AcneNet This Month
July 1999

Tip of the Month

The severity of acne really has two components. One measure of acne’s severity is its effect on one’s emotional and social life. Acne blemishes can be disheartening or even emotionally devastating for young people whose emotional life is still in process of formation. Others who are significantly affected by acne’s stigma include actors/actresses, models, sales people, or anyone whose appearance is important to their profession or occupation. A person who is very conscious of his or her acne may be shy about social contacts.

The other measure of acne’s severity is by some kind of objective grading scale, such as a physician may use in assessing what kind of treatment to undertake. A grading scale’s purpose is to rate the physiological severity of acne, so that treatment will be appropriate to the condition. It is important to discuss with your dermatologist the psychological effect of acne, so the dermatologist can base a treatment decision on both physiological and psychological factors.

How severe is your acne by the objective measure of a grading scale? There are several approaches to grading severity of acne, but in general, on a scale of 0 to 8:

0 = a few scattered comedones (blackheads and whiteheads)

2 = 30 to 40 papules and comedones over about one-fourth of the face

4 = about half of the face has papules, comedones and a few pustules; some lesions are red and inflamed

6 = about three-fourths of the face is involved; many comedones and numerous pustules, some quite large

8 = all or most of the face is involved; large, prominent pustules; much inflammation; acne conglobata may develop; healed lesions leave scars

A dermatologist will "fine tune" assessment of each individual patient’s acne on the basis of medical history and physical examination.

Fact of the Month

One of the questions that puzzles people with acne is why acne lesions often behave so erratically. One time an acne lesion may appear and disappear in a few days, while at other times a lesion may persist for weeks in one form or another.

One answer to the question is that acne lesions are the end result of inflammatory processes. The intensity of inflammation is the result of your body’s reaction to inflammatory stimuli produced by bacteria within sebaceous follicles. 

The other answer to the question is that lesions that show the most activity usually last the longest. Superficial lesions include papules, pustules and comedones. Papules may last 5 to 10 days, depending on their activity. Pustules may last for 5 or 6 days, depending on how active they are. Both papules and pustules may resolve into a macule that can persist for several weeks and contribute to the "inflamed" look of acne. Comedones may persist for years as the manifestation of plugged sebaceous follicles.

Deep lesions include nodules and "cysts". Nodules may persist for a month or more. Cysts may remain for several months.

However, lesions also may not resolve directly from appearance to disappearance. Rather, some may go through intermediate stages before they finally disappear, and in some cases they may regress to their original form before disappearing.

If you are under a physician’s care for acne, it is always important to follow the treatment plan recommended by your doctor. Click on Acne treatments to learn more about what you can do about treating acne.

Question of the Month

Each month we pose a question that is answered the following month. This month’s question:

We’ll have the answer, and a discussion of the answer, on AcneNet next month.

Last month’s question was:

What is sebum?

Answer: Sebum is a complex substance produced by sebaceous glands, but it is not the only oily substance found on the surface of the skin.

Sebum is a normal constituent of the skin, produced in the sebaceous glands that are found in sebaceous follicles. Overproduction of sebum can be involved in the development of comedones and acne.

The composition of sebum is a mixture of fatty acids, waxes, triglycerides and cholesterol. Since sebum has a complex composition it also has a unique "odor profile" that is usually undetectable by modern humans but can be identified by sensitive noses—for example, a bloodhound. Some investigators believe that sebum may be one of the substances our ancient ancestors relied upon for "odor communication" with one another. Other investigators believe that sebum may act as an oily barrier to prevent dehydration.

Sebum is only one of the oily substances on the surface of the skin, but perhaps the most important one. Where sebaceous glands are especially plentiful—for example, on the forehead—the skin oil is almost pure sebum. Other skin oils may be produced by other glands, or by bacteria.

Excessive production of sebum can cause the "oily skin" look often associated with acne. Click on Acne treatments for information about controlling the oily-skin look with gentle cleansing.