Getting acne....Q&A............(part 3 of 5)

I’ve started getting acne spots. How long do they last?
This depends on what type of spots they are and, even then, it can
be very difficult to predict what will happen. Some spots will
appear and then disappear during the course of a day but others
will evolve more gradually through the various stages. Comedones
can be very persistent if they don’t get inflamed. Mildly inflamed
spots will last 5–10 days before settling down, but can leave a flat
red mark (macule) for several weeks. Nodules and cysts may last
for weeks or months unless you get some treatment.

What is the difference between a whitehead and a yellow-
head spot?
These two common terms describe quite different types of spot.
A whitehead is a closed comedone where the pore is blocked and
not open to the air. There is no inflammation (redness). A yellow-
head suggests a spot with pus in it. The medical term is a ‘pustule’.
Whiteheads may become yellowheads if the blocked pore becomes
infected.

My daughter is only 9 but she seems to have developed some
blackheads around her nose. Can this be acne – like I had?

Girls seem to be starting puberty earlier and earlier, and many
9-year-olds have started to develop some hormone changes.
Blackheads are one of the types of spots that occur in acne so,
yes, this could well be the start of it. Almost all children will get
some blackheads and other spots as they start and go through
puberty, so your daughter will not necessarily get worse but this
might depend on how bad your own acne was. We don’t fully
understand the role of genes in acne but there is some inherited
factor that makes acne more likely in some families. If you had
severe acne, it is worth starting a simple treatment approach to
reduce the number of blackheads on your daughter’s nose.

I am an identical twin and I have acne but my sister
doesn’t – weird or what? Can you explain why?
Answering questions like this is always difficult. We can’t give you a
reason why your twin doesn’t have acne, because the precise cause
and triggers are not fully understood. However, studies of twins
have helped to work out that some genetic inheritance is involved,
as identical twins tend to produce similar amounts of the skin
grease called sebum. This is not the case for non-identical twins.
You don’t say how old you are – it may be that your sister will
go on to develop acne. She is certainly more likely to have acne
than if she were not your twin.

I have been having problems with my skin for about two years. Can you tell me what the difference is between spots and acne? I think that to have acne you must have at least 20 spots but my mum thinks otherwise.
There is no real difference between spots and acne, assuming
that the type of spots fits into the pattern we have described withblackheads, whiteheads, papules and pustules. What is most
important is the effect the spots have on you and whether you
have any of the more serious types of spot that might cause long-
term scars. If you are upset by the appearance of your skin, it
doesn’t really matter how many spots you have – you have a
problem that is worth seeking some treatment for.

Why am I the only one in my class who has spots? I heard
it was very common but I don’t think it is really.
The most important spots are the ones that you have, and you
will be much more aware of them than anyone else. Other
students might have spots that you can’t see – on their back or
chest – or they might be using some treatment or camouflaging
make-up. Don’t worry about them; just talk to your pharmacist or
doctor if you are not already using some creams.DBE6SCXAA5WF

What is acne?.....................(part 2 of 5 )

Below we outline the types of spots you can get, so you can tell whether you have a mild, moderate or severe problem. They do not all have to be present for you to have acne. Just one type will still mean you have this condition, and there are effective treatments no matter how bad your problem is.

Comedones

These are the starting point of all acne. They begin as very small blockages in the pores. At this stage a blockage is referred to as a microcomedone – the comedone is too small to be seen. Microcomedones can progress to become larger comedones, or they can burst (rupture) internally, causing different types of spots.They burst because of the build-up of pressure and the damage that the inflammatory process does to the wall of the duct.

Whiteheads (closed comedones)

Some people think of whiteheads as a type of pus-like spots, but they are not. As the microcomedone gets larger, because swelling is building up behind the blockage, it becomes visible. If the initial blockage is quite deep in the pore, the opening onto the skin will remain closed; this causes the typical whitish lump that can be seen and felt on the surface.
Blackheads (open comedones)

These are clearly visible and very annoying because they look so dark and obvious. The blockage has occurred further up the duct, so its opening is widened and the contents are visible. If you were to dissect your skin, you would see the curly sebaceous gland –which is the escape route for oil – blocked full of a hard, yellow plug. This plug is a mixture of the sebum that has solidified and
the dead lining cells that have been shed. Because these are like skin cells, they contain some of the pigment (melanin) that gives skin its colour. This pigment turns dark when it is exposed to air,so the ‘black’ in ‘blackhead’ is notdirt.

Inflamed spots

Comedones can stay quite happily in your skin for months, or even years, without changing. If they progress or burst (rupture), though, different kinds of spots result: papules, pustules, nodules and cysts.

Papules

If the comedones start to leak sebum into the surrounding tissue, this produces inflammation and a red spot results. Papules are less than 5mm across and have no pus visible. They could be
called ‘redheads’, as they are otherwise like the whiteheads. If your microcomedones rupture, you will produce papules without going through the whitehead and blackhead stage.

Pustules

A pustule is the typical pus spot or yellowhead. These occur when the bacteria present on the skin and in the duct start to multiply. These bacteria are called Propionibacterium acnes
(usually shortened to P. acnes). They prefer dark places with no air to breed. A blocked pore is ideal and soon there will be lots of bacteria producing more inflammation; this triggers the body’s
own defences as mentioned above, leading to a head of pus on a red swelling.

Nodules and cysts

Comedones, papules and pustules are nasty to look at and caus pain associated with the swelling and inflammation but will clea up without causing much scarring except in people wit
pigmented skin. (This is discussed further in Chapter 6, The physical scars.) The next two types of spot mentioned, howeve – nodules and cysts – can cause real and lasting damage.

Nodules

Nodules are solid spots; they are much bigger than papules and extend deeper into the skin. They are caused when a large comedone has ruptured, releasing lots of inflammatory contents
(white cells and bacteria) into the surrounding skin. More inflammation and pus result, leading to more pain and swelling.The nodule extends deeper into the area that contains the skin’s
structural support. Damage here leads to the scarring.

Cysts

Unlike nodules, cysts are bags of liquid that is a mixture of pus and bacteria. Cysts usually occur only with nodules, often when two or three are close together. They are even more destructive
than nodules to the structure of the skin but, luckily, are quite rare.

Who Gets Acne?

People of all ages get acne, but it is most common in adolescents. Nearly 85
percent of adolescents and young adults between the ages of 12 and 24
develop the disorder. People of all races can have acne, but it is more
common among Caucasians. For most people, acne tends to go away by the
time they reach their thirties; however, some people in their forties and fifties
continue to have the disorder.