Types of Acne Lesions

• Open comedones (blackheads): These are dilated hair follicles that are filled with sebum, dead cells and bacteria, and which have central, dark, solid plugs. The follicles are not completely blocked; the black appearance is caused by oxidation, not dirt.
• Closed comedones (whiteheads): These form when skin cells and oil completely block the opening of a hair follicle, usually after a blackhead has formed.
• Nodules: These are solid, dome- or irregularly shaped, inflamed lesions that extend deep into the skin, sometimes causing tissue damage and scarring if not treated. Nodular acne, which can be painful, is the most severe form of the disease.
• Papules: This type of whitehead (5 mm or less) is one that has become swollen, red and inflamed
• Cysts: These sac-like lesions contain white blood cells, bacteria and dead cells in a liquid or semi-liquid state. They can result in scarring, and may be very painful and severely inflamed. Cysts and nodules often appear together to form nodulocystic acne, also very severe.
• Pustules: This whitehead is pus-filled and inflamed. Once they rupture into the skin, they form pustular heads.
Acne can be caused by environmental and genetic factors. The role of hormones in the development of acne is apparent at puberty, when there is a surge in the production of male hormones (which are present in both males and females), enlarging the sebaceous glands in the skin. This results in increased sebum production, which leads to the aforementioned plug formation, creating as well a fertile environment in which bacteria can multiple. Unlike male-hormone androgens, female-hormone estrogens have a beneficial effect on acne, which is why some doctors recommend birth control pills for women who have acne. But when a woman’s estrogen levels decline, as they do just before the beginning of a menstrual cycle, acne may worsen.
Acne or acne-like lesions can develop in response to various substances, including corticosteroids, lithium, and some psychotropic drugs. Use of many types of cosmetics, oil-based hair products, and suntan lotions can block oil glands and worsen acne.


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