How to recognize different types of skin imperfections?

The term "imperfections" is often misused. It is sometimes used to refer to areas of the skin that are dry or shiny, or even a dull complexion. However, it actually refers to small temporary impurities, caused by specific factors, which can appear on the face and certain parts of the body.

Similarly, when discussing skin imperfections, the term acne is most frequently used. However, there are many other skin issues associated with imperfections, which can appear at any age. Among those commonly encountered, we have:

• Visible Pores : Enlarged pores are defined as a skin imperfection. Indeed, they are dynamic structures whose size can fluctuate, although it is genetically determined. Thus, enlarged pores manifest as a micro-depression on the surface of the facial skin with a "tangerine skin" appearance. According to a study, skin pores are said to be "visible" and "enlarged" when their diameter oscillates between 0.06 and 0.1 mm2.

  This increase in pore size can be associated with three potential factors, namely an increased sebum production, a loss of skin elasticity with age or an increase in the size of hair follicles (thickness of the hair). This dilation makes the pores more likely to become clogged, leading to the formation of comedones and pimples. Most enlarged pores are found on the nose and the medial aspects of the cheeks;

  

• Blackheads (open comedones): Blackheads are classified as a common form of non-inflammatory mild acne. They are easily recognizable by their black color, which comes from the melanin contained in the sebum that oxidizes when in contact with the surrounding air, forming a black plug on the surface of the pilosebaceous follicle.

  Particularly stubborn and difficult to remove, blackheads form as a result of the obstruction of skin pores by an excessive secretion of sebum (hyperseborrhea) and/or dead cells (hyperkeratosis). They primarily appear in the T-zone of the face, which includes the area around the nose, the forehead, and the chin, parts of the skin with the highest concentration of sebaceous glands. Often confused with sebaceous filaments, it's important to accurately distinguish between the two.

  

• Whiteheads (closed comedones)) : Whiteheads appear as small bumps, typically less than 3 mm in diameter, almost invisible to the naked eye. They are flesh-colored, round, raised, and non-inflamed, caused by the clogging of follicular openings due to an excess of dead skin and sebum.

  They typically appear around the hairline, on the upper cheeks, and on the chin, but can be found anywhere on the body. Unlike blackheads, closed comedones form beneath the skin's surface, thus preventing their oxidation. However, if they are picked at or if conditions are conducive to infection, they can develop into a papule or a pustule;

  

• Papules (red bumps): Papules are the most common but less severe inflammatory acne lesions. They appear as small red protrusions, due to inflammation, with a diameter less than 1 cm, and do not contain purulent material.

  They form when sebum, unable to flow freely, accumulates in the hair follicle, creating an environment conducive to the colonization of the bacteria Cutibacterium acnes, formerly listed under the name Propionibacterium acnes, but also causes the rupture of the pore walls to which the skin responds with a visible inflammatory response ;

• Pustules (white bumps) : Unlike papules, pustules are small bumps, measuring between 5 and 10 mm in diameter, with a white or yellow center filled with pus due to its composition of inflammatory cells, a sign of a bacterial, fungal, or viral infection, and a red perimeter.

  Their cause? An accumulation of sebum and keratinocytes, and the proliferation of the bacteria Cutibacterium acnes, just like papules. Although they can easily resolve, they tend to recur;

  

• Nodules: Present in the most severe forms of acne, nodules are dome-shaped infected lesions, palpable to the touch, larger in size (measuring approximately 1 - 6 mm in diameter), flesh-colored, white or red, which can be physically painful, and develop deep within the skin. They generally heal with scarring. Their appearance involves increased activity of the sebaceous glands, abnormal keratinization of the follicles, the action of microorganisms, and subsequent inflammation;

  

• Cysts: Much like nodules, cysts are considered a form of severe acne. Generally painless, these are thin-walled tissue pockets containing fluid or semi-fluid matter with an epithelial lining, and they develop deep within the skin. However, a rupture in the microcyst wall can make it sensitive to touch and cause inflammation, leading to the appearance of a red and purulent pimple;

• Brown Spots : Acne and blackheads are not the only skin imperfections we may encounter. The pigment spots, which include solar spots, melasma , and post-inflammatory hyperpigmentation marks, are also considered skin imperfections. They appear as flat, asymptomatic spots ranging in color from light brown to dark brown, typically with irregular edges and varying in size from a few millimeters to several centimeters in diameter.

  This abnormal skin pigmentation results either from an increase in melanin content by melanocytes, or from an abnormal distribution of it in the skin. Spots most often appear on the face, the back of the hands, the décolletage, or in the folds of the skin. This disorder is favored by various factors such as sun exposure, hormones, or even repeated skin friction ;

  

• Residual Scars: Beyond pimples and dark spots, scars are also considered as skin imperfections. It happens that some acne pimples leave lasting marks, especially if they have been handled improperly. These scars form when new collagen develops rapidly and deposits to heal an inflammatory lesion and prevent infection. Unfortunately, acne scars never completely disappear, even though their appearance tends to generally improve over time. Ice pick, atrophic (indented), hypertrophic (raised)... there are different types of acne scars.