What the Heck is Acne? Here is How It Forms. 2

How to prevent acne - investigation

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How to prevent acne?

This is probably a question that you have been constantly thinking about even while you are in deep sleep (at least I think I am like this). Just like how we solve any problem, the first we need to figure out is what makes it happen. That’s why I think it is important to start the systematic learning process by learning how acne forms on our face and body as well as the cause of it. This post will focus on the physiology of acne formation. To me, this knowledge is crucial. Once we know how acne take shapes on our body and how it actually gets worse, we will be able to develop a clearer understanding on why and how different treatments work and form our own judgment on whether a particular treatment really works (isn’t this amazing? You will eventually become your own expert!). Also, we will be able to know what to avoid getting it worse.

Are you ready for the ride? Let’s go!

4 Triggers

There are four triggers that provide favorable conditions for acne growth: 1. overproduction of skin cells on the follicle walls, 2. over production of cells in sebaceous glands, 3. excessive oil and dirt covering the surface of the skin, and 4. proliferation and colonization of normal bacterial resident of the follicle overgrows.

Scenario 1: over production of cells in sebaceous glands (medical term: hyperplasia of the oil-producing sebaceous gland)

This situation will translate into excessive sebum (oil) production. Sebum in the skin will later clog pores, which allows bacteria to begin to grow in the blocked pores, leading to infection and breakouts. By following the logic, breakouts will become more severe in excessively oily skin because, as you can imagine, oil clogs pores.

Scenario 2: overproduction of skin cells on the follicle walls (medical term: hyperkeratinization of the hair follicle)

In this case, not only there is increased turnover of the skin cells on the follicle walls, but also the cells stubbornly hold onto the follicle walls. The fact that they don’t want to fall off leads to obstruction and clogging of the canal.

Scenario 3: dead skin, excessive oil and dirt covering the surface of the skin

Not exfoliating the top layer of the skin or not removing oil and dirt from the skin surface can result in re-absorption. Specially speaking, the resulting dry skin and dirt can be sucked downs by sebum into a pore, which can be why a blackhead or blemish forms.

Scenario 4: proliferation and colonization of normal bacterial resident of the follicle overgrows (medical jargon: Propionibacterium acnes, or P. acnes bacteria)

According to The Clear Skin Diet, acne can occur even without the presence of P. acnes bacteria. However, this kind of bacteria “contributes to blockage and provokes an immune system response that causes inflammation”

Consequences in 5 Phases

Once a favorable condition is provided, acne will “happily” and naturally step into life (well, however we don’t want it to). In general, there are two big categories for acne breakouts: non-inflammatory ones (including blackheads and whiteheads) and inflammatory ones (including papules, pustules, nodules and cysts).

How to prevent acne -  acne formationPhoto from Home Blackhead Remedies

Phase I: Non-inflammatory acne breakouts, aka comedones

Because a comedone can release its contents to the surface of the skin and heal itself without growing into a larger infection, this kind of breakouts will not create an inflamed and would-like blemish:

  1. An open comedo, aka a blackhead, is formed because of failure of cells to shed, causing buildup and improper expulsion of cells. Even though a blackhead is basically a mixture of cells, fat, and other gunk, the black color is not derived from the mixture of dirt, it reflects the skin pigment melanin reacting with oxygen (because a pore opens up to the skin surface).
  2. In the case of a closed comedo, aka a whitehead, it is caused by the buildup of the same mixture. Unlike a blackhead, a whitehead is not exposed to the skin surface. Without air exposure, there is no reaction with melanin, hence the white appearance.

Inflammatory acne takes place when follicles or pores erupt or explode. Below are four phases formed based on Phase I.

Phase II: papules

When the follicle can no longer hold the buildup of bacteria within and erupts. White blood cells will rush into the pore, which then becomes inflamed. Local immune reaction causes the characteristic red bump that can be up to half a centimeter in diameter.

Phase III: pustules, aka a zits or pimples

In this situation, “the dam has burst”, as The Clear Skin Diet describes. The follicle wall breaks to a more severe degree. This leads to a considerable spillover into the surround area beyond the follicle. A large collection of white cells and bacteria emerges, which is seen as the yellow pus color on the skin surface. This stage demonstrates significant inflammation and free-radical damage. Usually, it takes a few days from a papule to turn into a pustule. Pustules should be treated with cautions, as improper healing process “can lead to a walled-off cyst and an increased risk of scarring”, according to the book.

Phase IV: Nodules

They are one of the most severe forms of acne. When the pressure of the infection causes a rupture along the bottom of the follicle or pore, the follicle or pore may completely collapse. This is when nodules form, large and inflamed bumps that hurt to touch.

Phase V: cysts, or cystic acne

They are the most severe case in all forms of acne, resulting from a severe inflammation reaction. They are extremely large, pus-filled legions on the face or body.

You see, acne takes place and gets worse as the health condition of a follicle or pore deteriorates and white cells and bacteria spread. So, how to prevent acne? The first thing that comes to mind should be “what is acne”. If we want to define acne in one sentence, it will be: acne is a skin condition when an overproduction of skin cells or excess dirt and oil clog our pores, resulting in a buildup of oil which allows bacteria to form and spread.

I hope that the layout of this post is clear to you, and that you go to bed tonight with some new knowledge learned from this post ; ) Next time, I will share with you the cause of acne, both from dermatology’s and Traditional Chinese Medicine’s perspectives.

Till the next post!


Western and Eastern Medicines’ Views on Acne Causes (Part I)

Western and Eastern Medicines’ Views on Acne Causes (Part II)




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