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Types Of Acne



Causes and Types of Acne


What are the Different Types or causes of Acne?

There are several different types of acne and what is referred to as acne. Dr. Edwin Ishoo and the staff of Boston Acne Specialists evaluate not only your skin but also the type of acne. Knowing the type of acne you may be suffering from is important so that your condition can be managed more effectively. No aesthetician or paramedical personnel can possibly recognize the variety of diseases presenting as Acne. Improper diagnosis and treatment may not only risk your skin’s appearance but also your health. These include:


  1. Bodybuilding Acne:  Triggered by the prolonged use or rather abuse of high doses of anabolic androgenic steroids, usually used for bodybuilding purposes.

  2. Cosmetic Acne:  Triggered by the use of oil rich skin care products that clog the skin pores. It is also known as acne cosmetics or pomade acne.

  3. Steroid Acne:  Triggered by the prolonged use of prescription catabolic corticosteroids as topical skin applications, inhaled or intravenous; usually for treatment of autoimmune diseases such as asthma, psoriasis, Lupus etc.

  4. Acne Detergens:   Triggered by excessive washing of skin, which causes removal of skin oils and dryness causing stimulation of the sebaceous glands to produce more sebum or oil which can clog the pores.

  5. Adolescent or Teenage Acne:  Triggered with onset of puberty by increase in androgen hormone production and increase in sebum as well as skin turnover leading to clogging of pores. It is frequently the source of significant stress and emotional impact on the adolescent and parents.

  6. Mechanical Acne:  Triggered by physical trauma and mechanical breakage of sebaceous glands by external forces such as rubbing of helmets or face mask, head bands or stiff collars. Also known as Acne Mechanica.

  7. Cyclic / Hormonal Acne:  Triggered by release of hormones after ovulation and it is usually seen as a premenstrual flare-up of acne or development of pimples just before the monthly period. Acne in adult women can signal hormone problems, which should be addressed as part of successful acne management.

  8. Pregnancy Acne:  Acne is common during pregnancy. In fact, more than one out of every two pregnant women can expect to develop acne. High levels of androgen hormones especially in the first trimester can stimulate increased sebum oil production, which along with increased skin turnover and shedding dead skin cells leads to pores becoming blocked and comedone breakouts. This environment is also a fertile ground for bacteria leading to inflamed acne. Acne can vary in severity and may persist throughout pregnancy. It’s hard to predict who will develop pregnancy acne, but if you have a history of acne or have acne flares at the start of your menstrual cycle, you have a higher risk. If you do not develop acne during the first trimester, it’s unlikely you’ll develop it at all.  Managing acne when you’re pregnant can be tricky. That’s because many prescription and over-the-counter treatments come with a high risk of birth defects. In general, you should avoid any medications you don’t absolutely need when you’re pregnant that has even a remote chance of harming your baby.  Generally the safest acne treatment involve medical extractions and light-based treatments and diligent home skin care. 

  9. Occupational acne:  This is triggered by machine oils, coal tar derivatives and halogenated hydrocarbons especially by those who are exposed to them in their line of duty.

  10. Chloracne:  This is triggered by exposure to halogenated hydrocarbons such as chlorinated dioxins and dibenzofuranes through either direct contact, inhalation or ingestion of contaminated foods.

  11. Iatrogenic:   Triggered by the use of prescription medication such as phenytoin, lithium and isoniazide. It is also known as acne medicamentosa.

  12. Neonatal acne:  This is triggered by the stimulation of the newborn baby’s sebaceous glands by the mother’s hormones especially within 2 weeks of birth but may continue with continued hormonal stimulation with breast feeding. Also known as Acne Neonatorum.

  13. Acne conglobata:  It is the most severe form of acne vulgaris. It is the coalescence of deep, inflamed nodulocystic acne and can cause significant pain and disfiguring scaring. It is mostly affects men between the ages of 18 – 30 and can persist for many years. Acne conglobata is very difficult to treat and leaves severe scarring and permanent damage to the skin. It is characterized by extremely deep inflamatory cysts and nodules that connect under the dermis to other nodules. These large, often interconnected, lesions are often painful.  They can develop on the face, upper arms, chest, back, buttocks, and the thighs. The trigger is unknown but it has been associated with chromosomal abnormalities such as the XXY karyotype. Acne conglobate is sometimes very dangerous as it doesn’t have a proper treatment so far and is sometimes resistant to the usually effective drugs used in treating acne vulgaris. Therefore, it requires aggressive treatment with multiple anti-acne medications including isotretinoin as well as emotional support.

  14. Acne fulminans:  Acne fulminans is a sudden onset of acne conglobate in young caucasion men presenting as ulcerating acne which lead to severe scaring. This is thought to be triggered by the bacteria Propionibacterium acnes which results in an immunological reaction.  It is also known as acne maligna or acute febrile ulcerative acne. Typical symptons of acne fulminans include the onset of fever and a general aching of joints occurs in conjunction with outbreak. This form of acne very resistent to antibiotics; rather, it is treated with isotretinoin and oral steroids. Sometimes due to severe pains fulminans leads to fever as well. People are also admitted in hospital for 3 – 5 weeks to get proper treatment for this.

  15. Acne keloidalis nuchae:  This condition is not a “type of acne vulgaris” but it has been included in this list because its name includes the word “acne” though that is a misnomer. The specific triggers of this chronic folliculitis that develops keloid-like scars on the occipital scalp or the back of the head and neck is not known but inward growth of curved nape hairs are believed to contribute to its development.

  16. Acne Rosacea: This condition is not a “type of acne vulgaris” but it has been included in this list because its name includes the word “acne”. It is thought to be triggered by the Demodex folliculorum mites, weather extremes, alcohol, hot and spicy foods but most commonly by emotional stress. Rosacea is seen to be affecting millions of people all round the world, but mostly in women in their 30. It appears as a red mark like rash, which is normally seen on cheeks, nose, and chin and sometimes on forehead. Acne rosacea is often confused with chronic acne vulgaris and that is because the two types of acne share most of the same presentations. All of the lesions of acne vulgaris except blackheads are seen with acne rosacea. However, acne rosacea results in visibility of blood vessels on the skin which presents as distinctive red rash on the cheeks, chin, nose and forehead. Another way to distinguish acne rosacea from acne vulgaris is the visibility of blood vessels on the skin. However, the definitive presentation of acne rosacea is the nose swelling it causes. The condition of growth of excess tissue near nose due to swelling is referred as rhinophyma, which causes permanent deformity of the nose. Acne Rosacea should be treated by medical specialists with experience in managing such skin diseases.

  17. Pyoderma Faciale (Rosacea Fulminans):  This is a restricted form of severe acne rosacea. It only affects 20 – 40 year old women. This type of acne is characterized by sizable and painful nodules, sores and pustules on the face resulting in severe scarring. It’s onset is rapid and can affect females with no prior history of acne.  The condition often persists for approximately a year. This form of rosacea is treated with isotretinoin and oral corticosteroids.

  18. Acne Inversa: This condition is not a “type of acne vulgaris” but it has been included in this list because its name includes the word “acne” It is correctly known as hidradenitis suppurativa or an infected ingrown hair.

  19. Acne Aestivalis:  This condition is not a “type of acne vulgaris” but it has been included in this list because its name includes the word “acne”. It is triggered by exposure to sunlight as it is a type of polymorphous light eruption. It is also known as Mallorca acne.

Acne Related Syndromes


Acne, one of the most common skin disorders, is also a cardinal component of many systemic diseases or syndromes. Acne presents an intriguing model for the study of interactions between hormones, innate immunity, inflammation and wound healing (scarring). The syndromic associations illustrate the nature of these diseases and is indicative of the pathogenesis of acne. The manifestations and involvement of acne in different systemic diseases and some rare syndromes demonstrate its multifaceted nature. Congenital adrenal hyperplasia (CAH) and seborrhoea-acne-hirsutism-androgenetic alopecia (SAHA) syndrome highlight the role of androgen steroids, while polycystic ovary (PCO) and hyperandrogenism-insulin resistance-acanthosis nigricans (HAIR-AN) syndromes indicate insulin resistance in acne. Apert syndrome with increased fibroblast growth factor receptor 2 (FGFR2) signalling results in follicular hyperkeratinization and sebaceous gland hypertrophy in acne. Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) and pyogenic arthritis-pyoderma gangrenosum-acne (PAPA) syndromes highlight the attributes of inflammation to acne formation. Advances in the understanding of the manifestation and molecular mechanisms of these syndromes will help to clarify acne pathogenesis and develop novel therapeutic modalities. A serious approach to every individual’s acneic eruptions requires serious commitment by serious medical professionals. This is the impetus for the foundation of the Boston Acne Specialists, where acne and the acne-afflicted are taken seriously and offered clinically proven, evidence-based treatments.

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