Types of Acne

People generally find it difficult to understand the different types of acne, mostly because dermatologists keep on changing their minds about how acne should be classified. Each time a new skin disease is discovered, or the cause of an existing condition is identified, there is a tendency to re-examine, reclassify and sometimes rename all the associated skin conditions in the light of this new knowledge. Acne had experienced more than its far share of this type of 'shifting of the sands' over time.

Historical Confusion Over Acne

In the early days of medicine, the term acne applied to a number of different skin disorders, which included, amongst others, acne vulgaris, acne rosacea and acne inversa. As dermatology advanced, it became clear that some fairly major blunders had been made These conditions were grouped together under the umbrella term 'acne' because they had a similar appearance and were thought to cause the skin to develop spots of a characteristic 'acne type'. However, as dermatological skills advanced, it became clear that some fairly major blunders had been made. Acne rosacea, for example, caused swelling within the skin that made its surface appear red and shiny. However, the shininess did not indicate greasiness due to an excess production of sebum, as was the case in acne, merely that the skin was stretched and taught. It remains unclear what causes the spots of acne rosacea, but its quite clear that its a completely different pathological process to that which occurs in acne vulgaris.

'Acne Like' Skin Disorders

As the inconsistencies were ironed out of the original model of the different types of acne, various skin diseases were renamed or reclassified so that it was clear that their 'acne like' qualities were not quite as 'acne like' as first thought. Acne rosacea became known simply as rosacea, in recognition of the fact that it is an entirely separate disease to acne. Rosacea damages the skin in a quite different way to acne, affects a different section of the population and requires specific rosacea treatment in order to resolve the condition. It is rare today to find doctors refer to the condition rosacea as acne rosacea, but the name persists amongst the general population and in old medical textbooks. Acne inversa underwent a less certain period of transition and is known currently by one of three different names - acne inversa, apocrine acne or the preferred name, hidradenitis suppurativa. What is certain is that hidradenitis suppurativa is not all that closely related to acne, since it is a disease of skin's apocrine glands and not the sebaceous glands, as is the case with acne. Although the two conditions can coexist in the same patient, it is accepted that hidradenitis suppurativa and acne are separate skin disorders affecting different elements of the skin and requiring different treatment. Having reclassified and renamed acne inversa, acne rosacea and a number of other conditions which originally came under the term acne, dermatologists found that there was only one type of acne remaining from their original list, acne vulgaris.

Acne Vulgaris

Under the old classification, acne vulgaris was by far the commonest type of acne, indeed the name acne vulgaris translates as 'common acne' Acne vulgaris translates as common acne - that's common as in widespread, not as in... - that's common as in widespread, not common as in muck. Acne vulgaris is now considered to be the only form of true acne and the terms Acne vulgaris and acne are considered to be both synonymous and interchangeable. What this means in practice is that all patients who have been correctly diagnosed as having acne are suffering from the same disease and their skin is being subjected to the same pathological processes, that is the skin is being damaged by the same mechanism.

Classifying Types of Acne

Within a large group of people who are all suffering from the acne, it is possible to identify sub-groups whose condition all has similar characteristics. These shared characteristic may be discernable by examining the patients and relate to the appearance and development of the spots, their distribution about the body or the age of the patients. Sometimes the common characteristic will only become apparent by asking about the history of the condition or the patients exposure to acne causing drugs, chemicals or cosmetics. Sometimes the only common feature will be that one group of acne sufferers respond to a particular type of acne treatment, whereas other do not. From all these possible ways of classifying different types of acne, two main systems have evolved. The classification of clinical types of acne centres around grouping patients with common causative factors to their acne, identified by a clinical examination of the patient. In contrast, classification according to acne distribution is an epidemiological exercise looking at the patterns of acne in large populations of patients in relation for example to their age, gender, race.