Acne

  • Basics

    Acne is an abnormal blockage in a pore that results in an inflamed lesion or non-inflamed "blackhead" on the surface of the skin Figure 01.

    Click to enlarge: Anatomy of the skin

    Figure 01. Anatomy of the skin

    Most people between the ages of 12 and 17 have some acne. Most cases of acne start between the ages of 8 and 13, when the body starts to produce increased amounts of hormones. The increase in hormone levels creates excess oil production and changes within the pore, which leads to acne. In most cases, acne resolves within five to ten years.

    Acne lesions usually occur on the face, but they can also occur on the neck, chest, back, shoulders, scalp, upper arms, and legs.

    Many people are able to manage their acne with over-the-counter treatments [Table 1].

    If you are not able to control your outbreaks with over-the-counter therapies, there are prescription drugs available to help you. For about 40% of adolescents, acne is a more serious condition that requires treatment by a physician. A doctor may prescribe topical therapy (cream, gel, or lotion) to be applied to inflamed areas. In some cases, oral antibiotic therapy is warranted.

    Occasionally, acne may persist into the late twenties, thirties, or beyond. Although acne affects young men and women equally, men are more likely than women to have severe, longer lasting forms of acne. Young women often experience mild to moderate acne that occurs during the week of their period.

  • Causes

    Plugged pores in the skin are the cause of acne. Acne usually emerges when adolescents enter puberty and their hormone levels begin to change. The hormones cause extra oil production and changes within the pilosebaceous unit that lead to acne. Acne occurs when the tiny hair follicles or pores (pilosebaceous units) become clogged. Inside the pilosebaceous unit is a hair and several sebaceous glands that produce a thick, oily substance called sebum. Sebum is the skin’s natural lubricant and softener. Under normal circumstances, the skin undergoes a process of renewal without any trouble—new cells replace the dead ones, and the sebum travels up the hair follicle, bringing the dead cells with it to be disposed of on the surface of the skin. However, during puberty, the hormones cause more sebum production, and dead cells are shed more quickly. The extra sebum increases the size of the pore, changes the inner lining of the hair follicle, and makes the skin appear oily. These changes may prevent dead skin cells from shedding normally. Usually, the dead cells inside the follicle are shed gradually, and are expelled onto the surface of the skin. However, in patients with acne, dead cells are shed more rapidly and tend to stick together. When they mix with sebum, they can form a plug in the follicle.

    The clogged follicle creates a perfect environment for breeding bacteria, which causes the inflammation and results in redness and pus. There are bacteria that exist on the surface of the skin normally, even in people who do not have acne. These bacteria can multiply as a result of the oil buildup around the hair. The bacteria break down the oil into very inflammatory chemicals that cause redness, pus formation, and pain.

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