There are several different types of acne. From infection based, to clogged pores, to sebaceous filament, to acne rosacea. Acne is graded on a scale from 1-4 medically speaking, stage 4 being the worst. Acne is an inflammatory issue, at its most basic, so is rosacea. Inflammation + infection= acne. *Disclaimer*: I will not be getting into specific products that I think work well for different types of acne, that will be a different post. I do note what types of ingredients work well for each kind, but not specific products.
So here’s the technical stuff:
Acne exists because of the P.Acne bacteria that lives in our skin. Here’s a super technical explanation of the P. Acne bacteria from wikipedia:
P. acnes bacteria live deep within follicles and pores, away from the surface of the skin. In these follicles, P. acnes bacteria use sebum, cellular debris and metabolic byproducts from the surrounding skin tissue as their primary sources of energy and nutrients. Elevated production of sebum by hyperactive sebaceous glands (sebaceous hyperplasia) or blockage of the follicle can cause P. acnes bacteria to grow and multiply.
P. acnes bacteria secrete many proteins, including several digestive enzymes. These enzymes are involved in the digestion of sebum and the acquisition of other nutrients. They can also destabilize the layers of cells that form the walls of the follicle. The cellular damage, metabolic byproducts and bacterial debris produced by the rapid growth of P. acnes in follicles can trigger inflammation. This inflammation can lead to the symptoms associated with some common skin disorders, such as folliculitis and acne vulgaris.
So in other words, the food that the bacteria lives on is our dead skin cells, and then the enzymes the bacteria secretes build up and cause cellular damage, triggers inflammation and eventually leads to acne.
So lets break down the different types of acne, from grades 1 to 4:
Blackheads/sebaceous filament: Stage 1, non-infection based. Now non-infection based acne still totally sucks and can be harder to treat, because blackheads don’t like things to penetrate them. That bumpy texture can sometimes be worse those freaking whiteheads, because they won’t go away! Blackheads are easy to spot because they’re black on the surface (duh), and are a little hard plug in the pore of dead skin cells and oil that has oxidized on the surface (think of how an apple turns brown after you cut it open, thats whats happening to the surface of your pores). Sebaceous filament is like a blackhead that hasn’t gotten as big, or oxidized yet. Those little white bumps you see when you pull your skin taught is a version of these. Extractions are the best way to reduce these, along with a salicylic treatment, or glycolic exfoliator.
Pustule whiteheads: Stage 2-3, infection based, varies in size. These are what most people think of when they use the term ‘pimple’. Whiteheads are infection based and create a head of white blood cells/pus on top, hence the term ‘whitehead’. This is the most common type of acne, and is very common in teens. These types of lesions can range from small to large, and are best left alone, or only treated by a professional (this means no picking!!). A deep pore facial with good extractions is a great idea for these types of breakouts, as well as salicylic, glycolic or retinol treatments. Derms will want you to get on an oral antibiotic to treat these, which I’m not a fan of. Ask for a topical antibiotic if they really want to treat them that way, it’s a better long term solution.
Cystic lesions: Stage 4. Cystic lesions are those hard, painful, big, deep lumps that form under the skin and never form a whitehead/ ‘come to the surface’. I highly recommend leaving these alone, NO PICKING! You won’t get anything out of them, and will only cause more problems long term. A cystic lesion is usually more than one follicle, and they usually take a few weeks to form deep under the skin. It’s rare to get an instant cystic breakout from something, it was most likely brewing under the surface for at least a week, if not two. They are usually more than one follicle because the infection is so deep and big that it will breakdown the follicle wall next to it and consume that pore as well. I’ve seen, worked on, and had enough cysts in my day to be able to feel the bump and know if it’s 1, 2 or 3 follicles at this point, I’ve seen it all! These types of lesions are what can cause scarring on the face, which is why I recommend leaving them alone. Even though they can scar without touching them, it raises the chances if you try to extract them on you own. When cystic acne gets bad enough, Derms will recommend Accutane, I did Accutane, and will write another post on that topic later. All this being said, cystic acne is the hardest to treat, and hardest to control. Work with a good Derm and a good esthetician, which in tandem, can really help to treat this kind of acne.
Perioral dermatitis: This is also an inflammation based skin issue. What is more difficult about this condition is that you can’t be as aggressive as you would be with acne. The skin is/will get too inflamed, and cause the problem to worsen. Perioral dermatitis is pictured below, and can often look like acne, so people start treating it aggressively and then it only gets worse. If you want read up on this condition further, click here.
Acne rosacea: This is very similar to the condition above, and can often times be linked. There are a few things that can help: keeping your products simple, fragrance free, hydrating, and staying away from harsh exfoliators are all good ideas. Also work with a Derm and ask about a topical called MetroGel, I’ve seen it help with calm the effects of acne rosacea. This is also a difficult condition, because the rosacea triggers the inflammation that leads to the acne, so it’s kind of a viscous cycle. I recommend a Derm for best results with this type of skin issue.
I hope this gives you a good, yet simple breakdown of acne and it’s different types. We all at some point deal with some form of acne, and if you haven’t, then consider yourself lucky!! I’ve been working on skin for over a decade and it’s rare to find someone that hasn’t had at least some form of acne, so you’re definitely not alone in your struggle!
Thanks for reading! XO’s~ Jennifer