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What is Acne?

Acne is one of the most common skin diseases and affects about 85% of individuals at some time between the ages of 11 and 30 years. Girls are usually are affected by acne at an earlier age but boys are affected more severely and frequently. Acne may result in scarring and disfigurement but more importantly acne can have significant effects on psychosocial development and emotional well-being.

Acne is a disease of the pilosebaceous units. These units consist of a sebaceous (oil) gland connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle. Pilosebaceous units are largest and most numerous on the face, upper back, and chest.

Acne severity is correlated with the amount of sebum or oil produced; therefore these areas, the face, upper back and chest, are affected the most. Acne results from a change in the inner lining of the follicle that prevents the sebum from passing through. Cells from the lining of the follicle are shed too fast and clump together. The clumped cells plug up the follicle's opening so sebum cannot reach the surface of the skin. The mixture of oil and cells causes bacteria that normally live on the skin, called Propionibacterium acnes (P acnes), to grow in the plugged follicles. These bacteria produce chemicals and enzymes that can cause inflammation. When the plugged follicle can no longer hold its contents, it bursts and spills everything onto the nearby skin -- sebum, shed skin cells, and bacteria. Lesions or pimples develop as a result of the skin's being irritated.

People with acne frequently have a variety of lesions. The basic acne lesion, called the comedo or comedone, is simply an enlarged hair follicle plugged with oil and bacteria. This lesion is often referred to as a microcomedo because it cannot be seen by the naked eye.

If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo or whitehead. Whiteheads usually appear on the skin surface as small, whitish bumps. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin's surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Other troublesome acne lesions can develop, including the following:

  • Papules- inflamed lesions that usually appear as small, pink bumps on the skin that can be tender to the touch
  • Pustules (pimples)- inflamed, pus-filled lesions that can be red at the base
  • Nodules- large, painful, solid lesions that are lodged deep within the skin
  • Cysts- deep, inflamed, pus-filled lesions that can cause pain and scarring Pilosebaceous Unit Microcomedo Blackhead

    The cause of acne is the result of several related factors. One main factor is rising hormone levels. These sex hormones, called androgens (male sex hormones), increase in both boys and girls during puberty and can cause the sebaceous glands to enlarge and make more sebum. The excess sebum provides an environment suitable for the development of acne. Another factor is heredity. The tendency to develop acne can be inherited from parents. Changing hormone levels in girls and women may cause a flare in their acne 2 to 7 days before their menstrual period starts. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne. Certain drugs, including androgens, lithium, and barbiturates, are known to cause acne as well.

     Squeezing or picking at blemishes, and hard scrubbing of the skin can make acne worse!

December 2001