Acne Vulgaris and other types of Acne

If you suffer from acne, you likely have the most common form of the condition: "acne vulgaris," characterized by whiteheads and blackheads. This basically means that eruptions are occurring beneath the skin's surface.

Let's review the biology: When cells stick together, instead of properly shedding, they block a pore. A sac is formed, which contains dead skin cells and oil. This is a breeding ground for bacteria. As the sac grows, a whitehead or blackhead surfaces. If the sac grows even larger, you may develop a cyst.

As these lesions are forming, your behavior can make them worse: If you are too aggressive when cleansing your face or use overly abrasive products, a sac may rupture before it reaches the skin's surface. At that point, the sac contents will spill out underneath the skin, spreading to other areas and leading to more breakouts.

Other Types of Acne

Menstruation-Related Acne

Menstruation-related acne, obviously limited to females, usually occurs one week before your period. It is caused by shifts in hormone levels. (We will cover this more thoroughly in Chapter 5.)

Breaking out right before your menstrual period is so common that it has become a cliché. It's hard to believe, therefore, that the first major study of premenstrual acne was conducted only in 2001 and that no one had thought to perform a large-scale study before then. Predictably, the study found that many women experience breakouts before their periods. This isn't exactly news to women who have dealt with the problem for years-or even decades. In most cases, breakouts occur right after ovulation or right before the onset of menstruation. These are the points in the hormonal cycle when most flare-ups will occur.

Breakouts are often accompanied by other signs and symptoms of premenstrual syndrome (PMS): tenderness in the breasts or armpits, mood swings and/or irritability, and bloating and water retention. Doctors chalk this up to hormones, but the true mechanism of breakouts hasn't been fully studied.

Acne Excoria

Acne excoria occurs in individuals who compulsively-and continually-pick at their pimples, thereby traumatizing delicate skin. They develop scabs and inflammation, which compel them to pick even more. The acne worsens, and scarring is a nasty consequence.

Acne sufferers of all ages should avoid the temptation to squeeze a lesion ("popping a pimple"). Only 10% of the material inside the sac will come to the surface-and the remaining 90% will be forced back into the underlying skin. This worsens inflammation, so avoid such "bathroom surgery."

"Picking or squeezing blemishes can actually inhibit healing," confirms Cammie Cannella, assistant vice president of global education for Kiehl's, a New York-based company that has manufactured skin-care products since 1851-and whose offerings are a favorite among Hollywood's top celebrities. (See Resource Guide, Appendix I.)

"Because regular pimples are the result of inflammation, squeezing can simply worsen the inflammation and cause an infection," she says. "Blackheads may be removed by dermatologists and/or cosmetologists," a process called "extraction."

If you ask your best friend whether he or she has ever picked at a pimple and the answer is no, it's a virtual certainty that you're talking to a liar. It is a natural human tendency-and everybody knows it. Your dermatologist, in particular, understands your desire to do so. It comes down to the same reason Sir George Mallory climbed Mount Everest: because it was there. You see a pimple-and you want it gone. The natural reaction: Give it a little squeeze. In our quest for unattainable perfection, we often resort to destructive behaviors, even when we know they are bad for us.

For some people, however, picking becomes a daily occurrence-perhaps even an obsession. They stare at the mirror, count the number of pimples they see and go to work on their face. Some become so out of control that they actually see pimples where none exist.

Continual picking turns small pimples into larger lesions. The end result is scarring, pitting and infection. The best way to kick this habit is to eliminate acne altogether by seeking help from a compassionate dermatologist. In extreme cases, your doctor may refer you to a therapist or counselor for behavior modification to curb the urge to pick. An antidepressant may also help.

Acne Mechanica

Acne mechanica is usually caused by friction. The classic patient is the teenage athlete who wears a helmet with a chinstrap, which rubs against his face.

Cosmetic Acne

Cosmetic acne is caused by using the wrong cosmetics, such as oil-based products that plug pores and encourage the development of comedones. When shopping for makeup, be sure to buy products with the word "noncomedogenic" on the label. This means the product won't clog your pores.

Acne Keloidalis

Acne keloidalis affects individuals of African descent who develop pimples along the neck when hair follicles become plugged. Infection may result, and a dermatologist's attention is required to prevent large lesions from forming. The dermatologist may inject large lesions with steroids and prescribe topical preparations. Large cysts may need to be removed.

Pomade Acne

Pomade acne occurs in individuals of African descent who use pomades or thick oils to control their hair. When the pomade comes in contact with the skin, pores and glands may become blocked, and acne lesions develop.

Drug-Induced Acne

Certain drugs will aggravate acne. They include steroids like corticosteroids, testosterone, certain antidepressants and certain antiepileptic drugs. If you notice a change in your skin after starting a new prescription, alert your physician.


Rosacea (sometimes called acne rosacea) is a chronic condition characterized by a flushed appearance, redness and swelling. It often goes untreated, particularly in its earliest stages, because patients fail to realize they have a dermatological problem.

Rosacea is more prevalent in women. Men who do suffer from it, however, often have a more acute, disfiguring form. Researchers still don't know what causes it, but heredity seems to play a role. It is most common in people of Celtic ancestry and less common in those of African descent.

There is a distinct progression to rosacea, which usually first presents when patients reach age 30-50. It is usually symmetrical and begins as a tendency to flush or blush easily. The redness may then become permanent, particularly in the center of the face and moving outward to the cheeks, forehead, chin and nose. Ultimately, tiny blood vessels and whiteheads may appear on the face.

"Because it is so noticeable on a person's face, rosacea can be socially and emotionally distressing," says Dr. Michelle T. Pelle, a clinical associate professor of dermatology at the University of California, San Diego. "While the cause is unknown, the good news is that this condition can be controlled if people know and look for the symptoms, as well as follow a supervised treatment plan."

In the most advanced cases, patients may develop "rhinophyma"-the bulbous red nose and swollen cheeks associated with comedian W.C. Fields. Thick bumps may also develop on the nose and cheeks. That's why early intervention is paramount.

"There is no cure for rosacea, and it can become significantly worse without treatment," Dr. Pelle cautions. "The key is to identify the condition early. When the skin doesn't return to its normal color, and when other symptoms such as tiny blood vessels and pimples become visible, it's time to see a dermatologist for professional treatment."

Rosacea patients may also find that certain behaviors exacerbate the condition. These "triggers" include eating hot or spicy foods, consuming alcohol, sun exposure, physical exertion, emotional extremes, rubbing the face and using irritating topical products/cosmetics. Menopause may also cause flare-ups.

Patients may be tempted to overcleanse their skin, but rosacea calls for a gentle approach. Products that cause excessive dryness, or contain additives like glycolic acid or alcohol, should be avoided.

Dermatologists will often prescribe the antibiotic tetracycline (taken orally) when inflammatory lesions are present. The topical gel form of the drug metronidazole, available by prescription, is also extremely effective.

Ear Cysts

Another site where acne and breakouts can occur is behind the ears, which many women incorrectly attribute to an allergic reaction to pierced earrings.

In reality, these painful lesions-most commonly cysts-are tied to hair and oil that come in contact with the skin. See a dermatologist, who can inject the cyst with cortisone for instant relief.

Back to Acne Vulgaris

Background: Acne vulgaris affects 85-100% of the world's population (at some point during their lives), which makes it one of the most common forms of skin disease.

What characterizes it?

  • noninflammatory follicular papules
  • inflammatory papules
  • pustules
  • nodules in its more severe forms.

What areas of skin are most affected by Acne Vulgaris?

Areas of skin with the highest concentration of sebaceous follicles are affected by Acne Vulgaris (including the upper part of the chest, the face, and the back)


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