Patients almost always present with lesions on the face. Smaller percentages exhibit body lesions, most frequently, on the back and on the chest. Type and location of the lesions may guide treatment. Acne manifestations and evaluation of disease severity are mainstay of diagnosis and treatment of acne. Inflammation is a major and primary culprit in development of acne by which manifestations and acne types used to be categorized into inflammatory and non-inflammatory lesions. Skin treatment of acne vulgaris seeks basis in severity of lesions . Precedently-known non-inflammatory lesions or comedones are subdivded into closed comedones, whiteheads, and open comedones, blackheads.
White heads are closed comedones with some pathological changes in pilosebaceous duct (hypercornification of the duct, which results in closure of the follicle). Blackheads or open comedones presents as an obvious black lesion especially on the top.1-3 mm in diameter. Accumulation of the melanin (skin pigment) in blackheads cause the black color. There are many patients who have few or no black heads. Manifestations of adult acne in form of white heads and black heads is very common and they may be the starting point for an inflammatory lesion.
Inflammatory lesions such as papules, pustules, nodules, cysts, macules and scars are among other acne types. Papules and pustules are more superficial compare to the rest of inflammatory acne and their cure takes a shorter period of time, 5-10 days. These pimples are caused by blockage of sebaceous glands sometimes called, oil glands.
No papule or nodule seen in this stage, closed or open comedones are present. A comedo is a blocked pore, which leads to a sebaceous gland. It may be black in appearance due to its oxidized sebum as in open comedones, or skin color with a slight inflammation in closed comedones.
Papules are red lesions, colloquially known as pimples, small, less than 1 cm, red, circumscribed, elevated and superficial, largely epidermal involvement.
Pustules are similar to papules but with a central collection of white pus at their top. Pustules look yellow with a pus component on top, a superficial elevation and circumscribed, in greater number and in a wider area
Nodules are tender and feel hard on palpation, larger than 5 mm in size, with dermal and subcutaneous involvement. Nodules are deep-seated structures and tend to remain for as long as eight weeks before finally resolving.
Cysts are fluctuant nodules containing fluid. Cysts are not very common types, a common manifestation of stress, but when they occur they may reach several centimeter in diameter. Cysts are tender, sensitive, deeper and larger pimples filled with pus. Cystic form is considered among severe acne types and its treatment must be consulted with a physician. Cystic acne cure may take longer period of time and its recurrency is very likely.
There are three major therapeutic goals for acne vulgaris: Resolve existing acne by early intervention reconizant of acne types, prevent scarring, and suppress the development of new clinical lesions by treating and preventing the development of subclinical microcomedones. Treatment serum is aimed at these objectives. Topical acne treatments such as, benzoyl peroxide, alpha and beta hydroxy acids, and azelaic acid are appropriate treatment modalities for acne commonly used in maintenance therapy. Those agents that demonstrate the best cutaneous tolerability, are easily integrated into patients’ lifestyles, and are associated with potential therapeutic dividends such as “skin-repairing” effects offer the highest potential for patient adherence.