Acne initially starts off presenting itself as microcomedones, these are very small and are not visible to the eye. They form due to excessive sebum production and dead cells which block hair follicles.
These microcomedones can then develop into comedones. Comedones are non-inflammatory spots.
Comedones
Closed comedones are commonly known as white heads .
The dead skin cells and sebum are not exposed to the air and the opening onto the skin remains closed. They can provide conditions for bacteria to grow and multiply, namely , Propionibacterium acnes (P.acnes).
Open comedones are also known as black beads.
The dead skin cells and sebum are exposed to air. Black heads have pigmented skin cells due to retained melanin, so they appear black.
Inflammed lesions
Comedones can develop or rupture into different types of inflamed lesions.
Papules - These are often red and painful spots. They occur when comedones rupture and leak onto the surrounding skin. Bacteria can cause infection which signals for white blood cells to come and attack the bacteria.
Pustules/ Pimple - Yellow heads.
These occur when bacteria in the follicle duct is mixed with white blood cells. The white blood cells produce Pus. Pus is a mixture of white blood cells, dead white blood cells ,dead skin cells and bacteria.
Nodules - Solid spots. These occur when large comedones rupture deep in the skin. Causing inflammation. They can cause significant scarring.
Cystic spots are fluid filled pockets containing pus. They form deep in the skin. They can also cause significant scarring.
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