Acne is a chronic inflammatory skin disorder of the sebaceous glands that occurs when the hair follicles become plugged with oil and dead skin cells. Even if this condition appears to be quite common and simple, actually is very important to understand all the details and also the causing factors involved.

Considered before as most common among teenagers, due to the increase in the androgen hormone, testosterone around the time of puberty, lately became more predominant in people in mature ages, especially in Western diet/culture.

Acne signs vary depending on the severity of the condition:

  • Whiteheads (closed plugged pores)
  • Blackheads (open plugged pores)
  • Small red, tender bumps (papules)
  • Pimples (pustules), which are papules with pus at their tips
  • Large, solid, painful lumps under the skin (nodules)
  • Painful, pus-filled lumps under the skin (cystic lesions)


Even acne has a genetic condition, but this should not sound like a merciless sentence forever. There are multiple factors that combine in the formation of this condition including inflammation, hormones, dead skin cells, excess sebum and bacteria.

A successful acne treatment will not focus only on a single symptom like the bacteria for example; rather will targeting all of the contributing factors.

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. The first factor in acne formation is an increase in the androgen hormone testosterone, which can occur around the time of puberty, pregnancy, menopause and / or periods of long-term stress. This increase in testosterone levels will lead to stimulate the sebaceous glands to produce excess sebum (oil). Under the presence of an enzyme will also cause the excess sebum to become ‘sticky’ in texture and it mixes with corneocytes (dead skin cells) to form a blockage known as microcomedon or plug. As the skin continues to shed dead cells and produce more sebum, this blockage causes a build up and the plug develops into a comedone (blackhead or whitehead).

If this blockage is not cleared the lifecycle continues. Propionibacterium acnes (the P.acne bacteria), is anaerobic, meaning it thrives in an oxygen-free environment. The P.acne bacterium also uses sebum as its main food source. Therefore, with an abundance of excess sebum and oxygen unable to enter the pore freely, it’s the perfect environment for the bacteria to multiply.

P.acne bacteria releases an enzyme called lipase to help digest the sebum into free fatty acids that irritate the lining of the follicle. This results in an inflammatory response and an inflamed lesion known as a ‘papule’ is formed.

As the cycle continues your skins autoimmune system attempts to fight the bacterial infection with white blood cells, that transition from the blood to the skin and surround the infection. This is known as ‘pus’ and the formation of a ‘pustule’.

If the inflammation is allowed to spread to the deeper layers of tissue, then a large painful pus-filled lesion known as a Nodule is formed.

There are commonly 4 grades used to categories the severity of acne:

Grade I – Comedonal Acne
The presence on non-inflammatory lesions including closed comedones (whiteheads) and open comedones (blackheads) plus the occasional papule or pustule. 

Grade II – Mild Acne Vulgaris
The presence of open and closed comedones plus multiple inflamed papules and pustules.

Grade III – Moderate Acne Vulgaris
The presence of open and closed comedones plus large numbers of inflamed papules and pustules plus the occasional nodule.

Grade IV – Severe Acne Vulgaris
The presence of large number of open and closed comedones, papules, pustules, and nodules. Skin appears highly inflamed. This is sometimes referred to as Cystic Acne.

Controlling the inflammation is the key to both prevention and treatment.

Depending on its severity, acne can cause emotional distress and can lead sometimes to some other complications, as well. People with darker skin types are more likely than are people with lighter skin to experience these acne complications:

  • Scars Pitted skin (acne scars) and thick scars (keloids) can remain long-term after acne has healed.
  • Skin changes After acne has cleared, the affected skin may be darker (hyperpigmented) or lighter (hypopigmented) like before the condition occurred.

Although acne is not dangerous it can lead to long-term scaring and facial disfigurement, as well as social and psychological effects.

The very good news is that there are effective solutions for each particular case and the earlier you start treatment, the lower your risk of such problems.

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