Externally Induced Acne
Acne is a disease, which occurs predominantly on the face and, to a lesser extent, occurs on the back and chest. In young men, it affects mainly the face, and in older men back is significantly affected, though this rigid age-related distribution does not always occur. Noninflamed comedones are more frequent in younger individuals and consist of blackheads or open comedones, in which the black color is due to melanin pigment, not dirt, closed comedones, and the so-called noninflamed intermediate lesions.
1. Cosmetic Acne
The acneiform eruptions characteristically occur around the mouth in mature females, especially those who had acne as adolescents, and have used cosmetics for a long time. Some cosmetic preparations, especially those containing lanolin, petrolatum, certain vegetable oils, butyl stearate, lauryl alcohol, and oleic acid, are comedogenic. Switching to a cosmetic labelled as "non-comedogenic" will cause rapid improvement in cosmetic acne.
2. Pomade Acne
Pomades are greasy preparations, used to defrizz curly hair. The rash is similar to cosmetic acne but consists of skin colored boils around the forehead and other areas, where greasy pomades may extend onto the hairless skin. Restriction of the use of pomades is necessary to cause significant improvement in acne.
3. Occupational Acne Due To Oils And Tar
This uncommon acneiform eruption occurs in areas of skin, in contact with oils and crude tar. Men are affected more often than women. The skin may show conspicuous blackheads and whiteheads, and only occasionally do frank acne arise. Comedones can occur within six 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 industries. Crude petroleum can affect oilfield and refinery workers; workers exposed to heavy coal tar distillates, especially pitch and creosote, may also develop acne. DDT, asbestos, and heavy water distillate can also cause acne.
These type of acne follow exposure to certain toxic, chlorinated hydrocarbons. They consist of multiple comedones or blackheads, that are often localized on both sides of the face, especially near the temples, but in a more severe form, may occur on other parts of the body. Other skin signs, such as pigmentation, overgrowth of hair on a particular area of the body, and excessive sweating on palms and soles, may also accompany the acne. Other symptoms, such as loss of appetite, tiredness, nerve damage and weakness (neuropathy), disturbed liver functions, and increased blood cholesterol levels, may also occur. These changes may last for many years following exposure. Contamination often follows an explosion in a chemical factory, resulting in uncontrolled liberation of the chemical.
5. Mechanical Acne
This pattern of acne occurs at the site of physical trauma. Hair bands (as worn by sports people and hippies) and tight bra straps, can be the causative agents. Boils may occur on the neck of violin players, along with thickening and pigmentation of the skin. Continuous friction from turtle neck sweaters may localize acne on the neck. A peculiar type of acne is the so-called "immobility acne", such as that develops in adolescents lying in bed for a long time, as following a fractured thigh bone. This form occurs due to a change in the environment of the skin, which may enhance the bacterial colonization of the oil-producing sebaceous glands.
6. Detergent Acne
This uncommon form of acne develops in individuals who wash many times each day, in the mistaken hope of improving their existing acne. Pinkish red bumps and pus-filled boils appear. Several antiseptic soaps contain weak acnegenic compounds (that which provoke acne), such as hexachlorophene.
7. Tropical Acne or Hydration Acne
Certain occupations may aggravate pre-existing acne, for example, workers in a hot, humid environment, such as cooks are at risk. Hydration of the duct of oil glands may accentuate their blockage and precipitate the boils. "Mallorca acne" are the small boils that appear, especially on the upper trunk, during or after a holiday in a hot, humid environment. Potentially comedogenic sunscreens may add to the misery.
8. Infantile And Juvenile Acne
These are pimples on the face, that mainly affect male infants, and may last up to 5 years of age. The boils are more localized and particularly affect the face. Black heads, white heads, pinkish red bumps, nodules and even scars can develop. The acne initially results from transplacental stimulation of the adrenal gland of the infant, as most sufferers have elevated plasma adrenal androgens. There are no other features of androgen excess, such as an excessive growth of facial hair (hirsutism) or premature closure of epiphyses or growing ends of bones. This is probably because sebaceous or oil-secreting glands are unique in the skin, having enzymes capable of converting adrenal androgens, dehydroepiandrosterone to androstenedione and testosterone. Infantile acne is very rarely associated with persistent high plasma hormone levels of testosterone, or a tumor or genetic defect of adrenals.
9. Acne And Non-Acne Naevi
These are a type of birthmark, with symmetrical areas of normal skin, set in the midst of severe acne on the back, or with acne localized to one side of the back.
10. Comedo Naevus Or Naevus Comedonicus
This is an uncommon developmental defect of the hair follicles. The associated oil glands may be normal, enlarged, or reduced in size. The individual lesions are large-sized white or blackheads, often grouped, or in a linear arrangement. They often occur on the scalp, face, and trunk. Usually present at birth, they can even appear much later in life.
11. Familial Comedones
This is an uncommon genetic disorder, in which mono porous or polyporous comedones, cysts and scars occur on the face. New boils may continue into middle age.
12. Solar Or Senile Comedones
These commonly occur in the elderly people especially around the eyes. High exposure to ultraviolet radiation causes sun-induced damage to the dermis of the skin, leading to a widening of oil gland ducts, and impaction of bunches of skin cells in them. This results in blackheads and whiteheads.