Types of Acne
There are varying forms of acne.
1. Comedonal acne This is the earliest type of acne presenting with blackheads and whiteheads, known as open or closed comedones. Mostly seen in preteens or early teenage years and is caused by hyper-keratinization of the epithelial cells.
2. Mild inflammatory acne – acne vulgaris Here we see inflammation due to the proliferation of Propionibacterium acnes and Staphylococcus epidermidis resulting in less than 20 pustules.
3. Moderate to severe acne Here we see more than 20 pustules and there can be an rapid increase in numbers due to stress. The number of comedones are few.
4. Severe Nodulocystic acne: – this presentation includes some cysts to the face, chest and back. In some cases the acne can be on the arms. This condition can be emotionally challenging to the patient as their presentation can affect their ability to secure jobs, induce ridicule and cause stress and depression.
5. Pyoderma faciale is a variant of cystic acne as it presents only on the face. The condition seen in women from their teens to their forties. The sore erythematous cysts predominately are on the central portion of the cheeks. Comedones are absent and scarring invariably occurs. This is a traumatic experience to the patient as often there is no history of acne. Research suggests that pyoderma faciale is a type of rosacea.
6. Acne fulminans This is a rare form of acne that ulcerates. Usually presents in adolescent boys with a possible genetic predisposition. There can be painful episodes of muscle pain and arthraglias and painful bone lesions can occur in around 40% of patients. Weight loss and fever are symptoms associated with this type of acne.
7. Acne conglobata This type of acne is highly inflammatory and it presents with a mixture of double comedones – two black heads linking under the skin, papules, pustules, cysts that link together – communicating, abscesses and draining sinus tracts. This particular type of acne is associated with other follicular occlusion conditions – hidradenitis suppurativa, dissecting cellulitis of the scalp and acne conglobata.