Most of us have experienced a terrible acne problem in our teenage years. It plagued us with self-consciousness and worry. Some are lucky enough to outgrow the “breakout” and just have acne from time to time, but there are those who have the misfortune of carrying their zit problems into adulthood.
This is probably due to our misunderstanding of the concept of acne. To understand it better, we need to look at its science.
Acne is much more than just your standard red pimple with a little whitehead on top. There is a medical name for it: acne vulgaris. It is the phenomenon responsible for the presence of blackheads, whiteheads, and other types of pimples on the skin.
Acne for most people is a broad, sweeping definition for all pimple breakouts on our face, chest, shoulders, and back. What we fail to understand is that there are different types of acne, and we mistakenly use the term “breakout” to describe its spread across the skin.
The worst part is that there isn’t a one-size-fits-all approach to nixing acnes for good. This is because there are several factors causing it to occur.
Acne vulgaris encompasses a variety of skin issues known as “multifactorial diseases”, meaning the condition is caused by a combination of the effects of genes and their interactions with the environment.
Here are the main factors of acne occurrence:
To understand acne, you have to start with human hair. Except on our palms and feet, our entire body is covered by hair shafts anchored by a follicle. Each hair follicle is embedded in the skin with a sebaceous gland filled with oil or sebum. Sebum protects the skin against dehydration and external factors. It also keeps the skin flexible and our hair shiny and soft.
The sebaceous glands grow in size during puberty and certain phases of life (menstruation, pregnancy, illness) because of increased hormonal activity. This in turn leads to increased sebum production. An increased production of sebum can cause ingrown hairs or a pore blockage, resulting in small pimples.
The skin renews itself every 28 days. During this renewal process, new skin cells migrate from the bottom to the surface of the skin. The ‘corneocytes’ or the old, dead skin cells flake off the skin, giving way to the new cells. Hyperkeratinisation is the process in which the corneocytes stick on the skin’s surface and fail to peel off. This accumulation of the old skin cells cause pore blockage resulting in the development of primary acne lesions.
The bacterium Propionibacterium Acnes (P. acnes) is always present on the skin. However, it can grow inside the pores where there is an increased production of sebum, which then facilitates the development of acne. The bacteria cause inflammation.
When the clogged pore bursts open, all the sebum and P. acnes bacteria spill onto the surface of the skin. The presence of large numbers of P. acnes bacteria causes your immune system to react, manifesting in inflammatory lesions.
All of the factors above can be triggered by the unhealthy parts of our lifestyle:
Treating our acne depends on what type of acne it is and what caused it.
Identifying which type of acne you have is key to successful treatment. There are two types of pimple: noninflammatory and inflammatory.
Comedones are referred to as noninflammatory acnes. They are hair follicles that are clogged with sebum and dead skin cells. They develop into bumps that are open (blackheads) or closed (whiteheads). Products that may trigger comedones are called “comedogenic” like some makeup. These normally don’t cause swelling.
Pimples that are red and swollen are referred to as inflammatory acne. Sebum, dead skin cells, and bacteria are pushed deep within the skin, clogging up pores and causing inflammatory acne. The inflammation is caused by an infection deep beneath the skin’s surface.
It’s important to understand the difference between hormonal acne and good old-fashioned pimples. Hormonal acne is tied to fluctuations in your hormones such as estrogen, progesterone, androgen, and cortisol (stress hormone). It’s especially common in women.
For some people, hormonal acne takes the form of blackheads, whiteheads, and small pimples. They typically form at the bottom of your cheeks and around the jawline. More often than not, they become inflamed and develop into cysts that tend to pop up in the same place over and over again.
You will know what type of acne you have based on the severity of your acnes. Each type of acne has a different level of severity and causes. All this manifests to different appearances, volume, and pain level.
There are a wide range of prescription oral and topical treatments.
Topical therapy is acne medication that is applied directly to the skin, like gels or creams. Over-the-counter and prescription topical products such as antimicrobial or retinoid creams can often help mild to moderate acne.
Systemic therapy refers to acne medication taken orally or by mouth, like antibiotics. It is mostly used to treat moderate to severe acne.
You may have access to all these treatments, but don’t get too frustrated when they don’t immediately and completely solve the problem. It typically takes about 8- 10 weeks for an acne treatment plan to take full effect. You should also use caution in using too many acne products at once. This may dry your skin, making your pores create more sebum resulting in more acne issues.
Although mild acne may improve with over-the-counter treatments, more severe forms should be treated by dermatologists. They can give you a full and accurate diagnosis. They can also revise your current regimen and incorporate different treatments to maximize your results.
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