Acne indurata differs from the simple form chiefly in the degree and extent of the symptoms and the hardening (induration) which are present.
Acne papulosa, or papular acne, is simple acne in which papular eruptions (solid raised spots on the skin) predominate.
Acne pustulosa, or pustular acne, is acute acne simplex with papules developing into pustules.
Acne rosacea is acne plus rosacea, or a chronic congestion of the nose and parts of the face.
Acne scorbutis, or scurvy acne, is a papular acne with hemorrhages into the skin.
Acne scrofulosum, or malnutritional acne, called also scrofulous acne and acne cachecitcorum, occurs in undernourished or scrofulous or emaciated individuals. If develops chiefly on the trunk and lower limbs, though, occasionally, the arms and face are affected.
Acne simplex is simple acne, which is the most common form, hence the term acne vulgaris.
Acne varioliformis is a form of acne, the pustules of which resemble those of variola (smallpox). It develops chiefly on the forehead, along the hair margin, also the scalp, face and neck, and, sometimes, the shoulders and breastbone.
With the exception of acne artificialis, these various forms of acne are merely variations of simple acne, hence we will describe this only.
Simple acne is seen more often in girls and women than in boys and men; develops chiefly on the forehead, cheeks, lower jaw and chin, and sometimes on the chest, shoulders, upper arms, and even down the back and thighs; develops chiefly during the adolescent years and tends to disappear upon the attainment of maturity, although it may persist long after thirty is passed. It is often aggravated before and during menstruation.
Blackheads usually constitute the center or nucleus for the beginning of the inflammation. A papule develops around this center and later becomes a pustule. However, acne may develop without blackheads and blackheads may exist without acne developing.
A crust forms on the pustule, then falls off, leaving a redness which lasts a few days, or a depression or scar may be left. In many cases no pustules develop, the condition remaining in the papule stage, in which cases, the papules are absorbed after a few days.
On the same face, or other portions of the body, and without any semblance of regularity, there may be seen all stages — blackheads, papules, pustules, crusts, redness, pittings or scars. Frequently we see faces that have become so badly pitted their owners look like they have had smallpox. Few things can so completely spoil the beauty of the face as acne. The scars may be permanent, or they may gradually smooth out. In some cases no scars are formed. The stain that often remains tends to fade out, eventually.
If the papule of acne is opened or squeezed, blood, pus and fatty substance and, if present at the beginning of the papule, the blackhead, are found. Healing is usually rapid after evacuation of the contents, though squeezing usually tends to aggravate the local lesion. If the pustule is not molested spontaneous evacuation occurs.
In acne indurata the areas of hardening vary from the size of a pea to as a large as a hazel nut. They begin deep below the epidermis, are usually deep red or purplish, often involve several adjacent glands, thus giving the appearance of boils, and may contain much pus. The lesions often fail to rupture spontaneously. When opened and evacuated artificially, they tend to refill rather than to heal. Scar formation is often very pronounced, especially where there has been much squeezing or direct pressure. Fibroid changes in the scars may cause them to resemble fibroid tumors.
There are no general symptoms with acne and the sufferer is inclined to regard himself as otherwise healthy.ACRODYNIA
Definition: A symptom-complex marked by pricking pains in the palms and soles, hyperesthesia, and eruption on hands and feet.
Symptoms: This is an acute non-febrile erythema accompanied by nervous symptoms. It is considered to be related to pellagra, as it possesses similar symptoms. There are swelling of the face or extremities, erythematous eruptions on the hands up to the wrists and the feet up to the ankles, involving, as well, the fingers and toes; there is redness of the eyes, sensory disturbances such as a sensation of crawling insects on the skin, pain in the fingers and toes, sticking pains in the palms and soles, feeling of weight in the extremities, hyperesthesia and, sometimes, anesthesia. There is also irritation of the stomach and intestine. This symptom-complex occurs epidemically usually following the many catarrhal crises called "influenza."CARBUNCLE
Definition: This is a circumscribed subcutaneous inflammation, having a deep-red knob and often ending in a suppurating slough.
Symptoms: Carbuncles resemble boils but are more extensive, the inflammation involves the deeper tissues as well as the skin, are very painful and discharge their contents through several openings. Beginning as a fairly rapidly increasing painful knob on the skin, of a deep-red color, and flattened on top, surrounded by a hardened, painful and dusky-red area, It enlarges, pus forming in seven to ten days, which is discharged through craters formed by sloughing of the top. General symptoms such as may appear in any suppuration — fever, malaise, etc. — are pronounced. Carbuncles develop most often on the nape of the neck, back and buttocks. The scalp, face and back of the forearm are less frequent locations of development.CTHYMA
Definition: The word means pustule. It is applied to an inflammatory skin affection characterized by separate, flat, deep-seated pustules having broad inflamed bases.
Symptoms: This condition seems to be secondary to other skin inflammations and is seen chiefly in the poorly-nourished and debilitated. The pustules range from the size of a pea to as large as a dime, are sometimes long and narrow, and are yellowish in color. The pustules usually dry, forming reddish-brown crusts. Pigmentation and raw surfaces, followed by scar formation, usually succeed the disappearance of the pustules. The legs are most often affected; sometimes the trunk and neck.FURUNCLE (Boil)
Definition: An inflammation of the skin and underlying connective tissue surrounding a hair follicle or oil gland, leading to the formation of pus and death of the central portion or core, which is expelled. If a crop of boils appears the condition is called furuncolosis.
Symptoms: Boils are more common in men, especially youths, than in girls or women. The boil, develops rapidly, reaching full development within three or four days. It begins with a dull, aching pain, which rapidly grows more intense, with severe throbbing and a sense of tightness, these symptoms being more intense at night. The boil becomes "ripe" in seven to ten days. When the boil cap ruptures the core is usually expelled spontaneously leaving a small cavity of considerable depth. This heals quickly, leaving a small scar which gradually fades. Boils are occasionally accompanied with slight fever and other symptoms of a general nature. A "blind boil" is one in which no core is found. They may develop anywhere on the body, in the outer canal of the ear, etc.IMPETIGO (Scrum pox)
Definition: This is a skin inflammation characterized by a pustular eruption occurring chiefly around the mouth and nostrils, the pustules of which rupture within a short time or become encrusted.
Symptoms: Two chief forms are described as follow:
Impetigo contagiosa is the, common form and is considered "contagious" since epidemics are common among children under ten in institutions. It is the most common skin affection of school children, especially among the poor, and is seen often in adults, especially in the beards of men. The eruptions are flat, yellowish, superficial vesicles or blebs, usually on the face, neck and hands. These rapidly develop into indented pustules, surrounded by a red area. Wafer-like crusts form, their edges loosen, the crust curls up and falls off, leaving a red spot that soon fades to normal. There may be slight fever and itching.
Impetigo herpetiformis is a rare acute form presenting crops of clustered small pustles developing usually on the lower front of the trunk (pelvis), the groins, and inner and back sides of the thighs. Chills and fever accompany each eruption of pustules and various severe general symptoms may develop.POMPHOLYX (Dysidrosis)
Definition: A rare acute skin inflammation occurring usually in those who sweat excessively and characterized by the formation of deep-seated vesicles symmetrically between the fingers and on the palms.
Symptoms: Developing on the hands, and occasionally the feet, the vesicles gradually increase in size until they become blebs, which do not rupture, their contents being gradually absorbed, to be followed by extensive scaling which exposes a red skin beneath. Heat, itching, tingling or burning, pain and sensitiveness, and often some nervous depression, usually develop. The surrounding skin becomes sodden, painful and scaly. Repeated crops of vesicles and blebs, differing in intensity, are frequent. Healing takes place slowly within a few weeks.
URTICARIA (Nettle Rash, Hives)
Definition: This is a transitory inflammation of the skin characterized by short-lasting elevations that itch intensely. It is also called hives, in America. In Great Britain, the term hives is applied to croup, laryngitis, and chicken pox.
Symptoms: This affection seems to develop most often in the nervous type of child and in children with a very sensitive skin. The eruption in the form of firm, well-defined wheels with red bases and white summits, raised irregularly on various parts of the body, appears suddenly. They may appear locally or generally. "Individual" hives usually last but a few hours, but each crisis usually lasts a few days, new eruptions appearing as others subside. Occasionally, chronic hives develops. The term nettle rash is applied to these symptoms because they resemble those occasioned by the sting of the nettle.