Medical, Surgical, Cosmetic

Here is a brief summary of definitions of words used to describe acne, with accompanying photos. Let’s begin, though, with the definition of lesion, an all-purpose word:

Lesion—a physical change in body tissue caused by disease or injury. A lesion may be external (e.g., acne, skin cancer, psoriatic plaque), or internal (e.g., lung cancer, atherosclerosis in a blood vessel, cirrhosis of the liver). Thus, when you read about acne lesions you understand what is meant—a physical change in the skin caused by a disease process in the sebaceous follicle (pore). Acne lesions range in severity from comedones (blackheads and whiteheads) to nodules and cysts. Here is a brief definition of acne lesions:

Comedo (plural comedones)—A comedo is a sebaceous follicle plugged with sebum, 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 follicular opening of the blackhead. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a dermatologist under sterile conditions. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other skin bacteria. The following photos are characteristic of acne with comedones: View Samples

Papule—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 microcomedones may be almost invisible but have a “sandpaper” feel to the touch. A papule is caused by localized cellular reaction to the process of acne. This photo shows papules and comedones on the face of an acne patient: View Samples Pustule—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: View Samples Macule—A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the “inflamed face” appearance of acne. This photo shows the “red face” appearance of acne with macules: View Samples Nodule—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 results in scarring. A nodule may be very painful. Nodular acne is a severe form of acne that may not respond to therapies other than isotretinoin. Cyst—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. Systemic therapy with isotretinoin is sometimes the only effective treatment for nodulocystic acne. Some acne investigators believe that true cysts rarely occur in acne, and that (1) the lesions called cysts are usually severely inflamed nodules, and (2) the term nodulocystic should be abandoned. Regardless of terminology, this is a severe form of acne that is often resistant to treatment and likely to leave scars after healing. These photos show nodular, cystic acne: View Samples

Who gets acne?

Close to 100% of people between the ages of twelve and seventeen have at least an occasional whitehead, blackhead or pimple, regardless of race or ethnicity. Many of these young people are able to manage their acne with over-the-counter (nonprescription) treatments. For some, however, acne is more serious. In fact, by their mid-teens, more than 40% of adolescents have acne severe enough to require some treatment by a physician. In most cases, acne starts between the ages of ten and thirteen and usually lasts for five to ten years. It normally goes away on its own, sometime in the early twenties. However, acne can persist into the late twenties or thirties or even beyond. Some people get acne for the first time as adults. Acne affects young men and young women about equally, but there are differences. Young men are more likely than young women to have more severe, longer lasting forms of acne. Despite this fact, young men are less likely than young women to visit a dermatologist for their acne. In contrast, young women are more likely to have intermittent acne due to hormonal changes associated with their menstrual cycle and acne caused by cosmetics. These kinds of acne may afflict young women well into adulthood.

View Samples Acne also has significant economic impact. Americans spend well over a hundred million dollars a year for nonprescription acne treatments, not including the cost of special soaps and cleansers. There are also the costs of prescription therapies, visits to physicians and time lost from school or work.

What are some myths associated with Acne?

Myth #1: Acne is caused by poor hygiene. If you believe this myth, and wash your skin hard and frequently, you can actually make your acne worse. Acne is not caused by dirt or surface skin oils. Although excess oils, dead skin and a day’s accumulation of dust on the skin looks unsightly, they should not be removed by hand scrubbing. Vigorous washing and scrubbing will actually irritate the skin and make acne worse. The best approach to hygiene and acne: Gently wash your face twice a day with a mild soap, pat dry–and use an appropriate acne treatment for the acne.

Myth #2: Acne is caused by diet. Extensive scientific studies have not found a connection between diet and acne. In other words, food does not cause acne. Not chocolate. Not french fries. Not pizza. Nonetheless, some people insist that certain foods affect their acne. In that case, avoid those foods. Besides, eating a balanced diet always makes sense. However, according to the scientific evidence, if acne is being treated properly, there’s no need to worry about food affecting the acne.

Myth #3: Acne is just a cosmetic disease. Yes, acne does affect the way people look and is not otherwise a serious threat to a person’s physical health. However, acne can result in permanent physical scars–plus, acne itself as well as its scars can affect the way people feel about themselves to the point of affecting their lives.

Myth #4: You just have to let acne run its course.The truth is, acne can be cleared up. If the acne products you have tried haven’t worked, consider seeing a dermatologist. With the products available today, there is no reason why someone has to endure acne or get acne scars.

How can I treat my Acne?

Today, virtually every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:

  • Resolution takes time.
  • What works for one person may not work for another.
  • A dermatologist’s help may be required.

A Dermatologist can provide you with all the options available today which include over-the-counter products, physical procedures such as light therapy and lasers, and prescription medications.

When should I see a dermatologist?

You may feel awkward about seeing a dermatologist, especially if you’ve been told that acne is something you will eventually outgrow. To help you decide whether or not it’s time to consult a dermatologist, listed below are some statements. Do any apply to you?

  • My acne makes me shy.
  • I am embarrassed by my acne.
  • My outlook on life is less optimistic since I developed acne.
  • None of the over-the-counter products and/or remedies I’ve tried has worked.
  • I am beginning to see scars after acne lesions clear.
  • I have painful, pus-filled lesions (nodules) in addition to blackheads and whiteheads (comedones), and reddened spots on my skin.
  • I have dark skin, and a patch that is darker than my skin appears when an acne lesion clears.

If you said “yes” to any of the above statements, seeing a dermatologist may be beneficial. Today, virtually every case of acne can be successfully resolved. Not only can dermatologists help resolve existing acne, they can also help prevent new lesions from forming and reduce your chance of developing disfiguring scars.

Can a dermatologist help with the Acne Scarring?

Yes, there are many procedures today that can effectively reduce or remove the appearance of scarring such as dermasandingsubcisionlaser resurfacingand fillers. Your dermatologist can assess your scarring and advise you on which techniques or procedures can help you! For more information about Acne, go to http://www.skincarephysicians.com/acnenet/index.html __________________________________________ All photos and Information used with permission of the American Academy of Dermatology. National Library of Dermatologic Teaching Slides.

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