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What are Pimples?
A normal follicle looks like this:
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For reasons no one completely understands, follicles, often called pores, sometimes get blocked. Sebum (oil) which normally drains to the surface gets blocked and bacteria begin to grow. Both whiteheads and blackheads start out as a "microcomedone". The picture below is a "microcomedone":
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What causes acne?
Acne is caused by overactive sebaceous glands in the skin. The sebaceous glands, triggered by the hormone androgen, produce sebum (oil) in the skin. Although androgen is a male hormone, and its level is highest during puberty, it is present in both men and women.
When androgen levels increase, the sebaceous glands release sebum. Ordinarily this oily substance spills onto the skin. When cells from the lining of hair follicles shed too quickly—clumping together and clogging pores—sebum is trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes)—bacteria normally found on the skin–to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin. |
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Microcomedones become skin blemishes called comedones--either a whitehead or a blackhead:
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Whitehead:
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Blackhead:
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Either way, blackheads and whiteheads are filled with trapped sebum and bacteria. The treatment advice for how to get rid of blackheads and how to get rid of whiteheads is therefore the same.
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Types of Acne Lesions
Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition and photographs of typical acne lesions:
| Comedones |
Comedones are sebaceous follicles (oil glands) plugged with sebum (oil), dead cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. When a comedo is open, it is commonly called a blackhead because the surface of the plug in the follicle has a blackish appearance. A closed comedo is commonly called a whitehead; its appearance is that of a skin-colored or slightly inflamed "bump" in the skin. The whitehead differs in color from the blackhead because the opening of the plugged sebaceous follicle to the skin’s surface is closed or very narrow, in contrast to the distended opening of the blackhead.
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| Papules |
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A papule is defined as a small (5 millimeters or less), solid lesion slightly elevated above the surface of the skin. A group of very small papules and comedones may be almost invisible but give a "sandpaper" feel to the skin. This photo shows papules and comedones on the face of an acne patient:
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| Pustules |
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A dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria. A pustule that forms over a sebaceous follicle usually has a hair in the center. Acne pustules that heal without progressing to cystic form usually leave no scars. This photo shows pustules, papules and comedones on the face of an acne patient:
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| Macule |
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A macule is a red spot left by a healed acne lesion. It is flat, usually red with a well defined border. A macule may persist for a long time.
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| Nodule |
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Like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterized by inflammation, extends into deeper layers of the skin and may cause tissue destruction that result in scarring. A nodule may be very painful. Nodular acne is a severe form of acne.
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| Cyst |
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A cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic acne. This is a severe form of acne that is often resistant topical and oral medicines and likely to leave scars after healing. These photos show nodulocystic acne:
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What are the Acne Subtypes and Severities of acne?
Mild acne is extremely common and describes rare acne breakouts that are mild, don’t leave scarring and don’t interfere with life in any way. These are generally hormone related.
Moderate acne may include blackheads and whiteheads in addition to papules —inflamed lesions that appear as small, reddish or pinkish bumps that can be sensitive to touch—or pustules—inflamed, white-centered bumps that can be red at the base.
Severe acne is characterized by nodules —large, painful, solid lesions that appear as lumps under the skin—and cysts —deep, inflamed, pus-filled lesions that can be very painful. Nodules and cysts are inflammatory and can cause scarring. Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs.
Acne Mechanica is a form of acne caused or aggravated by heat, covered skin, constant pressure and repetitive friction against the skin.
Causes:
Common sports-related causes of acne mechanica are:
- Helmets and helmet straps, especially those worn by football and hockey players and motorcycle riders
- Shoulder pads and straps worn by football players
- Tight uniforms made of synthetic fabric
- Tight headbands worn by soccer players and runners
- Straps and packs on backpacks
Other common causes of acne mechanica are:
- Straps used by soldiers for weapons and equipment
- Headbands worn for long periods of time
- Musical instruments, such as the violin, tucked against the neck for hours
- Tight fur caps worn for long periods of time
- Tight clothing, such as jeans and underwear made of synthetic fabric
- Snug bra straps
- Adhesive tape that remains on the skin for several days (occasionally)
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