Acne Cysts : What is Acne?

Acne is a skin disease, caused by changes in the skin structures, usually involving the hair follicle and its associated sebaceous gland. Severe Acne is inflammatory, but Acne can also manifest in a non-inflammatory form. Acne lesions are commonly referred to as pimples, spots, or zits.Acne vulgarisAbout 80% of people develop some spottiness. Acne may be very mild indeed, but at its most severe, gross and unsightly changes are seen.Acne may be associated with underlying endocrinological abnormalities but usually it is not.Age of onset and courseThe first problems are usually encountered in adolescence, although there are exceptions.Lesions of acne vary considerably with time. Most patients notice marked fluctuations in the number and severity of spots, and in girls this is often related to the menstrual cycle. The condition frequently deteriorates at times of stress.Acne usually gets worse for a while before gradually settling after 2-3 years, and usually disappearing altogether. The peak of severity is earlier in girls than in boys. In some individuals, the time-course may be much more prolonged, with lesions continuing to develop well into adult life.There are two groups, described below, in whom true acne develops outside adolescence.Infantile / juvenile acneTypical acne is occasionally seen in infants and children (especially boys), usually at 3-12 months of age. Although lesions subside after 4-5 years, adolescence often heralds a severe recrudescence. Endocrine abnormalities are very rare, but should be considered, especially in a girl with signs of virilism.Late-onset acneA number of women and some men develop acne in their twenties and beyond. In women, this is often with marked premenstrual exacerbations. Endocrinological investigation is generally unrewarding, but polycystic ovary syndrome I an important exception.Physical signsThe characteristic distribution is as follows.Site and distribution of acne• Face, any part of which maybe involved• Neck, especially posteriorly• Ears• Upper back• Anterior chest, in an inverted ‘V ‘from the shoulders to the xiphisternum• ShouldersIn severe acne, lesions may extend down the arms, across the whole of the central back, and onto the buttocks.The appearance of the skinThe first physical sign to note is that the face and upper trunk become very greasy due to increased production of sebum. This is normal at puberty, but is excessive in those with acne. Scalp hair is often very greasy too. Greasiness alone may be bad enough for the patient to seek advice.The individual lesions of acneA cardinal feature is that there are several different types of lesion at any one time.Acne vulgaris lesions• Comedones: closed (white heads’) open (‘blackheads’)• Papules• Pustules• Nodules• Cysts• ScarsComedones (singular: comedo)The presence of comedones is an important diagnostic aid. There are two types: closed (or ‘whitehead’) and open (or ‘blackhead’).Closed comedones are more easily felt than seen. They are very small papules, with a central point or elevation. They are often most numerous on the forehead and cheeks. There is little or no inflammation.Open comedones (blackheads) are dilated, blocked hair follicles, but it is not clear what causes the characteristic black dots. Burnt-out inflammatory lesions may leave multiheaded blackheads, particularly on the shoulders and upper trunk. Blackheads are virtually pathognomonic of acne in the younger patient (although advanced solar damage may also result in blackhead formation).Papules and pustulesThe majority of patients with acne develop papules and pustules. They are the well-known little red spots or pustules on a red base. They may itch or be quite painful. Papules develop rapidly, often over a few hours, and frequently become pustular as they evolve. They resolve over the course of a few days. New lesions may arise in exactly the same site on many occasions.Nodules and cystsWith increasing severity, and as the inflammation extends deeper, the size of visible and palpable lesions increases, resulting in deep-seated nodules and cysts. Many patients develop a few, but some have large numbers: a situation in which the term ‘acne conglobata’ is used.Such lesions are often extremely uncomfortable and last much longer than more superficial changes. Some become chronic, and may result In permanent cyst formation.ScarsThe final common pathway for the inflammatory process of acne is scarring, which will remain as a lifetime’s legacy of adolescent anguish.Characteristically, small, deep ‘ice-pick’ scars occur, but more severe disease can leave gross changes, with a trophy or keloid formation.Systemic symptoms (acne fulminans)Very occasionally a young man (almost always) develops severe nodulocystic acne accompanied by fever, malaise and joint pain and swelling. This is known as ‘acne fulminans’.

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