Understanding Acne

About 85 percent of teens experience some type of acne, but even many adults deal with at least occasional breakouts too. About half of teens and young adults suffering from acne will have severe enough symptoms to seek out professional help from a dermatologist.

From mild to severe, acne can cause painful and unsightly outbreaks on the face, back, chest and even arms. Left untreated, acne can also lead to diminished self-esteem and long-term hyperpigmentation or scarring. Genetics, changing hormone levels, lack of sleep and stress are all contributing factors to acne.

What Is Acne?

Acne vulgaris is the term for a group of skin conditions that cause most acne pimples. Acne is typically categorized into two main types: non-inflammatory and inflammatory acne. Acne is also described as mild, moderate or severe acne, or sometimes given a grade of either grade I, II, III or IV acne.

The main types of acne include:

  • Non-inflammatory acne—characterized by whiteheads and blackheads, but not cysts/nodules.
  • Inflammatory acne— usually caused by small infections due to P. Acnes bacteria.
  • Cystic acne (also called nodulocystic acne)— an intense form of acne that results in large, inflamed cysts and nodules that appear on the skin

Here is how acne is graded depending on the type of symptoms it causes:

  • Grade I— causes mild whiteheads, blackheads, and small pimples that are not inflamed.
  • Grade II— Moderate acne that causes frequent breakouts of pustules and papules.
  • Grade III— large amount of inflammation, numerous papules and pustules, and some nodules.
  • Grade IV— the most severe form of acne, causing many nodules, cysts, pustules, and papules that often appear on the face, back, chest, neck, and buttocks.

Signs & Symptoms of Acne:

Acne symptoms will depend on the specific type of acne someone has and the underlying cause of the skin irritation/inflammation. The most common symptoms that acne causes include: 

  • Blackheads, or small black dots on the skin, usually around the nose, forehead or chin. These are also called “comedones” and result from debris getting trapped inside of a follicle.
  • Whiteheads, which can form when pus builds under the skin and forms a “head”. These result from follicles getting plugged with sebum and dead skin cells.
  • Papules and pustules (the technical name for pimples) which cause small or medium sized bumps on the skin that are round, red and don’t always have a visible “head”. These are caused by “moderate” types of acne and are not as severe as cysts or nodules. 
  • Cysts or nodules, which are severe pimples that are infected and painful. They can form within deeper layers of the skin, become very swollen or tender, and take longer to heal then papules and pustules.
  • Dark spots on the skin (hyperpigmentation).
  • Scars, most often left behind from nodules or cysts, especially if they have been “popped” or picked.
  • Increased sensitivity to products, heat, sweat and sunlight.
  • Decreased self esteem, self consciousness, anxiety and depression

Common Causes of Acne

The main causes of acne include:

  • Clogged pores, caused by things like excess oil production and dead skin cells. Sebum is the type of oil released into hair follicles that can become trapped beneath surface of the skin and clog pores.
  • Bacteria.
  • Hormone fluctuations or imbalances. For example, when androgen hormones increase oil production rises. This often happens in teens and young adults suffering from acne, especially women experiencing PMS, irregular periods, pregnancy, early menopause, and other hormonal conditions such as poly cystic ovarian syndrome (PCOS).
  • Poor diet that includes lots of refined grains, sugar and unhealthy fats.
  • High amounts of stress and related problems like psychiatric disorders such as depression and anxiety.
  • Use of certain medications, including corticosteroids, androgens, birth control pills and lithium
  • Sleep deprivation.
  • Friction and irritation to the skin, such as from sports equipment and backpacks that can lead to acne breakouts on the chin, forehead, jawline and back.
  • Genetic predisposition.
  • Smoking and other causes of inflammation.

Once believed to strike most often during teen years, acne is now affecting millions of adult women, many of which never had a problem with acne in the past. Some women (and men too) will only deal with acne during puberty and their teenage years, but others will suffer well into adulthood, especially during times of stress and hormonal changes. While acne among adult women is usually linked to hormonal shifts and imbalances that occur during the menstrual cycle, or when transitioning into menopause, it’s important to consider elevated stress levels, a lack of sleep and a poor diet might also be root causes.

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