Acne and Pimples, What Types are There?
Acne can be basically divided into two groups: non-inflammatory and inflammatory acne. Both present quite differently and require unique treatment approaches.
What is non-inflammatory acne?
Non-inflammatory acne is the first sign of the skin condition. It sometimes disappears and other times it progresses to mild, moderate, or severe acne. As its name suggests, it isn’t red or inflamed but can evolve into that state as time progresses.
What is comedonal acne?
People with acne often have skin-coloured bumps (comedones) on the forehead and chin. The term comedo is used to describe a single lesion. This is an early presentation of acne which will sometimes remain the same or may progress to more red, inflamed types.
Increased oil (sebum) production and cell proliferation (cornification) in the lining of the sebaceous duct give rise to comedones. Once the sebaceous duct and hair follicle get clogged, the result is a comedo. Recent research has suggested that comedones may also trigger inflammation.
A comedo is considered closed if the clogged follicle does not break the skin’s surface. In most cases, this presents as tiny pearly-white lumps on the skin. Whitehead is a common name for this, and they are not inflamed.
When a comedo’s plug becomes big enough to break the skin’s surface, the resulting lesion is known as an open comedo. These are called blackheads, but they can be grey, orange or brown as well. Melanin, the component of skin responsible for its pigmentation, has built up over time, giving the plug a darker look. Blackheads are not trapped dirt.
It is rare for comedonal acne to progress to scarring but it can progress to inflammatory acne types.
What is inflammatory acne?
Inflammatory acne as its name suggests, progresses to being red and inflamed. There are three types: papular, pustular and nodulocystic.
What is papular acne?
Acne papules are mild, red bumps that form when oil and dead skin cells accumulate on the skin’s surface. They are generally under 5mm in size and contain no pus. Scarring can occur but is minimal with this type of acne.
What is pustular acne?
If pus begins to develop from inflammatory papules, the bump will then change into a red and inflamed pustule. This is the first sign that Cutibacterium acnes bacteria has become involved. What we often call a pimple is really a pustule. Pustules are larger than papules and feature a yellow or white pus-filled head. They can be mildly painful and are relatively shallow and contained. Scarring can occur with this type of acne.
What is nodulocystic acne?
A more severe form of inflammatory acne, nodulocystic acne is characterised by nodules and cysts affecting the face and upper body. Pseudocysts and inflammatory nodules can occur singly (nodular) or in clusters (cystic). This type of inflammatory acne involves the face, neck, and body and the lumps are firm, wavy, and/or tender. The bumps are deeper, more red and more painful. When they are adjacent to bony structures like the jawline or along the spine, the pain and pressure of these can be excruciating. This type of acne will almost always scar.
What’s the difference between mild, and moderate to severe acne?
There is no universally accepted rating to measure the degree of acne severity for us to follow, but the following examples can give us a guide.
Mild Acne
Acne vulgaris, in its mildest form of the disease, can be identified by the presence of a few, scattered comedones or red, painful inflammatory papules (<30) that are less than 5 millimetres in size. They don’t leave scars and occur in only one body area.
Moderate to severe acne
One way you can try to classify moderate acne is if there was <100 breakouts and no more than half of those are red or painful. With severe acne there would be >100 breakouts with most of those red or painful but in its nodular or cystic form, severe acne would include large, deep painful lumps and sometimes an involvement of the lymph glands.
Some evidence for moderate to severe disease might be found if the following is happening:
- Acne is quite noticeable due to the presence of many comedones, inflammatory papules, or pustules
- Involvement of several sites on the body
- Large, inflammatory papules or nodules (lesions >5 mm in diameter)
- Pain and discomfort
- Associated scarring
- Psychological impact
- Presentation of the signs and symptoms of more complex forms of acne
