Taking into account the clinical picture of the disease, there are:
1. Comedonal acne;
2. Papulo-pustular acne of mild to moderate severity;
3. Severe papulo-pustular acne, nodular acne of moderate severity;
4. Severe nodular acne,
5. acne conglobata.
Acne is localized mainly on the skin of the face, upper extremities, upper chest and back and is manifested by papules, pustules and nodes, as well as open and closed comedones.
Comedo is a clinical manifestation of the accumulation of sebum and keratin in the hair follicle. There are closed and open comedones. A closed comedone differs from an open one in that the keratin masses are not so compact, and the hair follicle opening is narrow.
Papular acne are inflammatory nodules that are conical or hemispherical in shape and up to 2–4 mm in diameter. Pustular acne can occur primarily or transform from papular acne.
Nodular acne is characterized by the development of nodules on the skin of seborrheic areas. In patients with acne conglobata, in addition to comedones and papulo-pustular acne, numerous large nodes appear, localized mainly on the skin of the back and back of the neck. The consistency of the nodes is initially dense, but gradually they soften. The skin above them acquires a bluish-pink color, becomes thinner, and holes appear in it, from which pus is released. Part of the separately located nodes merges into massive infiltrates with numerous fistulous passages, purulent openings and cavities filled with sluggish, gelatinous granulations, the process can become widespread.
The clinical picture of acne in adults and adolescents has its own characteristics in terms of the ratio of lesions in the lower and upper parts of the face:
In adults,
1. The U-zone (cheeks, around the mouth and the lower part of the chin) is usually affected, and in adolescents - the T-zone (forehead, nose, upper chin).
2. Papules and pustules may be absent.
3. Comedones are always present in adolescent acne, but may be absent in adults. Inflammation in adults is usually more pronounced.
In women , there are 3 subtypes of acne:
1. Persistent (persistent) acne - observed in approximately 80% of women and is characterized by the onset of the disease in adolescence with a gradual transition into adulthood.
2. Late-onset acne - first appears in women after 25 years of age. Both subtypes have similar clinical features.
3. Recurrent acne - develops in women who had a history of acne in adolescence, resolved within a few years.