Types of Acne – Which One Do You Have?

There exists a range of different types of acne, ranging from mild to severe forms, with different causes and treatments. Knowing which type you have will help you deal with the problem most effectively.

Types of acne include:

– acne vulgaris (mild to moderate)
– acne vulgaris (moderate to severe)
– acne rosacea
– acne conglobata
– acne fulminans
– gram negative folliculitis
– pyoderma faciale

Acne Vulgaris (mild to moderate)

This is the most common form of acne. It usually consists of skin lesions such as white heads, blackheads, papules and pustules.

Whiteheads are caused by a follicle or pore becoming completely blocked with shed skin cells and oil or sebum accumulating behind the blockage, leading to the raised white appearance.

Blackheads result from partial blockage of a pore with slow leakage of trapped oil, bacteria, and skin cells onto the skin surface. The characteristic dark colour is caused by the oxidation of skin pigment, melanin, on exposure to oxygen in the air at the skins surface. Blackheads tend to be more stable than white heads and may take a long time to resolve.

Papules are inflamed, red, tender, raised areas that in contrast to white heads or blackheads do not have a ‘core’ or head.

Pustules appear generally similar to white heads except that they are more inflamed and red and the centre may appear more yellowed. This is a result of the bodies inflammatory immune reaction to the trapped oil and bacteria leading accumulation of white blood cells and leakage of fluid from capillaries.

Acne Vulgaris (moderate to severe)

Moderate to severe acne vulgaris is defined by the presence of nodules and cysts.

Nodules are large, firm, raised inflamed areas that in contrast to the milder lesions mentioned above are more deeply situated in the skin. These nodules can be quite painful and sometimes will last for a number of months.

A cyst is similar to a pustule but is larger (greater than 5mm in diametre) and more deeply seated within the skin. The cyst is full of pus, which is debris of bacteria, skin cells, and immune cells. These lesions are often painful and squeezing or trying to pop them can make this much worse by causing the accumulated pus to spread into surrounding tissues, widening the inflammatory reaction.

Acne Rosacea

Rosacea is characterised by a red rash, mostly on the nose, cheeks, chin and forehead. There are often associated white heads, bumps, blemishes and blood vessels (capillaries) may become more prominent. In contrast to acne vulgaris, rosacea is more common in women and in people over 30 year of age. Rosacea, if untreated over the long term may cause a condition called rhinophyma. Rhinophyma is where there is excessive growth of the tissue affected by rosacea, which can lead to an enlarged and bumpy or knobbly nose. Treatments for rosacea differ to those for acne vulgaris so it is important that your doctor correctly identifies your condition.

Acne Conglobata

Acne conglobata is a rare, but particularly severe form of acne vulgaris that is most common in men aged 18-30 years old. It consists of many large and often interconnected lesions that may spread across the face, back, buttock, upper arms, neck and chest. Numerous blackheads are common. Unfortunately this type of acne is likely to lead to scarring, which in severe cases may be permanently disfiguring. Treatment is best guided by a specialist dermatologist and will often include Isotretinoin.

Acne Fulminans

As the name suggests, acne fulminans is the sudden onset of severe acne, with nodular and cystic lesions similar to those seen in acne conglobata. The lesions may progess to ulceration, which is the breakdown of the skin overlying the cysts or nodules. In addition, people with acne fulminans will feel generally unwell with fevers and arthralgias (aching of the joints). This type of acne is most common in young men. Treatment will usually include Isotretinoin and oral steroids such as prednisone. In contrast to some other types of acne, acne fulminans tends not to respond well to antibiotics.

Gram Negative Folliculitis

Gram-negative folliculitis is a bacterial infection that results in cysts and pustules. Sometimes this can be a complication of antibiotic treatment for other types of acne but fortunately it is quite uncommon. Treatment with isotretinoin is usually effective.

Pyoderma Faciale

Pyoderma faciale is a severe form of acne that occurs only in women, most often between 20 and 40 years of age. This condition usually begins quite suddenly and can affect people who have never had acne of any type before. It will often resolve within a year but the nodules and pustules can cause permanent scarring.