Infantile and juvenile acne

Infantile and juvenile acne, which mainly affects males, presents as facial acne at around 3-24 months, and may last up to 5 years of age. Acne are more localized than in adults and particularly affect the cheeks. The individual lesions include not just comedones, papules and pustules, but also both nodules and scarring may be found. It is thought that juvenile acne initially results from transplacental stimulation of the adrenal gland, as most sufferers have elevated plasma adrenal androgens, but it is uncertain why the acne lasts for up to 5 years.

Acne fulminans

The patients are predominantly young males, who quite suddenly develop extensive inflammatory lesions, especially on the trunk Associated features are fever, joint pain , weight loss, anorexia and general malaise. Bone pain also common may show lytic lesions on X ray. It is an uncommon, immunologically induced, systemic disease in which the offending antigen is P. acnes. This is considered as sever form of acne due to systemic features

Acne conglobata

This is a most uncommon but severe form of acne, found particularly in males; the lesions usually occur on most of the trunk, face and limbs. Nodules are characteristic and frequently fuse to form multiple draining sinuses. Grouped, multiple, fused blackheads and extensive scarring are also features. The disease is characterized by persistence well into 40-50 years of age.

senile comedones/pimples

These are common in elderly people, especially in the periorbital areas. Most patients have had high exposure to UV radiation, and the solar damage to the supporting dermis allows the pilosebaceous duct to become more easily distended with impacted corneocytes. The edge of the adjacent skin may be mistaken for the pearly edge of a basal cell carcinoma. The lesions are easily removed with a comedo expressor, but they slowly recur.

Tropical/hydration acne

Certain occupations may aggravate pre-existing acne, for example workers in a hot, humid environment, such as cooks and pressers, are at risk.It is thought that hydration of the pilosebaceous duct pores may accentuate blockage of the duct and so precipitate inflamed lesions. Potentially comedogenic sunscreens may be an additional factor in these patients. These types of acne also common after a holiday in a hot, humid environment.

Detergent acne

This uncommon form of acne. This type of acne develops in patients who wash many times each day with soap, in the mistaken hope of improving their existing acne. Pustular and papular lesions are most noticeable. Several bacteriostatic soaps contain weak acnegenic compounds, such as hexachlorophene are responsible for such acne. These acne start improving once they discontinue using of such soaps.

Mechanical acne

This term covers a mixed group of disorders in which the acne occurs at the site of physical trauma, as indicated by the pattern of the lesions. Examples are so-called fiddler's neck, which occurs on the neck of violin players, and is also characterized by the presence of lichenification and pigmentation. Headbands (as worn by sports-people and hippies) and tight bra straps are other causes. Continuous friction from turtle-neck sweaters may localize acne to the neck. Adolescent patients lying in bed for a long time, for example following a fractured femur in the orthopaedic ward, may develop a flare of acne-the so-called 'immobility acne'. This is probably due to a change in the environment of the skin, which may enhance bacterial colonization of the duct.

Occupational acne

Acne can appear in areas in contact with oils and crude tars in certain workers. Men are more often affected than women. The skin may show conspicuous comedones, and only occasionally do frank inflammatory lesions arise; these are usually superficial. Lesions can occur within 6 weeks of exposure on almost any site, but the thighs and lower arms are especially prone. The commonest oils involved are the impure paraffin mixtures used in the engineering industry. Crude petroleum can affect oilfield and refinery workers; workers exposed to heavy coal-tar distillates.

pomade acne

Pomades are greasy preparations used in hair creams. The rash is similar to cosmetic acne but consists of non-inflamed lesions around the forehead and other areas where greasy pomades may extend onto the hairless skin. It may also coexist with acne vulgaris. The rabbit-ear model has shown that certain pomades are comedogenic. Restriction of the use of pomades is essential.

cosmetic acne/pimples

Use of potentially comedogenic cosmetics causes acne known as cosmetic acne. The lesions characteristically occur in the perioral area of mature females, especially those who had acne as adolescents and have used cosmetics for a long time. some cosmetics, especially those containing lanolin, petrolatum, certain vegetable oils, butylstearate, lauryl alcohol and oleic acid, are comedogenic.

Acne excoriee

This is a variant of acne, occurs predominantly in females. Two subgroups exist: those with some primary inflammatory acne lesions, and those with virtually none. Both groups usually consist of females who 'fiddle' with the skin to exacerbate even the smallest lesions. There is often some personality or psychological problem.

conditions resembling Pimples

Rosacea, which occurs in an older group and lacks comedones, nodules, cysts or scarring.In females, confusion with perioral eczema is possible, but in these patients the lesions itch, the skin is dry and non-inflamed lesions are lacking.Whiteheads may resemble small epidermal cyst known as milia.
Drugs like corticosteroids,anabolic steroids for bodybuilding, androgens (in females), oral contraceptives,isoniszid, iodides and bromides may produce acneiform/pimple like eruptions.

Stress and pimples

It is unlikely that stress induces the formation of acne lesions. However, acne itself induces stress, and 'picking' of the spots will aggravate the appearance.This is particularly obvious in young females who present with acne excoriée.Acne patients experience shame (70%), embarrassment and anxiety (63%), lack of confidence (67%), impaired social contact (57%) and a significant problem with unemployment.Severe acne may be related to increased anger and anxiety.