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Causes and Types of AcneAcne is a disorder of the pilosebaceous (hair and sebaceous gland) structure, which opens to the skin surface through a pore. The sebaceous glands, which empty directly into the hair follicle, produce sebum, a lipid substance. Sebaceous glands are present over the entire surface of the skin except the soles of the feet and the palms of the hands, but the largest glands are on the face, scalp, and scrotum. Sebum production is a response to direct hormonal stimulation by testicular androgens in men and adrenal and ovarian androgens in women. Acne can be inflammatory or noninflammatory. Noninflammatory acne lesions are primarily comedones, which are more commonly known as pimples, whiteheads, and blackheads. Whiteheads are pale, slightly elevated papules categorized as closed comedones. Blackheads are plugs of material that accumulate in the sebaceous glands. They are categorized as open comedones. The color is the result of the movement of melanin into the plug from surrounding epidermal cells. Inflammatory acne lesions include comedones, erythematous pustules, and cysts. Inflammation close to the surface of the skin results in pustules; inflammation deep in the skin results in cysts. The inflammation is believed to result from irritation from fatty acid constituents of the sebum and from substances produced by Propionibacterium acnes bacteria, both of which escape into the dermis when the follicular wall of closed comedones rupture. There are several different forms of acne that occur at different periods of the life span. The three most common forms of acne are acne vulgaris, acne rosacea, and acne conglobata. Acne Vulgaris This is the form of acne most common is adolescents, teenagers, and young adults. Although the lesions may persist longer in women, the incidence is greater in men. It is unknown as to what exactly causes acne vulgaris. Androgenic influence on the sebaceous glands, increased sebum production, and proliferation of the organism Propionibacterium acnes are all thought to be possible causes. Many factors that were once thought to cause this form of acne, including high fat diets, chocolate, infections, and cosmetics, have been proven false. Mild cases may involve only a few scattered comedones, but severe cases are manifested by multiple lesions of all types. Most acne vulgaris lesions form on the face and neck, but they also occur on the back, chest, and shoulders. The lesions are usually mildly painful and may itch. The complications of acne vulgaris, especially in severe cases, are formation of cysts, pigment changes in persons with dark skin, severe scarring, and lowered self esteem from the skin eruptions. Acne Rosacea This is a chronic type of facial acne that is normally seen in middle aged and older adults. Much like acne vulgaris the cause of this type of acne is unknown. The lesions of acne rosacea begin with erythema over the cheeks and nose. Other skin lesions may or may not appear. Over the years skin color can change to dark red, and the pores over the area become enlarged. The soft tissue of the nose may exhibit rhinophyma, an irregular bullous thickening that can be treated with plastic surgery. Acne Conglobata This is another type of chronic acne that is of unknown cause that starts during middle adulthood. This type causes serious skin lesions such as comedones, papules, pustules, nodules, cysts, and scars occur primarily on the back, buttocks, and chest but may occur on other body surfaces. The comedones have multiple openings and a discharge that ranges from serious to purulent with a foul odor.
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