Acne (also known as Acne Vulgaris or “common acne”) is extremely common and affects almost everybody at some point in their life, but is most common during adolescence. Acne typically presents with areas of skin that may have the following conditions and appearances;
Blackheads – occur when skin debris (formed from keratin) combines with oil and causes your pores to be clogged. These blackheads are also known as comedones. Can occur anywhere but most commonly Zones 4, 10 & 7
Whiteheads – are similar to blackheads but there is skin that is covering your pore, therefore giving a white appearance. Can occur anywhere but most commonly Zones 5, 9, 6 & 8
Pimples – A pimple occurs when a blackhead or whitehead becomes inflamed and starts to develop pus. These lesions are referred to as papules or pustules. A large papule is also referred to as a nodule. Can occur anywhere on face and neck
Cysts – Cysts are large acneform lesions that usually affect areas where sweat collects like your buttocks, groin, and armpits, although cystic lesions can occur in other locations where hair follicles are subjected to excessive perspiration. Cysts in general affect deeper structures of your skin than more common place pimples and can be very painful.
Seborrhea – a reddened area of skin resulting from excessive oil (sebum) secretion. Most commonly zone 2
Location of Acne Lesions
Acne occurs most commonly in areas of your skin that have a high density of hair follicles like your face, chest and back. Notice that you will never see an acne lesion on the palms of your hands or soles of your feet as there are no hair follicles on those surfaces.
Causes of Acne
Acne develops as a result of blockages in your hair and sebaceous (sebum producing) follicles. This blockage is caused by excessive keratinized debris (a type of protein produced by your skin cells) combined with excessive oil (sebum) production. These blocked pores develop into blackheads and whiteheads. When blackheads and whiteheads are present, normal bacteria in the skin become starved for oxygen and a bacterium known as Propionibacterium acnes can grow in abnormal and unhealthy amounts leading to inflammation. This inflammation eventually causes the lesions known as papules, pustules and nodules (commonly known as acne pimples).
Hormonal Influences on Acne
Increased sebum production is a result of specific hormones in your body including testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and progesterone. Consequently, acne breakouts may occur or be worsened during times of hormonal shifts such as occur during your menstrual cycle or times of stress. Also diet and nutrition have effects on your hormonal balance and can lead to acne breakouts. Other lifestyle factors (like sleep-wake cycles, exercise) can result in hormonal changes and have an effect on your skin.
Acne, like all other diseases and conditions has a genetic component as to its cause. If acne “runs in your family” this really means that the aforementioned factors that cause acne (like hormonal disturbances and excess sebum production) run in your family as well.
Scars can result from inflammation which leads to excessive collagen production as your skin tries to heal itself.
Ice Pick Scars – A very common type of scar resulting from acne that causes an indentation in your skin that looks like you were stabbed with an ice pick. These are the most common types of acne scars.
Box Car Scars – These scars often occur on your cheeks and temples and look like indentations.
Rolling scars – These scars have a wavy appearance.
Hypertrophic scars - These scars consist of excessive connective tissue which leaves a thickened area over the original lesion. These scars have keloid-like properties.
Hyperpigmentation – The inflammatory processes associated with acne lesions can lead to overly stimulated melanocytes (pigment producing cells found in the stratum basale) which can result in uneven skin tone and hyperpigemented areas of skin.