HOW TO RECOGNIZE THE DIFFERENT TYPES OF 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).