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Overview of Acne


Many people think that acne is just pimples. However, acne is actually an inflammatory skin disease. This disease affects the part of the skin called the pilosebaceous units that are made up of a hair follicle and the sebaceous gland.Puberty is generally the time that cases of acne emerge, partly due to the sudden surge of testosterone that is related to the changes the body is going through. Genetics also plays a role in who develops acne. For many people, outbreaks of acne disappear once they have passed through their teen years. Others, however, will experience acne all through their life. In general, though, adult acne tends to be a milder form than teenage acne. This is a very common skin ailment, and in the United States, approximately 5-15% of the population will be affected by it at some point in their life.

Symptoms and Signs of Acne:


Acne is more than just pimples or blackheads. In fact, there are seven different kinds of skin lesions that are signs of acne. The symptoms and signs of acne include:
  1. Microcomedone or Comedone: Called a microcomedone because it is too small to be seen with the naked eye, this is what happens when an enlarged hair follicle become plugged with oil and bacteria. This is the smallest type of skin lesion that is associated with acne.
  2. Blackhead or Open Comedone: Many people assume that a blackhead is dirt that has become embedded in the skin because it has a dark color. In fact, a blackhead, or open comedone, is a plugged hair follicle that has come to the surface of the skin. The dark color is not from dirt, but from the oils and bacteria in the plugged follicle.
  3. Whitehead or Closed Comedone: These small, white bumps do not come to the surface of the skin, but, instead, stay just under the surface. Like blackheads, whiteheads are plugged hair follicles.
  4. Papules: These are small, pink bumps that appear on the skin. They are inflamed, but do not have any pus inside of them.
  5. Pimples or Pustules: These bumps are inflamed lesions that are filled with pus. They generally are red at the base.
  6. Nodules and Cysts: Cysts and nodules are lesions that are large, inflamed and filled with pus. These are deeply embedded in the skin and can be painful, can drain and cause scarring.
  7. Acne Scars: Cysts, nodules and other lesions can cause scarring as they heal. The scars vary in size and shape.

What are Acne Lesions and How Do They Develop?


Hair follicles can become blocked by the oils that are secreted by the glands under the skin. When these oils combine with dead skin cells, they can clog up or block the hair follicles. The hair follicles can also become blocked by the shedding of the skin lining of the pores. The oils from the glands build up underneath the pore and form what is called a comedone. The combination of the oils, dead skin and blocked pore creates an ideal place for bacteria to grow. The scientific name of this particular type of bacteria is Propionibacterium acnes, which is where we get the name for the skin disease itself. The bacteria that grows sets off a chain reaction that can start inflammation and cause a lesion. Once the lesion has healed, it can leave behind scarring.

How Does Acne Start?


There are several factors that can contribute to outbreaks of acne. Contrary to popular belief, diet and grooming, often blamed for acne, play very small roles in who will have acne. Genetics, gender and age play much more important roles in outbreaks of acne.

As mentioned before, hormones are important factors in acne. Hormones called androgens, which include testosterone and dihydrotestosterone, can cause acne. Other hormones, such as estrogen and progestin, are also related to acne. When androgen levels rise compared to other hormones in the body, acne can be the result. During puberty, and during the menstrual cycle, hormones are in states of flux, which can cause acne.

Another factor contributing to acne is the excessive production of sebum. This comes from overactive sebaceous glands that cause the sebum to rise in relation to androgenic hormones. This can happen due to hormone fluctuations or it can be triggered by stress or heat.

Stress is thought to be an outside factor that can affect acne. Studies indicate that stress can suppress the immune system, and change hormone levels, including the adrenals. All of these together can make acne worse.

Dead skin cells are sloughed off our bodies every day. However, these dead skin cells can clog pores, creating a perfect environment below the skin for bacteria to begin growing. Because the dead cells block the pores, the area below the skin does not get oxygen, and this is the type of environment where the bacteria thrives.

Bacteria is a normal part of our bodies. The microflora of the body maintains a delicate balance. But, when something happens to trigger the bacteria to grow too much, then there is a reaction, which is inflammation that indicates there is a problem. Propionibacterium acnes, the bacteria most commonly present in acne, can cause lesions when coupled with some or all of the factors already discussed. If a person develops an allergy to Propionibacterium acnes, then they can develop acne even when there is very little bacterial growth.

Skin irritations may start an outbreak of acne, or irritate already existing lesions. Generally, however, skin irritations do not cause acne by themselves.

Some drugs and pollutants have been shown to have some level of connection with acne. For example, lithium and anabolic steroids are known to have an influence on outbreaks of acne. Chlorine compounds can also cause long lasting cases of acne, called Chlorance, when there has been a high level of exposure to the compound.

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