Like many other diseases, acne is caused by a complex interaction of multiple factors. The process of forming a pimple is well understood. Accumulation of dead skin cells in the skin oil glands' opening, combined with excess sebum production clogs of the skin pores. A special kind of bacteria, Propionibacterium acnes (P. acnes) that lives in our skin oil glands proliferates in these enlarged clogged oil glands, triggering our immune response system, which then leads to skin irritation and the typical red acne pimples.
What are the different types of acne lesions?
The most common acne lesions are whiteheads, blackheads, papules, pustules, nodules, and cysts.
- Whiteheads: Whiteheads are clogged oil glands covered by a thin layer of skin that appear as white bumps or spots.
- Blackheads: Blackheads, aka open comedones, are usually located on the face but can appear on the neck, chest, and back. Blackheads are skin pores clogged by dead skin cells, dry sebum. The oxidation of sebum that is exposed to the air - gives the blackheads is a typical color.
- Papules: Papules are small re and inflamed lesions. They are usually sensitive and painful.
- Pustules: Pustules are red pimples that contain pus. Pustules are usually larger than papules and have the typical pus-filled yellow dot on their top.
- Nodules: Nodules are cysts like lesion situated under the skin. They don’t contain pus, are hard to the touch, and a bit painful.
- Cysts: Cysts are inflamed broader and deeper painful acne lesions. These lesions are usually part of severe and cystic acne and can live long-term acne scars.
What are the most common types of Acne?
Acne vulgaris is classified on grades of severity and divided into three primary classes: mild, moderate, and severe. Acne with only whiteheads and blackheads is called noninflammatory acne, and acne that included papules, pustules, or cysts is called inflammatory acne.
- Mild acne: People with mild acne will usually have less than 20 comedones and 15 lesions. Moderate acne: People with moderate acne will typically have 20 - 100 comedones and 15 - 50 papules or pustules.
- Severe acne: People with severe acne will usually have > 50 papules or cysts combined with 2-5 cysts.
- Cystic acne: Cystic acne is a type of severe acne with more than five deep inflamed cysts.
- Acne fulminans: Acne fulminans is another rare variant of severe acne. It happens when many acne pimples develop at a very rapid pace on the chest and back. It occurs more in your males and can be accompanied by painful joints, fever, and scarring.
- Acne mechanica: Acne mechanica is a type of acne that causes acne is triggered by pressure and friction on the skin. It is frequently aggravated by heat and humidity. Acne mechanica is characterized by small bumps that can range from tiny comedones to inflamed lesions. It is common in athletes that wear football masks or baseball hats and now in people that wear coronavirus face masks. Covid induced acne, also called maskne, can be reduced using special copper and silver infused anti-acne masks.
- Acne Conglobata: Acne Conglobata is the most severe form of acne. It is a very severe and deep cystic acne. It is characterized by many deep and inflamed cysts all connected underneath the surface of the skin.
How does Acne start?
The first step in acne is the androgen-induced enlargement of the sebaceous glands with the overproduction of sebum. In the second phase of acne, the sebaceous glands' opening is clogged by dry oil, dead skin cells, and dirt, forming the infamous comedones.
The comedones (Commonly called whiteheads and blackheads) are plugs made of a mixture of keratin, sebum, and bacteria. Comedones exposed to the skin surface and have a central black appearance (Due to the oxidation of tyrosine to melanin by tyrosinase) are called “blackheads,” or open comedones. However, comedones that remain underneath the skin surface are called “whiteheads” or closed comedones.
What is the role of bacteria in acne?
The third phase of acne includes the proliferation of acne bacteria—Propionibacterium acnes (P. acnes). Most P. acnes reside in the hair follicle's opening, an area rich in lipid nutrient sources and poor in oxygen (So, an ideal site for anaerobes). P. acnes is involved in developing inflammatory acne by activating complements and metabolizing sebaceous triglycerides into fatty acids that irritate the follicular wall and surrounding dermis. P. acnes produces lipases, proteases, and hydrolases, which contribute to inflammation and tissue destruction and express stress proteins responsible for comedonal rupture and inflammatory response.
What causes red, painful pimples?
In the fourth phase of acne, pilosebaceous follicles are surrounded by macrophages and inflammatory mediators expressing Toll-like receptors (TLR2) on their surface. TLR2 activation leads to transcription of nuclear factor triggering and thus heading toward the expression of cytokines (Such as interleukin-1β (IL-1β), IL-8, and granulocyte macrophage-colony stimulating factor (GM-CSF)) initiates and propagates the inflammatory response. The inflammation in and around the sebaceous gland further stimulates keratinocyte hyperproliferation. The enlargement of the sebaceous gland, the ruptures of its walls, and the following inflammatory response are the cause of the different acne lesions, papules, pustules, and nodules.
Which treatment is the best for your acne type?
The best treatment for your acne will be an acne treatment personalized to your type of acne, acne severity, skin type, gender, and age. One size fits all products that people buy online or at drugstores are frequently irritating or simply ineffective in the drugstore. Apps like MDacne, analyze your skin, and provide personalized acne treatment directly to your doorstep. Using the app algorithms and a medical support team, subscribers received continuous free fine-tuning of the medications, allowing faster and better results than the counter treatment option.
What are the best ingredients for the treatment of acne?
The basic acne treatment will usually combine a medicated acne cleanser, a non-comedogenic active daily moisturizer, and a medical-grade anti-acne treatment cream. More than 80% of acne people can expect improvement with over-counter medication, while 20% would need to see a dermatologist and get prescription medication.
According to the American Academy of Dermatology, the most effective single anti-acne topical medication is benzoyl peroxide. The most common topical medications used by dermatologists for acne treatment are benzoyl peroxide, salicylic acid, niacinamide, and retinoids.
The most common oral medications used by dermatologists are the tetracyclines: minocycline and doxycycline, erythromycin and isotretinoin (Accutane). Women with adult acne can also be treated with spironolactone, oral contraceptives, and DIM supplements.
Which treatment is the best for acne scars and dark spots?
People with acne's first goal is to heal current active poles and prevent new pimples from forming. Once the active acne is under control, there frequently a need to address post-acne signs. Fortunately, there are good options to face post-acne darks pots. Those will usually include a dark spot remover with hydroquinone or arbutin combined with a retinoid and an oil-free sunscreen. Treatment of real acne scars is usually more complicated and would need in-office dermatologist treatment with minor needle radio recent devices or lasers.
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