What Is Inflammatory Acne?

Acne is a common skin condition that affects millions of people worldwide. Among the different types of acne, inflammatory acne is one of the most prevalent and troublesome forms. It can cause significant discomfort and may leave behind long-lasting scars if not properly treated. This article aims to provide an in-depth understanding of inflammatory acne, including its causes, symptoms, and available treatment options.

Overview

Inflammatory acne is a type of acne characterised by the presence of red, swollen, and often painful lesions on the skin. These lesions are usually filled with pus and are commonly referred to as pimples or zits. Inflammatory acne occurs when the hair follicles become clogged with excess oil, dead skin cells, and bacteria, leading to inflammation and infection.¹

Causes of inflammatory acne

Several factors contribute to the development of inflammatory acne.² 

Excess Sebum Production

The sebaceous glands in the skin produce an oily substance called sebum. Excessive production of sebum can clog the hair follicles, leading to acne formation.

Bacterial Infection

The bacterium Propionibacterium acnes, which is naturally present on the skin, can multiply rapidly within clogged follicles, causing inflammation and acne breakouts.

Hormonal Changes

Hormonal fluctuations, especially during puberty, can stimulate the sebaceous glands to produce more sebum. This increase in sebum production can contribute to the development of inflammatory acne.

Inflammation

Inflammatory acne is characterised by a heightened inflammatory response in the affected areas. This immune response can exacerbate the severity of acne lesions.

Signs and symptoms of inflammatory acne

The symptoms of inflammatory acne are typically localized to the face, chest, back, and shoulders. Common symptoms include:

• Redness and Swelling: Inflammatory acne lesions are characterised by redness and swelling, giving the skin a raised and inflamed appearance
• Pustules and Papules: Inflamed pimples can form pus-filled lesions known as pustules or solid, tender bumps called papules
• Pain and Discomfort: Inflammatory acne lesions can be painful to the touch and may cause discomfort or tenderness

Management and treatment for inflammatory acne

Treating inflammatory acne involves a combination of self-care practices and medical interventions.³

Topical medications

Over-the-counter or prescription topical creams, gels, or lotions containing ingredients like benzoyl peroxide, retinoids, or antibiotics can help reduce inflammation and kill bacteria.

Oral medications

In more severe cases, oral medications such as antibiotics, hormonal treatments (e.g., oral contraceptives), or isotretinoin may be prescribed to control inflammation and reduce acne breakouts.

Professional procedures

Dermatologists may perform procedures like chemical peels, microdermabrasion, or laser therapy to reduce inflammation, unclog pores, and improve the appearance of acne scars.

Lifestyle modifications

Adopting a gentle skincare routine, avoiding excessive scrubbing or picking at the skin, and maintaining a healthy diet can contribute to the management of inflammatory acne

Diagnosis

Diagnosing inflammatory acne is usually based on a visual examination of the affected areas by a healthcare professional, typically a dermatologist. They will assess the appearance of the lesions and consider the patient's medical history. It's important to note that diagnosing inflammatory acne is primarily a clinical assessment based on visual examination. Laboratory tests or imaging studies are not typically required unless there are specific concerns or complications suspected.

The following steps are typically involved in diagnosing inflammatory acne.

• Medical History: including any previous skin conditions, acne treatments you have tried, any medications you are currently taking, and lifestyle factors e.g., skincare routine, diet, and stress levels.
• Physical Examination: Visual examination of your skin to identify the presence of inflammatory acne lesions, assessing the distribution, severity, and types of lesions present (e.g., pustules, papules, nodules). Examinations of other areas of your body, such as your chest, back, and shoulders.
• Differential Diagnosis: The dermatologist may need to differentiate inflammatory acne from other skin conditions such as rosacea, folliculitis, or perioral dermatitis, which can have overlapping features with inflammatory acne.

In certain situations, additional tests or examinations may be recommended such as:

• Skin Swab or Culture: If there is a suspicion of a bacterial infection, the dermatologist may perform a swab or culture of the affected area to identify the specific bacteria involved. This can help guide treatment decisions, particularly if antibiotic therapy is being considered.
• Hormonal Evaluation: In cases where hormonal imbalances are suspected to be contributing to inflammatory acne, the dermatologist may suggest hormonal evaluations, such as blood tests, to assess hormone levels and rule out underlying endocrine disorders.

FAQs

How can I prevent inflammatory acne?

Here are some tips to help prevent the occurrence and reduce the severity of inflammatory acne:⁴

• Keep your skin clean
• Avoid touching your face
• Use non-comedogenic products
• Moisturize appropriately
• Keep a healthy diet
• Manage stress
• Avoid excessive sun exposure
• Don't overdo skincare
• Avoid tight clothing and gear

How common is inflammatory acne?

While precise statistics may vary depending on geographical location, age group, and other factors, inflammatory acne is generally considered to be a prevalent condition worldwide.

During adolescence, it is estimated that around 85% of individuals experience some form of acne, including inflammatory acne. However, acne can affect people of all ages, from teenagers to adults, and its prevalence can vary among different age groups. It is estimated that about 40-50% of adults aged 20 to 40 continue to experience acne.

What can I expect if I have inflammatory acne?

If you have inflammatory acne, here are some general aspects you can expect:⁵

• Presence of Inflamed Lesions: the presence of red, swollen, and painful lesions on the skin, including papules (small red bumps), pustules (red bumps with pus), nodules (large, solid, painful bumps beneath the skin), and cysts (deep, painful, pus-filled lesions).
• Location of Breakouts: Inflammatory acne commonly occurs on the face, particularly on the forehead, cheeks, chin, and nose as well as the chest, back, shoulders, and upper arms.
• Varying Severity: Inflammatory acne can range from mild to severe.
• Potential Scarring: Inflammatory acne lesions, particularly deep cysts, and nodules, can increase the risk of scarring.
• Psychological Impact: Inflammatory acne can have a significant psychological impact on individuals, affecting their self-esteem, body image, and overall emotional well-being

Is inflammatory acne contagious?

No, inflammatory acne is not contagious. It is not caused by any type of infection or contagious agent. Inflammatory acne develops because of a combination of factors, including hormonal changes, excess sebum production, clogged pores, and inflammation within the skin.

The misconception that acne is contagious may arise from the presence of bacteria on the skin known as Propionibacterium acnes (P. acnes). However, P. acnes is a common bacteria found on the skin of most people, whether they have acne or not. It is not transmitted from person to person like a contagious infection.

While acne can sometimes be influenced by genetics, hormonal factors, and lifestyle choices, it is not something that can be passed from one person to another through direct contact or sharing personal items.⁶

Who is at risk of inflammatory acne?

Inflammatory acne can affect individuals of all genders, ages, and ethnicities. While there is no specific group that is completely immune to acne, certain factors can increase the risk of developing inflammatory acne.⁵

• Hormonal Changes: Fluctuations in hormone levels, particularly during puberty, can contribute to the development of inflammatory acne. Androgens, a type of hormone, can stimulate the sebaceous glands to produce more sebum (oil), leading to clogged pores and acne breakouts.
• Adolescents and Young Adults: Inflammatory acne is most associated with adolescence and young adulthood. The hormonal changes that occur during puberty make this age group more susceptible to acne breakouts.
• Family History: There is a genetic component to acne, and individuals with a family history of acne are more likely to develop inflammatory acne. If one or both parents have a history of acne, there is an increased risk of their children developing acne as well.
• Certain Medications or Medical Conditions: Some medications, such as corticosteroids, anticonvulsants, and hormonal medications, can trigger acne breakouts as a side effect. Additionally, certain medical conditions, such as polycystic ovary syndrome (PCOS) and hormonal imbalances, can increase the risk of developing inflammatory acne.
• Women with Hormonal Changes: Women may experience acne flare-ups during hormonal fluctuations related to their menstrual cycle, pregnancy, or menopause. Hormonal changes can influence sebum production and contribute to the development of acne.
• Cosmetics and Skincare Products: Certain cosmetics and skincare products that are comedogenic (tend to clog pores) or irritating can contribute to acne breakouts. People who regularly use such products may be at a higher risk of developing inflammatory acne.
• Environmental Factors: Exposure to certain environmental factors, such as high humidity and pollution, can exacerbate acne symptoms and increase the risk of inflammatory acne

When should I see a doctor?

It is generally recommended to see a doctor, specifically a dermatologist, for inflammatory acne in the following situations.

• Severity and Persistence: If your inflammatory acne is severe, characterized by deep, painful cysts, nodules, or many inflamed lesions, it is advisable to seek medical attention.
• Scarring or Hyperpigmentation: If your inflammatory acne is leaving behind scars or dark spots (hyperpigmentation), a dermatologist can assess the extent of the scarring and guide treatment options to minimize their appearance.
• Failed Over-the-Counter Treatments: If you have tried over-the-counter acne treatments without success in managing your inflammatory acne.
• Emotional Distress: If your inflammatory acne is causing significant emotional distress, affecting your self-esteem, or leading to symptoms of anxiety or depression.
• Acne that Affects Your Daily Life: If your inflammatory acne is impacting your daily activities, such as work, school, or social interactions

Summary

Inflammatory acne is a common and distressing skin condition that can have a significant impact on an individual's self-esteem and quality of life. Understanding the causes, symptoms, and available treatment options is crucial for effectively managing and reducing the severity of inflammatory acne. Seeking guidance from a dermatologist can provide personalized recommendations and help achieve clearer, healthier skin. Remember, patience and consistency in treatment are key to successfully managing inflammatory acne.