Júlia Putini, G1 – 3/01/2023

There are five different types of acne and the treatment, which must be recommended by a dermatologist, varies according to the degree of the lesions.

What is acne?

According to Giovanna Mori Almeida, a dermatologist at Hospital Albert Sabin, in São Paulo; acne in adults is characterized by the: papules (solid lesions); and smaller pustules (“little balls” with pus), less painful and fewer in number.

They appear in outbreaks and with small comedones [popularly known as blackheads]. The distribution of lesions coincides with seborrheic skin. In women, it is more common in the submandibular region (lateral side of the lower third of the face and chin) and is exacerbated in the premenstrual period.

Classification of acne by severity

This skin condition is classified from 1 to 5 according to the type and severity of the lesions, classified five grades. Are they:

• Grade 1: comedogenic (non-inflammatory)
• Grade 2: papulopustular (inflammatory)
• Grade 3: nodulocystic (inflammatory)
• Grade 4: conglobata (inflammatory)
• Grade 5: fulminating (inflammatory)
• Grade 1: Characterized by the presence of comedones (blackheads) and some papules (solid rounded, hardened, and reddish lesions).
• Grade 2: Presence of comedones, erythematous papules, and pustules (lesions with pus).
• Grade 3: Presence of comedones, papules, pustules, seborrhea, nodules (inflamed lesions, which expand through deeper layers of the skin and can lead to tissue destruction, causing scars), and cysts (larger than pustules, inflamed, expand deeper layers of the skin, can be very painful and leave scars).
• Grade 4: Severe form of acne with purulent nodules, which are numerous and large, forming abscesses and fistulas that drain pus.
• Grade 5: Among all, this is the rare condition, when acne conglobata suddenly evolves with fever, joint pain, inflammatory erythema, necrosis, and hemorrhage in some lesions.

The distribution of the lesions is variable, but they appear more frequently on the face, chest, and back.

Types of acne

1 – Acne after adolescence

Characterized by smaller, less painful papules and pustules, presenting in outbreaks. More common in women, where the lesions are worse in the premenstrual period. It occurs due to an excessive response of the sebaceous glands to androgenic stimulation.

2 – Androgenic acne

When the acne condition occurs due to excessive production of androgen hormones by polycystic ovaries or other endocrine alterations. The diagnosis can only be given after hormonal dosages and by the ovarian study via USG.

3 – Medicated acne

Called an acneiform eruption, it manifests itself with the use of various medications. The picture is characterized by the abrupt appearance of lesions such as papules and some pustules.

Medications frequently involved: corticosteroids, phenytoin, lithium, iodides and bromides, vitamins (mainly B-complex ones), food supplements, and anabolic steroids, such as danazol, testosterone, and estriol.

Most of the time, discontinuing the medication is sufficient for the regression of the condition. However, sometimes drug treatment is necessary.

Acne treatments

The basis of all treatments is cleaning the affected areas with a soap that has active ingredients to control oiliness.

In general, gel acid is also prescribed. The most used to treat acne are retinoic, azelaic, and benzoyl peroxide.

When it comes to papulopustular acne, the topical treatment (products to rub on the skin) is associated with the use of an antibiotic, also for topical use. If there is no improvement in the case, the drug will be administered orally.

Attention: consult your dermatologist to find out which treatment is most appropriate. Each case is individual and the use of incompatible products can worsen the condition, in addition to generating scars.

As a last resort, treatment with isotretinoin is prescribed, a medication that acts on the sebaceous gland, decreasing and normalizing sebum production and altering follicular keratinization

For nodulocystic, conglobate, and fulminating acne, treatment is done directly with isotretinoin, in addition to proper hygiene and reinforced use of sunscreen