Not All Acne is the Same

By Maggie Staszcuk

There are many types of acne and acne-like conditions, but the most prevalent type is acne vulgaris. This is a condition caused when a hair follicle is blocked by dead skin cells, sebum, and bacteria.  

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 c. acnes 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 dermatologist, who can then prescribe medicine or 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, 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. This condition must be treated by a dermatologist, and isotretinoin is often prescribed. Other treatments by a dermatologist include oral antibiotics and steroids to reduce inflammation and a CO2 laser. 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 and rubs 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 performed a complete and thorough consultation and skin analysis. Most importantly, be open to adjusting your treatment program. And when in doubt, refer out! 

Looking for more great content on acne and acne subtypes?

ASCP's Esty Talk episode 157, There's a Fungus Among us: Is It Acne Or Something Else?, breaks down the acne basics and addresses one of the leading acne healing trends on TikTok. 

Check out ASCP Esty Talk or subscribe to the podcast in the Apple Podcast Store, Google Podcasts, Spotify, YouTube, or wherever you access your favorite podcasts.