The Different Types and Stages Of Acne

Acne is an extremely common condition that mainly affects teenagers but is not uncommon in adults. All acne is hormonal but there is often a genetic or hereditary predisposition to more severe forms of acne.

Certain medications such as progesterone in the oral form, intramuscular form, implants, or progesterone released from an inter-uterine device may make acne worse. Oral, as well as topical corticosteroids, anabolic steroids, oral Lithium, and Lamotrogene, can also trigger acne worse. A high glycaemic diet, as well as excessive intake of dairy products, can worsen acne. Some studies have found an association between stress and increased acne severity.

There are many proposed classifications of acne but I like to keep it simple. Below are the different stages of what I see clinically on the skin. I have linked them to recommended products or treatments:

Comedonal Acne

This is the first or earliest stage of acne where males, as well as females, produce the hormone testosterone which works on their sebaceous glands causing the skin to become more oily. The top layer of the skin becomes more sticky, blocking the pores and this results in multiple, small blackheads and whiteheads. It is essential to start with the correct treatment at this stage to prevent worsening of the acne.

At this stage, I would recommend that you use a mild foaming gel cleanser such as mesoestetic purifying mousse . To treat the oiliness and blackheads you could use topical retinol at night PCA Skin Intensive Clarity Treatment®: 0.5% pure retinol night or Avène Cleanance Comedomed Concentrate in the morning and at night which reduces the quantity and the quality of the sebum produced on the skin. At this stage, it is also important to use a lightweight broad-spectrum sunscreen that does not clog the pores and that helps to prevent post-inflammatory hyperpigmentation: La Roche-Posay Anthelios Dry Touch SPF50+

Papulopustular Acne

This next stage of acne is where you develop multiple, papules (red bumps) and pustules. You could initially start off using topical products that contain ingredients like Azelaic acid, Tree tea oil, and Salicylic acid: Lamelle Clarity range. For the deeper infected lesions, you could use topical Benzoyl Peroxide as a spot treatment Obagi CLENZIderm Therapeutic Lotion or pHformula SPOT ON Blemish Active.

If the topical treatment is not controlling the papulopustular acne adequately then the next step would be a prescription of an oral Tetracycline antibiotic. This generally settles the papular/pustular element but it is not curative. The oral contraceptive pill especially in women with a hormonal imbalance will improve acne.

Nodulocystic Acne

If the acne has not been treated properly in the earlier stages, you can develop deeper red papules and cysts on the skin. Unfortunately, this type of acne often leaves permanent scarring on the face, jawline, upper back, and chest. The treatment of choice for this type of acne is oral Isotretinoin. This is the only drug that can put acne into remission. It is a powerful but very effective drug so it needs to be given under close supervision preferably by a Dermatologist.

While on the course of Isotretinoin, your lips, skin, and eyes become dry so it is necessary to use special products while on this treatment.

Backne

Acne of the back and chest is especially common in adult males. Unfortunately, deeper acne lesions on the upper back and chest in both males and females can leave raised keloid scars so this type of acne needs to be treated properly. As it is a large area, you need a special purifying gel to wash with and a body spray to help control the acne.

Adult-Acne Post-Inflammatory Hyperpigmentation

Acne in people with a darker skin tone is more likely to leave to post-inflammatory hyperpigmentation (PIH) i.e. dark marks at the site of the initial acne lesion. This PIH can be very frustrating and distressing for the affected person. Therefore, acne in people with a darker skin tone needs to be treated more aggressively at an earlier stage of acne to prevent PIH and/or scarring. Incorporating a Vitamin C antioxidant, will not only help prevent PIH but serums like the SkinCeuticals Silymarin CF can also help prevent the formation of blemishes.

An alternative to oral Tetracyclines and Isotretinoin is the Acleara Clearing Therapy System, a laser-like device that emits a special wavelength of light that kills off the bacteria causing the inflammatory acne. It also has a suction device that is able to very effectively extract the deeper blackheads and whiteheads.

Final Message

Nobody in this day and age should end up with any permanent scarring. Acne is treatable and the earlier the treatment is started the better.