How To Recognize the Different Types of Blemishes on Skin.

What is a skin blemish? The word “blemish” is often misused. It is sometimes used to refer to dry or shiny areas of skin, or to dull complexions. 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 it comes to a blemish, acne is the term most frequently used. Yet, there are many other types of skin blemishes, which can appear at any age. Among those frequently encountered are :

• Visible pores: Dilated pores are defined as blemishes on skin. They are dynamic structures whose size can fluctuate, even though they are genetically determined. Thus, dilated pores manifest themselves as a micro-depression on the surface of the facial skin, with a “tangerine skin” appearance. According to one 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 increased sebum production, loss of skin elasticity with age, or an increase in the size of hair follicles (hair thickness). This dilation makes pores more susceptible to clogging, leading to the formation of blackheads and pimples. Most enlarged pores are found on the nose and medial aspects of the cheeks;

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

  Particularly stubborn and difficult to remove, blackheads form when the skin's pores are blocked by large quantities of sebum (hyperseborrhea) and/or dead cells (hyperkeratosis). They appear mainly on the T-zone of the face, i.e., around the nose, forehead and chin, the areas of the skin with the most sebaceous glands. Often confused with sebaceous filaments, be sure to distinguish between them.

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

  They typically appear around the hairline, on the upper cheeks and chin, but can be found anywhere on the body. Unlike blackheads, closed comedones form below the surface of the skin, preventing their oxidation. However, if squeezed or infected, they can develop into papules or pustules;

• Papules (red pimples): Papules are the most common but less serious inflammatory acne lesions. They take the form of small red excrescences, due to inflammation, with a diameter of less than 1 cm, and containing no purulent matter.

  They form when sebum, no longer able to flow freely, accumulates in the hair follicle, creating an environment conducive to the colonization of the Cutibacterium acnes bacterium, formerly known as Propionibacterium acnes, but also causing rupture of the pore wall, to which the skin retaliates with a visible inflammatory response;

• Pustules (white pimples): Unlike papules, pustules are small bumps, 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 bacterial, fungal or viral infection, and a red periphery.

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

• Nodules: Present in the most severe forms of acne, nodules are infected, dome-shaped lesions, palpable to the touch, larger (measuring around 1 - 6 mm in diameter), flesh-colored, white or red, which can be physically painful, and which develop deep down. They usually resolve with scarring. Their appearance implies increased sebaceous gland activity, abnormal follicle keratinization, the action of microorganisms and subsequent inflammation;

• Cysts: Like nodules, cysts are considered a severe form of acne. Generally painless, they are thin-walled pockets of tissue containing fluid or semi-fluid material with an epithelial lining, and develop deep down. A rupture in the wall of the micro-cyst can, however, make it sensitive to the touch and cause inflammation, resulting in the appearance of a red, purulent pimple;

• Dark spots: Pimples and blackheads aren't the only skin blemishes we encounter. Pigmentation spots – sun spots, melasma and post-inflammatory hyperpigmentation marks – are also considered blemishes on skin. They take the form of flat, asymptomatic spots, light to dark brown, generally with irregular edges and ranging from a few millimeters to several centimeters in diameter.

  This abnormal skin coloration results either from an increase in melanin content by melanocytes, or from an abnormal distribution of melanin in the skin. Spots most often appear on the face, back of hands, décolleté or folds. This imbalance is encouraged by factors such as sun exposure, hormones and repeated rubbing of the skin;

• Residual scars: In addition to pimples and dark spots, scars are also considered skin blemishes. Some acne pimples can leave lasting marks, especially if they've been tampered with. These scars form when new collagen rapidly develops and deposits to heal an inflammatory lesion and prevent infection. Unfortunately, acne scars never completely disappear, although their appearance tends to improve over time. Ice-pick, atrophic (sunken), hypertrophic (raised)... there are different types of acne scars.