Acne is the most common of all skin diseases. Statistics show that eighty-five per cent of all people between the ages of twelve and twenty-five have some type of acne. It is a combined disorder of the oil glands and hair follicles in the skin. Contrary to some conventional conceptions, it is a problem suffered not exclusively by teenagers. Some people are plagued their whole lives by constant outbreaks of acne.
How do acne and scars develop?
Each follicle, or pore, in our skin contains a tiny hair and is connected with multi-lobed oil glands called sebaceous glands.
These glands produce sebum, an oily substance that lubricates our hair and skin. At the same time, skin cells inside the follicle are shed gradually and both the dead cells and sebum are expelled onto the skin surface. Most of the time the glands produce the right amount of sebum and the pores are fine. However, in acne, too much sebum is produced by the over-stimulated sebaceous glands. When excess sebum is mixed with the dead skin cells, a plug is formed in the follicle.
The sebum and dead skin cells are prevented from leaving the clogged up pore, while the excretion of sebum and the shedding of skin cells continue to take place. The accumulated sebum in turn causes a build-up of bacteria that live on it. This leads to swelling around the pore and acne is the result. This could happen to anybody, young and old. However, a few eruptions every now and then are not what concern us. We acne sufferers are concerned with those numerous and serious pimples that dotted our face and neck and never seem to go away. Another problem that concerns us is scarring. The accumulation of bacteria in acne could trigger our body’s defense mechanism. The white blood cell antibodies would enter the clogged up follicle and kill off the bacteria. Only that in the process of destroying the bacteria, the antibodies may severely affect other skin organisms and cells. This is how scars develop. Many unsightly marks would remain on our skin even after the acne is long gone.
Four stages of the common acne
Under normal conditions, sebum produced by the sebaceous glands and dead skin cells around the hair follicle are shed onto the skin surface.
1. Whiteheads—When the sebaceous glands are over-stimulated, they enlarge and produce more sebum. The follicle is plugged from the inside by the mixture of excess sebum and the dead skin cells. As the mixture continues to accumulate in the follicle, it eventually forms a whitehead (closed comedo). Whiteheads are small collections of pus around the follicle and the sebaceous glands. They usually appear on the skin surface as small, whitish bumps.
2. Blackheads—Sometimes, the mixture of excess sebum and dead skin cells serves only to block the pore partially, restricting but not completely sealing off the flow of oil onto the skin surface. This results in solidification of the sebum that fills the hair duct. The dried sebum and the shedded skin cells reach the skin surface at the pore opening and are discolored on exposure to air, forming a blackhead (open comedo). The dark color of blackheads is not due to dirt but is from a pigment, called melanin, of the shedded skin cells.
Both the whiteheads and the blackheads are non-inflamed lesions.
3. Pustules and Nodules—As we mentioned earlier, the accumulated sebum in a clogged follicle could cause a build-up of bacteria because some bacteria live on sebum. One type of bacteria specifically involved is Propionibacterium acne s, or P acne s for short. P acne s ingests sebum and is a normal resident on skin even in people who don’t have acne . However, when the hair follicle gets clogged and sebum builds up inside the follicle, P acne s multiplies rapidly. In addition, it produces an enzyme that breaks down sebum into a substance called ‘free fatty acid.’ It is this substance that causes inflammation, redness and swelling around the pus-formed area of the skin. These inflamed and generally more serious acne lesions are called pustules (pus-filled yellowish bumps) and nodules (firm, red, painful lumps just under the skin.)
4.Cysts—If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin tissues rather than onto the skin surface. Swelling and pain take place as the body’s activated defense mechanism sends bacteria-fighting white cells to the area. This deep-rooted inflammation and infection result in cyst formation. Cystic acne is the most severe and stubborn of all types of acne , and carries the biggest threat of scarring. The white blood cell antibodies that are to fight bacteria could destroy other skin organisms and cells, severely affecting the whole follicle. Sometimes, after the acne is healed, permanent scars remain on the skin.
What causes acne?
Most medical literature still maintains that the exact cause of acne is unknown. Actually, from what we have learned, we already know that acne is the result of excess production of sebum by the over-stimulated sebaceous glands and clogged follicles. The causes of acne therefore can only come from two fronts: Whatever that drives sebaceous glands to work overtime, and easily clogged pores.