Acne is a form of chronic inflammation of the pores of the skin. More than 85 percent of young people aged 12 to 14 develop the condition. Acne can also appear or reappear in adults in their 20s and 30s, or even into their 40s and 50s.
Across all age groups, acne is the most common of all skin problems. Among teenagers, acne that is bad enough to cause scarring is more common among boys than among girls. The persistence of acne into adulthood, however, is more common among women than among men.
Acne vulgaris is the technical term for the most common form of acne. This type of acne causes whiteheads, blackheads, papules, and pustules. Acne conglobata is the technical term for the more serious form of the disease. This type of acne causes cysts and makes scars. Both types of acne usually appear on the face, as does acne rosacea, reddening of the skin of the nose that is aggravated by changes in temperature (rosacea).
Acne vulgaris and acne conglobata can occur on the back, chest, and shoulders. More often than not, acne vulgaris clears up even if it is not treated. Nonetheless, any kind of acne can severely affect self-image, especially in teenagers.
The accumulation of sebum, an oil secreted by the skin, is the beginning of acne. Sebum is essential to healthy skin. Its primary function is lubrication of the hair shaft, allowing hair to move with the skin. This vital oil also helps prevent excessive evaporation and absorption of water.
Sebum keeps the skin soft and supple. It minimizes wrinkling. It enables the skin to act as a raincoat, protecting the body from water absorption through the skin.
Sebum prevents the evaporation of essential fluids from the skin. Because fat is a poor conductor of heat, sebum lessens the amount of heat lost from the body's surface in cold weather. So what can control sebaceous glands and the sebum they produce?
It's important to remember that by itself, sebum does not cause acne. Neither do the two strains of bacteria associated with acne, Propionibacterium acnes and Staphylococcus albus. In healthy skin, these bacteria feed on excess sebum, keeping it from blocking pores. These bacteria have unusually large ribosomes, energy factories that digest fats. As the ribosomes work overtime to digest sebum, they release a chemical related to hydrogen peroxide to release the fatty acids they use for energy.
This potent oxidant does no damage to the skin as long as it is free to flow to the surface, where ordinary washing with soap and water carry it away. Acne only occurs when the opening of the follicle is blocked and the peroxide is trapped inside, so that it attracts white blood cells that in turn release cytokine hormones that inflame the skin.
Several hormonal processes cause pores to narrow and trap inflammatory peroxides. One of them is stress. In both males and females, at all ages, stress contributes to the severity of skin inflammation.
Stress causes microscopic packets in the ends of the nerve cells controlling the muscles and skin to break open and release two stress hormones, adrenaline and substance P. These chemicals help nerve signals jump from cell to cell. Once in the bloodstream, substance P eventually reaches the skin where it signals the cells that make sebum not just to grow in numbers but also to increase productivity. Under conditions of stress, greatly in creased numbers of sebum glands pour out greatly increased amounts of oily sebum. This is the reason people who have acne have more severe outbreaks when they are under stress.
The primary hormonal imbalance that causes acne, however, is an excess of the male-associated sex hormone testosterone. This hormone is produced by the bodies of both men and women, but in vastly greater quantities in men. Most people have some understanding of how testosterone causes the hairiness, muscularity, and aggression of male secondary characteristics, but the role of testosterone in women requires some explanation.
Women's bodies contain testosterone throughout their lives, but only in vanishingly small quantities until puberty. About the time of a woman's first period, the adrenal glands begin to make massive quantities of dehydroepiandrosterone (DHEA) from cholesterol. Most of the young woman's DHEA is processed by the adrenal glands into the stress hormones so well known in adolescence. Some of the DHEA goes to the ovaries and uterus to form the female hormones estrogen and progesterone. Trace amounts of DHEA accumulate as a byproduct, dehydroepiandrosterone sulfate. When a woman's adrenal glands and ovaries turn this byproduct into testosterone, she begins to experience sexual desire. About the time a young woman becomes interested in sex, she also becomes at risk for acne.
Like sebum and acne bacteria, testosterone itself does not aggravate acne. Low testosterone and acne is also possible. Testosterone becomes a problem only when it is chemically processed by the enzyme 5-alpha-reductase into a more potent form of the hormone, dihydrotesterone. This form of testosterone stimulates the production of the tough protein keratin that lines the interior of the pore.
As keratin builds up in the cells lining the shaft of the pore, it narrows the pore's opening. The narrowed pore traps peroxide-producing bacteria, dead skin cells, and pus inside.
Testosterone levels are especially high in both boys and girls aged 10-14. They are also elevated in women who have ovarian cysts, in men who take the bodybuilding aid androstenedione, and in women who use oral contraceptives. All of these groups are especially susceptible to acne.
Acne also results from exposure to industrial pollutants, including machine oils, chlorinated hydrocarbons, and coal tar derivatives. Acne is a frequent side effect of treatment with steroids for asthma or rheumatoid arthritis, lithium carbonate for bipolar disorder, and isonicotinic acid (Isoniazid) for tuberculosis. Overdoses of vitamin B supplements (specifically vitamin B6 and B12) can cause acne.
Even more frequently, acne results from the overuse of pore-clogging cosmetics or pomades, or is a complication of skin irritation caused by overwashing and nervous, repetitive rubbing and touching of the skin.
Prescription medications for acne often make the condition worse before it gets better. Most drugs for acne require several weeks to several months to take effect. Any medication for acne must be used regularly to work.
And, of course, pimples usually eventually go away on their own. What does a pimple look like when it is going away? The healing skin lifts the pimple up and loosens it form the skin. Blackheads will stay black, but infected pimples get lighter and lighter as they begin to heal and fall out of the skin.
You may also be interested in:
Nutritional Recommendations for Acne
Vitamins, Water, and Acne
Acne and Diet
Healing Acne: The Prime Directive for Effective Skin Care
Fat, Fiber, Yeast, and Acne
Natural Products for Acne
Tips for Treating Acne
Homeopathy for Acne
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1 comments:
Great article! One thing that people are experiencing right now is unpredictable acne breakouts because of the weather. There is a way to deal with acne as the seasons change. The key to clearing up your blemishes and cleaning up your oily skin is not to completely rob it of moisture. You simply need a really good deep cleanser that deep cleans your pores and kills nearly one hundred percent of the bacteria hiding in them and on the surface of your skin. In so doing, it also soothes and calms your skin, which helps keep all its essential moisture right where it belongs.
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