Acne is the world’s most prevalent skin disorder. Since time immemorial, people from all over the world have struggled with bumpy, inflamed skin.
The condition may not be life-threatening, but anyone who has had it can attest to the havoc it can wreak on self-esteem. What we see on the outside cannot help but affect what we feel inside, and in that sense, acne is an debilitating condition that impacts our quality of life. There should be no shame in spending time, effort, and resources on trying to make acne go away.
But that doesn’t mean you should blow it all off on whatever product tickles your fancy. Let’s work smart here! In order to solve the problem, one must first understand it.
What Is Acne
In the simplest of terms, acne is a clogged pore. Our skin has millions of these tiny little openings, which are connected to sebaceous glands that produce a waxy, oily substance called sebum. More often than not, sebaceous glands are paired with a hair follicle. The pore surrounds the follicle.
Pores need to be open for sebum to spread over the skin and for new skin cells to push out dead skin cells to the surface. Sebum is important for hair and skin protection as well as moisture retention. Cell regeneration is important to keep the barrier healthy and intact.
But when a pore gets clogged, the sebum underneath is trapped and new skin cells accumulate. These conditions set the stage for acne to form.
How Acne Is Formed
Though it may feel like pimples just pop out randomly, the truth is it is a stepwise process. The different types of acne are actually stages of the same process.
Let’s start off with that clogged pore.
If the pore is only partially blocked, oxygen can come in and interact with the trapped sebum. The chemical reaction between the two causes oxidation of the melanin (yep, the same thing that gives your skin color and protects it from UV rays) in the sebum, turning it into a brown or black color. Presto, you’ve got blackheads! So contrary to popular belief, pore-trapped dirt is not what gives this type of acne its name.
If the pore is fully blocked, it forms a white- or skin-colored bump in the skin. Because oxygen cannot enter the pore, the accumulated sebum is not oxidized and appears white or clear. These are what we know as whiteheads.
These are what dermatologists call “non-inflammatory” acne. There is a bit of a misnomer, as blackheads and whiteheads have been found to contain inflammatory molecules. But because they are not red, nor sensitive to touch, they are called as such.
Blackheads and whiteheads may plague you for a couple of days or weeks, then resolve themselves on their own. Unfortunately, this is not the case for many of us who suffer from acne. On our skin, blackheads and whiteheads usually progress into pimples.
Pimples occur when the clogged pores are so full that it pops within the skin. The dead skin cells, sebum, and possibly bacteria are released into the surrounding area. It triggers an inflammatory reaction that causes the characteristic red, painful pimple that we are all too familiar with.
There are several kinds of pimples, depending on what’s inside it and how deep within the layers of skin it is.
What Causes Acne
All forms of acne, from blackheads to whiteheads to pimples, all start out when sebum is trapped inside the pore. So what materials could block the pore’s opening?
Sebum
It’s widely accepted that people with oily skin tend to be acne-prone. If glands make more sebum than can be released, build-up occurs. But recent studies have shown that it’s not just the quantity of sebum, but the quality of sebum that increases the tendency to get spots.
Research shows that acne patients have abnormal proportions of saturated to unsaturated fatty acids, a lower amount of linoleic acid, and a higher amount of oxidized squalene in their sebum than those with clear skin.
The mechanism that controls changes in sebum composition are not fully understood yet. But it appears that hormonal changes, stress, imbalance in the skin bacteria, and genetics play a role in making faces shiny and acne-prone.
Dead skin cells
It may sound gross, but your skin always has a layer of dead skin cells at its surface. It’s completely normal, and in fact is essential for protection. The skin cells at the top slough off for the next layer to replace it. The skin rejuvenates as the new cells underneath push the old ones off.
But in acne-prone skin, the production of new skin cells happens too fast and the sloughing off the dead layer takes too long. These cells also contain too much keratin that acts somewhat like a glue. It’s much easier for these cells to clump together and clog a pore. As a result, the dead skin cells block the opening while the new skin cells and sebum are stuck underneath.
Bacteria
As much as we freak out about bacteria, the fact is that our skin is always covered in it. There is still much to understand about the skin microbiota, but the fact that bacteria exist on all skin types means that they must serve an important function.
That being said, there is one bacteria species that is often associated with acne. Cutibacterium acnes is the microorganism most commonly found in the parts of our skin that produce sebum. They are one of the few bacterial species that thrive in a lipid-rich environment, and what could be more lipid-rich than a blocked pore?
This bacteria is harmless when it’s on the surface of our skin, but once they enter and proliferate within a blocked pore, they add to the pressure within. The body recognizes they’re not supposed to be there and send in the troops. White blood cells fight the bacteria and the resulting carnage results in what we call pus.
A comprehensive review on studies about bacteria and acne found that while C. acnes is found on everyone’s skin, the more pathogenic strains are usually found on those who suffer from acne.
Acne Treatments
Although acne has yet to be eradicated from the face of the Earth (excuse the pun), the years of research have resulted in products that have helped many people clear their skin.
There are chemical exfoliants that help clear off dead skin. There are active ingredients developed to speed up healing from acne lesions. There are topical and oral antibiotics that help stem the proliferation of acne-associated bacteria. There are drugs that help balance out the raging hormones that cause our faces to oil up.
With every breakthrough in our understanding of acne, we get one step closer to stopping those pesky breakouts.
This is a very light read on a very complex topic, so we encourage you to learn more about acne from reputable sources. Armed with the knowledge of how acne is formed and what factors influence it, you can better navigate among the plethora of products available on the market, grasp the reasons behind dermatological advice, and develop habits that will help minimize the occurrence of zits.
In the fight against acne, knowledge is indeed power. So read up!
This content is for general information only and is not a substitute for medical advice.
Resources:
Ottaviani, M., Camera, E., & Picardo, M. (2010). Lipid mediators in acne. Mediators of inflammation, 2010, 858176. https://doi.org/10.1155/2010/858176
Lee, Y. B., Byun, E. J., & Kim, H. S. (2019). Potential Role of the Microbiome in Acne: A Comprehensive Review. Journal of clinical medicine, 8(7), 987. https://doi.org/10.3390/jcm8070987
