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Not All Acne is the Same

Acne Statistics 

  • Acne affects up to 50 million Americans annually and is the most common skin condition in the US. 

  • 85 percent of people between the ages of 12 and 24 experience some form of acne. 

  • Adult acne is increasing, affecting up to 15 percent of women. 

  • Roughly 20 percent of newborn babies younger than six weeks develop neonatal acne. 

Acne lesions are either inflammatory or non-inflammatory. 

Noninflammatory lesions include open and closed comedones.  

Lesions become inflammatory when they become so filled with dead cells, sebum, and acne bacteria that the follicle wall ruptures. This activates the immune system, bringing blood with white blood cells to fight the acne bacteria. This appears on the surface of the skin as a papule. Pustules develop as white blood cells battle the acne bacteria that’s creating puss.  

There are four grades of acne: 

Grade 1 and Grade 2 are commonly treated with keratolytic topical products to break up follicle impactions—these topical products can include salicylic acid, benzoyl peroxide, alpha hydroxy acids (glycolic, lactic, or mandelic), sulfur, enzymes, or some combination of these ingredients. 

Grade 3 and Grade 4 acne is extremely inflammatory with significant redness and deep nodules and cysts. It must be referred to a professional, who can recommend treatment modalities. 

Acne sub-types: 

Fungal Acne (pityrosporum folliculitis) is a yeast infection of the hair follicle. It is a specific type of yeast that lives on 90 percent of humans’ skin.  When the yeast grows out of control, it triggers inflammation. Things that may increase the risk of fungal acne include:  

  • A weakened immune system 

  • Antibiotics or oral steroids 

  • Exposure to heat and humidity 

  • Excessive sweating 

Fungal acne appears more like a rash than traditional acne. It presents with tiny, pink, red, or purple bumps around hair follicles, usually the same size, and may be itchy. It is possible to have both fungal acne and acne vulgaris at the same time. Treatment for fungal acne often includes prescription anti-fungal shampoos, creams, or topicals, acne facials, and lifestyle adjustments.  

Acne Conglobata is a very severe form of acne where many inflamed nodules form under the skin causing long, tunneling tracts. These deep tracts are a result of the nodules swelling and connecting to other nodules under the skin. This condition commonly affects the back, chest, shoulders, and thighs and may be the result of steroid use, although there is no definitive evidence as to why this condition develops.  Treatments by a dermatologist include oral antibiotics, steroids to reduce inflammation, and a CO2 laser in conjunction with a regular acne facial by an experienced esthetician. If these remedies are not effective, surgical removal is the next step.    

Acne Mechanica is a common form of acne that can impact anyone. It is caused by friction, pressure, and heat against the skin. This is often the result of wearing sports gear, tight-fitting clothes, hats, face masks, etc. Anything that traps heat against the body for a long period of time. Rubbing and constant touching of the skin can trigger acne mechanica. Treatment for this type of acne will be the same as other common types of acne.  

Not all acne is the same. Before you reach for salicylic acid or benzoyl peroxide, be sure you have gotten a professional consultation and skin analysis and follow the recommended instructions. 

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