Clinical Signs and Symptoms
Acne is characterised by various symptoms throughout its progress.
Its clinical signs are seborrhea, (increased secretion of sebum), blackheads, whiteheads, papules, pustules, nodules and acne scars depending on the severity.
Localisation of acne is usually linked with the age of acne onset. Inflammatory lesions are usually present on the middle part of the face during its early phases. In light-skinned people, lesions often appear as a reddish-purple macule (flat, distinct, discolored area of skin) which disappear quickly, whilst in dark-skinned individuals, macular hyperpigmentation results which may last a few months.
Depending on the severity of the condition, acne usually appears as one of the following types:
Comedones are clogged hair follicles (pores) in the skin. and are early clinical signs of mild acne. Symptoms such as itching are not usually present. However, they become painful as they progress. Comedones are categorised in three types:
They are caused by the excessive number of exfoliated epithelial cells from the follicle wall in combination with excessive amounts of sebum, a fatty, lipid-rich substance produced by the sebaceous glands.
- Open Comedones (Blackheads)
They appear when the pores on the skin’s surface open, and sebum, which contains melanin in the skin, is oxidised making them turn brown/black.
- Closed Comedones (Whiteheads)
When trapped sebum and bacteria remain under the surface of the skin, white spots are formed. They may appear as small white spots, while their size may be that small, that they are not visible to the naked eye. Closed comedones often progress to erythematous papules or pustules.
Papules are comedones that become small red or pink bumps on the skin. They may be painful, and the presence of many papules may indicate moderate acne.
Multiple follicular inflammatory papules occur, most commonly on the seborrheic areas of the face, precordial region, and on the backs of men and women until the age of 40. The condition of papules worsens at puberty. They may enlarge, become more nodular, and coalesce into plaques of several centimeters that are indurated or fluctuant, contain sinus tracts, and discharge serosanguinous or yellowish pus.
Pustules are small bumps on the skin that contain fluid or pus. They look like white spots but are surrounded by red skin.
Sometimes a serious inflammatory reaction may lead to large lesions full of pus. It is also possible for comedones and cysts to occur on the ears, and on the area around and behind them. Also, large cystic lesions may occur on the neck and the nape of the neck.
When the lower part of a follicle breaks, it can cause inflammation, leading to the development of a large and painful pimple. In patients with moderate to severe acne, cysts and nodules may occur which may result in permanent acne scarring. Dyspigmentation is a common sequela especially in patients with darker complexions.
- Acne Scars
Acne Scars appear in patients with more severe types of papulopustular and nodulocystic forms of acne and develop due to the fibrous contraction following the inflammatory phase. The severity of the scarring depends on the depth and the degree of the inflammation and on each person’s individual susceptibility.
Acne Scars are heterogeneous in appearance. Morphologies include:
- deep, narrow ice pick scars seen most commonly on the temples and cheeks
- canyon-type atrophic lesions on the face
- whitish-yellow popular scars on the trunk and chin
- anetoderma-type scars on the trunk
- hypertrophic and keloidal elevated scars on the neck and trunk