very large follicular cysts that do not respond to medications may require drainage and surgical excision.