Acne is a very common skin disorder characterised by clogged pores and hair follicles, be it on the face, neck, shoulder, arms or back. It develops due to varying reasons such as hormonal imbalance, stress, poor diet, ingrown hairs, surplus oil/sebum secretions, accumulation of dirt, grime, dead cells and even a bacterial infection.

Also Read: Acne: What It Is, Causes & Treatment

Nowadays, among the multitude of skin problems that arise in people, acne is the foremost complaint reported by the vast majority of individuals, according to dermatologists worldwide. While the common notion is that all acne is nothing but breakouts on the skin, appearing as pimples or zits, this is actually not the case.

Moreover, contrary to general belief, inflammation is not always rampantly exhibited in every kind of acne. Based on its overall outlook and features, acne is categorised into non-inflammatory and inflammatory, which are further classified into distinct forms like whiteheads, nodules etc., depending on the intensity of swelling and penetration into deeper layers of skin.

Although acne predominantly affects teenagers during puberty and youngsters in their 20s, it can occur in much older people as well, afflicting both men and women, in the age group of 30s and 40s, to the middle-aged and elderly.

Also Read: Precocious Puberty: Causes, Symptoms And Treatment

While cases of acne can be very mild in some people and disappear on its own, it is a rather incessant chronic problem in quite a few individuals, thereby requiring accurate diagnosis of the skin bumps and proper medical treatment. It is hence important to understand what factors prompt widespread pimples, reddening on the skin’s surface, the specific types and forms of acne, besides its pertinent treatment measures.

Causes Of Acne

Four major reasons trigger the eruptions of acne on the skin. These consist of:

Overactive sebaceous glands in the body overflowing with the fatty sebum i.e. oil secretions

The roots of hair strands i.e. follicles congested with skin debris of dead cells, oily substances, or bacterial infection as in the case of folliculitis

Pathogenic microbes, mostly bacteria, that invade the skin cells

Underlying issues like diabetes, obesity, that prompt the activation of inflammatory proteins in the system

In addition, numerous other concerns including a hormonal imbalance of androgens, reproductive hormones witnessed in puberty, pregnancy, menopause, specific prescription medications, an unhealthy diet high in salt, sugar, carbs and mental stress, tension also exacerbate the indications of acne.

Types And Symptoms

To understand the differences in the several forms of acne, it is essential to gain an insight into the basic physiology and anatomy of the skin.

The skin is the largest organ in the human body and is composed of three distinct layers. The outermost layer is the epidermis, that forms the protective barrier, shielding the inner layers from invading germs. Beneath the epidermis lies the dermis, that houses the nerve endings, sweat and sebaceous glands, as well as the hair follicles. The bottommost layer is the subcutaneous tissue, that comprises insulating fat molecules, connective tissues and circulatory blood vessels.

Acne usually develops on the skin in the facial areas, jawline and neck, chest, upper back and shoulder vicinities, since these are the places in the human system where the maximum number of sebaceous i.e. sebum or oil-secreting glands are present.

Depending on the level of severity and how deep in the skin the acne arises, there are two major types of acne, non-inflammatory and inflammatory, which are further divided into many sub-types.

Non-Inflammatory:

These consist of blackheads and whiteheads, which rise on the skin but are usually not painful.

Blackheads, also called open comedones, form when the walls of the hair follicles in the dermis layer of skin bulge due to trapped bacteria, oil and open up. They appear as darkened raised spots, due to turning brown upon coming in contact with the surrounding air.

Whiteheads, otherwise termed as closed comedones arise when the follicular walls swell up as a result of bacterial contamination or excess oil, but remain closed, portraying light-coloured bumps on the skin’s surface.

Inflammatory:

These comprise papules, pustules, cysts and nodules, that occur deep within skin tissues, causing a lot of pain, redness and discomfort.

Papules develop when the tissue walls encompassing the pores on the skin are destroyed owing to inflammatory factors, resulting in rough contaminated pores that are pink in colour and feel slightly soft.

Pustules are essentially papules that are deep red on the outside and filled with yellow fluids known as pus, owing to broken pores and bacterial infection.

Nodules are acne that are embedded deep within the skin, wherein the hair follicles and sebaceous glands completely decline in structure, function and appear as red, hardened, big lumps.

Cysts develop from skin pores blocked with dead cells, debris, surplus sebum secretions and bacterial infections all at once. They penetrate even deeper into the skin than nodules, displaying a prominent red shade and causing excruciating pain.

Diagnosis And Treatment

By examining the external physical indications, the dermatologist can determine the exact type of acne. In certain scenarios, a piece of skin tissue from the inflamed acne is excised and examined under the microscope, to analyse which bacterial specimen is triggering acne and to probe if there are any underlying health anomalies.

Once the type and severity of acne have been concluded precisely, treatment options involve primarily topical creams and gels, which may be mild over-the-counter (OTC) products or prescription-strength lotions. Moreover, the healthcare provider also prescribes oral antibiotics, to combat the invading bacterial infection in the system. In very severe cases, hormonal drugs and oral contraceptives are recommended by the doctor to be taken stringently in appropriate doses, to remedy the hormonal imbalance, lower the recurrence of painful acne and improve the overall skin health of the patient.