Acne can be more than a teenage nightmare. There’s a common misconception that pimples are a transient plague that should disappear as you pass through the hormonal firestorm brought on by puberty. However, there can be far more common and serious cases where acne starts earlier, lasts longer, and can have a much harsher effect on the face and body overall. The diagnostic term given in such cases is Nodulocystic Acne. We will delve deeper into the leading causes of this condition, especially the longer-term effects.
There is a causal relationship between common pimples that come and go for teenagers, and nodulocystic acne, which can be a life-long condition. Both cases start when an infection sets in on a hair follicle. Hair follicles are connected to sebaceous glands that produce the oil known as sebum. To cause acne, the sebum that lines the cells of the follicle root becomes abnormally sticky, and the opening gets clogged, most often by dead skin cells. This can create the first stage of acne.Â
The overall effect is that increasing areas of skin are infected, red, and swollen. Most often, acne will break out in areas of the skin with abundant sebaceous glands, like the hairline, scalp, face, chest, and upper back.
Doctors grade acne into four stages:
- Comedones
- Papules and Pustules
- NodulesÂ
- Cysts
- Comedones are better known as blackheads (technically known as open comedones) or whiteheads (closed comedones). Contrary to common opinion, blackheads are not caused by or a sign of dirty skin. When the sebaceous oil trapped in an open comedone gets oxidized, it turns black. The only difference in whiteheads is that oxygen can’t reach the oil.
- Bacteria (proportion-bacterium acnes) live on the skin and secrete molecules that convert sebum into free fatty acids. These cause inflammation that results in papule formation. Papules have raised heads pushed up by accumulated pus around the follicle’s base.
- Pustules can develop when the pus around the base of a papule is pushed up toward the surface, creating a lump (nodule) or white bump (pustule) in the superficial dermis. What most people call pimples are really pustules.Â
- Nodules cause hard lumps or knots (nodules) to develop deep under the skin. The nodules below the surface start to swell and appear as red bumps on the skin. They typically do not have the same appearance as a whitehead or blackhead. They can persist for extended periods below the skin’s surface. Usually, they can’t be “popped” like pimples, which means the pus is trapped, leading to discomfort and swelling. The nodules can persist for weeks or even months
- Cysts, or cystic lesions, occur when the follicle’s root expands downwards into deeper skin levels. The accumulated sebum and dead epithelial cells may rupture through the wall of the follicle and be released into the surrounding layers. Cystic acne creates a large bump that’s full of pus. It may hurt or itch. A cyst bursting may spread the infection and cause more breakouts.
