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Comment reconnaître les différents types d'imperfections ?

HOW TO RECOGNIZE THE DIFFERENT TYPES OF IMPERFECTIONS

Whether it’s blackheads, spots, pigmentation marks… skin imperfections can take several forms, affecting your skin’s texture and complexion. This is why it’s important to know their characteristics and be better able to identify them and understand them before trying to treat them, and to use the right products for clean, clear skin. Let’s take a look at the different types of imperfections in this article.

Published November 29, 2022, by Stéphanie, Doctoresse en Sciences de la Vie et de la Santé, — 15 min read

What do we mean by “skin imperfections”?

The word “imperfections” is often used incorrectly. It’s sometimes used to describe dry or shiny skin, or a dull complexion. However, it actually means minor, temporary skin concerns, caused by specific factors, which can appear on the face or certain parts of the body.

Plus, when we talk about skin imperfections, the word “acne” comes up a lot. However, there are several other skin imperfections that can appear at any age. These are the most frequent types of imperfections:

  • Dilated pores: Dilated pores are defined as a skin imperfection. Pores are a dynamic structure, meaning their size can fluctuate, even though they’re determined by genetics. Dilated pores look like micro-depressions in the skin’s surface, giving it a “mandarin skin” appearance. According to one study, pores are described as “visible” and “enlarged” when their diameter is between 0.06 and 0.1 mm2.

    This increase in size can be caused by three potential factors: a buildup of sebum, loss of skin elasticity with age, or an increase in hair follicle size (caused by thicker hair). The dilation makes pores more susceptible to getting blocked, leading to blackheads and spots. Most dilated pores are found on the nose and the middle of the cheeks;

  • Blackheads (open comedones): Blackheads are a common form of non-inflammatory mild acne. They are easily recognizable by their black colour, which comes from the melanin contained in sebum that oxidizes on contact with air, leading to a black blockage at the surface of the pilo-sebaceous follicule. They’re especially tenacious and difficult to get rid of, and are formed when the pores get blocked by excess sebum (hyperseborrhoea) and/or dead skin cells (hyperkeratosis). They are usually found on the T-zone, meaning around the nose, forehead and chin, which are the areas with the most sebaceous glands. They’re often confused with sebaceous filaments, so take care to know the difference;

  • Whiteheads (closed comedones): Whiteheads appear like little lumps, usually less than 3mm in diameter, and almost invisible to the naked eye. They’re flesh-coloured, round, raised and non-inflamed, caused by excess dead skin cells and sebum blocking follicular orifices.

    They usually appear around the hairline, at the top of the cheeks and on the chin, but can be found anywhere on the body. Unlike blackheads, whiteheads form under the skin’s surface, so they don’t oxidize. However, if you squeeze them or they’re in an area where infection is more likely, they can turn into a papule or pustule;

  • Papules (red spots): Papules are the most common but least severe inflammatory acne lesions. They look like a small, red lump, because of the inflammation, are smaller than 1cm in diameter, and don’t contain pus.

    They’re caused when sebum is unable to flow freely and builds up in the follicle, creating a breeding ground for the bacteria Cutibacterium acnes, formerly known as Propionibacterium acnes, and also causes the pore wall to rupture, to which the skin responds with a visible inflammatory response.

  • Pustules (white spots): Unlike papules, pustules are small lumps, 5-10mm in diameter, with a white or yellow centre filled with pus and with a red border due to inflammatory cells, and are a sign of a bacterial, fungal or viral infection.

    Their cause? A buildup of sebum and keratinocytes, alongside the growth of Cutibacterium acnes bacteria, the same as papules. Although they easily subside, they tend to recur;

  • Nodules: Nodules are dome-shaped infected lesions, found in the most severe cases of acne. They’re palpable to the touch, larger (measuring 1-6mm in diameter), flesh-coloured, white or red, often painful, and grow deep within the skin. They generally leave scars. Their appearance is caused by increased activity of the sebaceous glands, abnormal keratinization and microorganisms, all of which lead to inflammation;

  • Cysts: Just like nodules, cysts are a form of serious acne. They’re usually painless, and are thin-walled pockets of tissue containing fluid or semi-fluid material with an epithelial lining, that grow deep within the skin. Rupturing its walls can lead to a cyst being sensitive to the touch and can cause inflammation, leading to a red and pus-filled spot.

  • Brown marks: It’s not just spots and comedones that are skin imperfections. Pigmentation marks, whether sun spots, melasma, or post-inflammation hyperpigmentation marks, are all considered skin imperfections. They are asymptomatic flat marks, from light brown to dark brown in colour, usually have irregular borders and can vary in size from a few millimeters to a few centimeters in diameter.

    This abnormal skin colouration is caused by either an increase in melanin production by the melanocytes or an uneven distribution of melanin in the skin. These marks appear most frequently on the face, the back of the hands, the chest or in the folds of the skin. They’re caused by several factors like sun exposure, hormones, or repeated friction on the skin.

  • Residual scarring: Alongside spots and brown marks, scars are also considered to be skin imperfections. They happen when certain acne spots leave lasting marks, especially if they’ve been squeezed. These scars form when new collagen develops rapidly to help heal an inflammatory lesion and prevent infection. Unfortunately, acne scarring never goes away completely, even if they do generally tend to look better with time. There are different types of acne scarring: ice-pick, atrophic (hollow), and hypertrophic (raised).

Where do imperfections come from?

Even today, people think that poor daily hygiene is to blame for skin imperfections. However, this isn’t always the case. There are several factors, both internal and external, which can lead to skin imperfections, such as:

  • Hereditary predisposition: Genetics and family history seem to play an important role in the appearance of acne, especially severe acne. Several studies show that acne appears earlier and more severely for people with a family history of acne. A study has even identified two new loci, 11p11.2 and 1q24.2, which are thought to be involved in androgen metabolism, inflammatory processes and scar formation in severe acne, highlighting another risk factor that influences the formation of acne.

    There is also genetic predisposition for patients with melasma, a frequent form of hyperpigmentation. 60% of those affected report that members of their family have it, too. In the same way, genetics also determine the size of your pores.

  • Skin type: Those with oily to combination skin are the most susceptible to imperfections like blackheads, comedones or spots, because they secrete more sebum than usual. Of course, these can also appear on other skin types, caused by several factors;

  • Aging: As we age, our skin loses its elasticity, and the skin around our pores becomes looser, which can increase their size and leave them more visible.

    Plus, with age, skin cell renewal slows down. This means more dead skin cells on the surface of the skin, leading to a buildup, blocked pores (also wider pores), and spots.

  • Hormonal factors: Hormones are one of the main causes of imperfections. For example, during puberty, the body produces more male hormones (testosterone, androgen), which boost sebum production in the sebaceous glands. Because of this, teenage men tend to suffer more with acne than teenage women. However, as adults, women are more affected by acne than men, caused by hormonal factors.

    Although men’s hormone levels tend to stabilise over time, for women they continue to fluctuate, especially before periods (pre-menstrual syndrome), during pregnancy, menopause, or after stopping hormonal contraception. A study showed that high levels of serum progesterone, but low estrogen, was found in patients with acne vulgaris.

    UV rays aren’t the only reason behind brown pigmentation marks. Hormonal factors are also behind irregular skin pigmentation. Studies have shown that feminine hormones, estrogen and progesterone, can cause hyperstimulation of the melanocytes.

  • Chronic sun exposure: Overexposure to the sun can lead to dehydration and dry out the skin. To counteract this, it starts producing more sebum. So, indirectly, the sun is also a risk factor for dilated pores. It weakens the structure of the dermis, damaging collagen and elastin fibres to leave it less firm and supple, meaning that the dermic structure around the pores weakens and widens.

    Ultraviolet rays are also the main factor in changing the skin’s normal pigmentation. Faced with the mutagenic effects of UV rays from the sun, the skin will secrete melanin in order to protect the nucleus, and therefore the DNA, of the keratinocytes of the basal layers of the epidermis, acting as a natural sunscreen. Plus, UV rays lead to an increased production of free radicals, which stimulate the production of melanin to protect cells from their harmful effect;

  • An unbalanced diet: There is proof that a poor diet can lead to the development of acne. Studies have evaluated the impact of glycaemic index on the skin, showing that people on a high glycemic load diet have more acne lesions, caused by a high production of insulin to lower blood sugar, which in turn increases androgen levels and promotes sebum secretion. Several studies have shown a link between consumption of dairy products and acne. They claim that whey protein or casein could contribute to the development, or aggravation, of acne by triggering sebum production. Plus, acne can be caused by the consumption of foods rich in fatty acids, which can cause proliferation of P. acnes;

  • Quality of sleep: Sleeping less than eight hours a night is a risk factor for acne. Studies have shown that lack of sleep (sleeping less than five hours) correlates to an increase in transepidermal water loss, when compared to those with a good quality of sleep (7-9 hours per night), which signals a change in the skin’s natural barrier. This means that the skin's defense system against external irritants is weakened, leading to skin problems such as acne, but also an increase in sebum production;

  • Touching your face: Generally, we touch our faces around 3,000 times per day. However, throughout the day our hands come into contact with all sorts of surfaces, bacteria, and dirt that aren’t good for our skin, leading to imperfections. Also, touching and squeezing spots considerably increase the risk of damaging your skin and causing scarring.

Sources :

  • JEREMY A. & al. Comedone formation: Etiology, clinical presentation, and treatment. Clinics in Dermatology (2004).

  • CHUNG K. & al. Sebum output as a factor contributing to the size of facial pores. British Journal of Dermatology (2006).

  • KITAHARA T. & al. Age-related changes in the epidermal architecture around facial pores. Journal of Dermatological Science (2008).

  • WILLIAMS H. C. & al. Epidemiology of acne vulgaris. British Journal of Dermatology (2012).

  • YOUN S. W. & al. Sebum, acne, skin elasticity, and gender difference - which is the major influencing factor for facial pores ? Skin Research and Technology (2013).

  • LAI W. & al. Two new susceptibility loci 1q24.2 and 11p11.2 confer risk to severe acne. Nature Communication (2014).

  • SEO S. J. & al. Facial pores: definition, causes, and treatment options. Dermatologic Surgery (2015).

  • CHEN W. & al. Sex hormones and acne. Clinics in Dermatology (2017).

  • LENORMAND C. & al. Hyperpigmentations. Annales de Dermatologie et de Venereologie (2019).

  • HE L. & al. A review of advancement on influencing factors of acne: an emphasis on environment characteristics. Frontiers in Public Health (2020).

  • TAN J. & al. Effects of diet on acne and its response to treatment. American Journal of Clinical Dermatology (2020).

  • VIE K. & al. Visible characteristics and structural modifications relating to enlarged facial pores. Skin Research and Technology (2021).

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