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How does acne start?
Acne affects almost
everyone — more than 90% of all adolescents,
nearly 50% of all adult women and 25% of all adults.
Crossing gender lines as well as national borders,
it's one of the most widespread medical conditions
in the world. Yet there's still no cure.
But there is hope. While acne is not curable, it is treatable. We now know
more about controlling this condition than ever before. The secret to managing
acne is prevention — stopping this condition before it exhibits visual
symptoms. Once you have found a treatment that helps you accomplish this, it's
important to stick with it. Even after pimples disappear, you may need to continue
treatment to keep new blemishes at bay. It's also crucial to begin treatment
as soon as the first signs appear; the sooner you address your acne, the less
likely you are to experience permanent damage to your skin. Of course, in order
to stop acne, we must first find out how it starts.
What causes acne? One of the most important things you can learn about acne
is this: It's not your fault. Contrary to popular belief, acne is not caused
by anything you're doing — what you eat, how often you wash your face
or work out — but by a combination of factors at work far beneath the
surface of your skin
 A
healthy follicle
A blemish begins
approximately 2–3 weeks before it appears on
your skin's surface. It starts in your sebaceous
hair follicles — the tiny holes commonly called
pores. Deep within each follicle, your sebaceous
glands are working to produce sebum, the oil that
keeps your skin moist and pliable.
As your skin renews itself, the old cells die, mix with your skin's natural
oils, and are sloughed off. Under normal circumstances, these cells are shed
gradually, making room for fresh new skin. But sloughing is different for everyone.
Some people shed cells evenly; some don't. Uneven shedding causes dead cells
to become sticky, clumping together to form a plug — much like a cork
in a bottle. This plug, or comedo, traps oil and bacteria inside the follicle.
 A
plugged follicle
The plug traps oil and bacteria
within the follicle, which begins to swell as your
skin continues its normal oil production. Your
body then attacks the bacteria with a busy swarm
of white blood cells. The whole process takes 2–3
weeks, culminating in a pimple.
 An
inflamed acne lesion
Why me? There is
no one simple "cause" of acne — the
condition is influenced by many factors, many which
are out of your control. The regularity with which
you shed skin cells can change throughout your life.
The rate at which you produce sebum is affected by
your hormone balance, which is often in flux — especially
for women. Research has also shown that genetics
play a big part in the development and persistence
of acne, so your family history is a valuable prediction
tool as well. One of the best weapons in the fight
against acne, however, is knowledge; if you know
what causes it, it's easier to formulate a good plan
of attack. There are five primary culprits contributing
to this process. Each of these factors may vary dramatically
between individuals. While you don't have control
over these factors, understanding them can help you
in your search for the proper treatment.
 Acne
culprit 1: Hormones. For the majority
of acne sufferers, the trouble begins at puberty,
when the body begins to produce hormones called
androgens. These hormones cause the sebaceous glands
to enlarge, which is a natural part of the body's
development.
In acne sufferers, however, the sebaceous glands are overstimulated by androgens,
sometimes well into adulthood. Androgens are also responsible for acne flare-ups
associated with the menstrual cycle and, on occasion, pregnancy.
 Acne
culprit 2: Extra sebum. When the sebaceous
gland is stimulated by androgens, it produces extra
sebum. In its journey up the follicle toward the
surface, the sebum mixes with common skin bacteria
and dead skin cells that have been shed from the
lining of the follicle. While this process is normal,
the presence of extra sebum in the follicle increases
the chances of clogging — and acne.
 Acne
culprit 3: Follicle fallout. Normally,
dead cells within the follicle shed gradually and
are expelled onto the skin’s surface. But
in patients with overactive sebaceous glands — and
in nearly everyone during puberty — these
cells are shed more rapidly. Mixed with a surplus
of sebum, the dead skin cells form a plug in the
follicle, preventing the skin from finishing its
natural process of renewal.
 Acne
culprit 4: Bacteria. The bacterium Propionibacterium
acnes, (P. acnes for short) is a regular resident
of all skin types; it’s part of the skin’s
natural sebum maintenance system. Once a follicle
is plugged, however, P. acnes bacteria multiply
rapidly, creating the chemical reaction we know
as inflammation in the follicle and surrounding
skin.
 Acne
culprit 5: Inflammation. When your body
encounters unwanted bacteria, it sends an army
of white blood cells to attack the intruders. This
process is called chemotaxis; or, simply put, the
inflammatory response. This is what causes pimples
to become red, swollen and painful. The inflammatory
response is different for everyone, but studies
have shown that it is especially strong in adult
women.
What can I do? Fortunately, you have options! There are many
kinds of acne treatment available today. But first, you should try to determine
the type and severity of your condition. Acne, like a person, is highly individual — it
can take many forms, and have a highly variable response to treatment. The
more you know about your specific form of acne, the more likely you are to
find a treatment that works for you. Learn more about the types of acne.
 
 Is
your acne really acne? If
you’re over thirty, have fair skin that flushes
or blushes easily and have had a bad reaction to
acne medication, your problem may not be acne at
all. Frequently mistaken for acne, rosacea affects
one in twenty adult Caucasians – yet a recent
Gallup survey showed that nearly 80% of people
surveyed were unfamiliar with the condition. Symptoms
include skin redness and swelling in the areas
that typically flush when we’re excited or
embarrassed; telangiectases (the appearance of
broken blood vessels), and, occasionally, acne-like
papules and pustules. For this reason, rosacea
is often misdiagnosed as acne and treated with
acne medications. While these courses of treatment
may have some success, there are treatments that
target rosacea specifically that may have better
results. It’s not acne! Scientists are unsure
what causes rosacea, but they do know that it differs
from acne in one important way. Unlike acne, which
is a condition of the sebaceous hair follicles,
rosacea is a condition that involves both the skin
and the blood vessels. Says Vic Narurkarm M.D.,
Assistant Clinical Professor of Dermatology at
the University of California at Davis: “Blood
vessels in people with rosacea seem to dilate easily,
causing a flushing response to any number of triggering
factors. After years of frequent dilation, it’s
thought that the blood vessels ‘wear out’ and
stay dilated permanently.”1 For this reason,
it’s important to treat this condition properly – or
risk permanent damage to the skin.
 Understand
your triggers. Like any skin condition, rosacea is different for
everyone – so first step in treatment is to identify your personal
triggers. Flushing triggers vary widely between individuals, but studies
have identified a number of common foods and situations that can bring on
the flush response. These may include: cheese, chocolate, vanilla, alcohol,
spicy foods, hot beverages, spicy foods, sunlight, cold winds, stress, steroids,
vigorous exercise and alcohol-based skin products. Since prevention is the
best medicine for rosacea, it’s important for sufferers of this condition
to be aware of diet, habits and surroundings. If you think a particular food,
skin product or lifestyle issue may be triggering your flushes, try discontinuing
it for a few weeks; if your flushing subsides, it’s a good idea to
eschew it altogether.
 Find
the right treatments. Of course, it’s difficult to pinpoint
every single thing that affects your rosacea. So when you do have flushing,
blushing or breakouts, be sure to treat them as rosacea, not as acne. The
acne-like lesions can be treated with topical and oral antibiotics, which
stem the profusion of the bacteria, acnes as well as demodex mites, which
are five times more prevalent in patients with rosacea as in those who don’t
have the condition. Topical antifungal agents, such as metronidazole, are
also quite helpful. There are also a wide variety of pulsed dye lasers that
can reduce the redness of telangiectases, or broken blood vessels. Most importantly,
just be kind to your skin; use a gentle cleanser without alcohol or exfoliating
grains.
Acne and Acne Scarrring
Though rarely severe
from a medical standpoint, acne is a widespread and
embarrassing condition. It can produce life-long
scars, both physically and emotionally. To date,
it has been disappointingly resistant to various
treatment methods.
Acne typically begins
during adolescence, when hormonal changes cause the
enlargement and obstruction of sebaceous glands in
the skin. Consequently, many people experience an
abnormal proliferation of bacteria, predominantly
propionibacterium acnes (P. acnes). This typically
causes painful, inflamed lesions that can appear
on the face, chest, back, limbs and virtually any
other part of the body.
There are a number
of different looking scars caused by acne. They can
be classified as follows:
Ice pick
scars - Deep pits, that are the most common
and a classic sign of acne scarring.
Boxcar scars - Angular
scars that usually occur on the temple and cheeks,
and can be either superficial or deep. These are
similar to chickenpox scars.
Rolling scars -
Scars that give the skin a wave-like appearance.
Hypertrophic scars -
Thickened, or keloid scars.
Although most patients
eventually outgrow their acne, some individuals remain
susceptible to it throughout their lives. Even for
those who no longer generate new symptoms, permanent
scarring frequently results.
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