Acne

Inside each pore is a hair follicle, a small sac holding the root of the hair. The hair follicle is surrounded by sebaceous glands that produce oil (sebum) to keep your skin lubricated and protect it. The oil travels through the pores to the surface of your skin, helping to keep it moisturized. Acne primarily appears on skin areas with many sebaceous (oil) glands, such as the face, back, and chest.

Although acne is most often associated with teenagers, it can persist into adulthood or begin later in life. Hormonal fluctuations due to pregnancy, menstruation, or conditions like polycystic ovary syndrome (PCOS) can trigger acne outbreaks later in life. Stress and lifestyle factors also play a role in adult acne.

Beyond its physical effects, acne can have a significant psychological impact, causing stress, embarrassment, and reduced self-esteem. Adult acne is becoming increasingly common, especially among women.

Acne is caused by a combination of factors, including the overgrowth of Cutibacterium acnes bacteria that naturally live on the skin.

1. Increased Sebum Production: The surge in androgens, the male hormones present in both males and females, enlarge the sebaceous glands, leading to increased sebum production. This excess oil can clog pores, contributing to acne formation. ​
2. Follicular Hyperkeratinization: Excessive shedding of skin cells can clog hair follicles, forming acne lesions. ​
3. Bacterial Overgrowth: Bacterial overgrowth within blocked follicles can lead to inflammation and pustule (pimple) formation.
4. Inflammation: The body’s immune response to bacterial overgrowth results in inflammation, causing redness and swelling associated with acne lesions. ​

Genetics plays a significant role. 80% of acne cases have a hereditary component, meaning individuals with a history of acne are likelier to develop the condition. While diet and stress have been investigated as potential contributors, evidence linking them directly to acne development remains inconclusive. Notably, cleanliness and exposure to sunlight are not associated with acne causation. However, scrubbing the skin can dry it and stimulate excess oil production, which can contribute to the development of acne.

Some medications, such as corticosteroids, lithium, and certain anticonvulsants, can contribute to the development of acne as a side effect. These medications can affect hormone levels or cause other changes in the body that promote acne.

Pimples, blackheads, whiteheads, and cysts are different types of acne lesions that vary in appearance, severity, and the underlying factors that cause them.

• Blackheads: These are small, dark spots on the skin caused by clogged hair follicles. The dark color is due to the oil and skin cells oxidizing when exposed to air.
• Whiteheads: Similar to blackheads, but the pore remains closed, so they appear as small, white, or flesh-colored bumps under the skin.
• Pimples (Papules): These are raised red bumps that form when hair follicles become inflamed.
• Pustules: These are like pimples but with pus at the center. They appear as red bumps with a white or yellow tip.
• Nodules are large, hard bumps that form deep under the skin. They can be painful and are often a sign of more severe acne.
• Cysts: The most severe type of acne is large, pus-filled lumps under the skin. They can be painful and may leave scars.

Diagnosing acne is primarily clinical, based on medical history and physical examination. A thorough assessment includes evaluating the severity of acne, identifying potential triggers, and distinguishing it from other dermatological conditions that mimic acne, such as rosacea or folliculitis. In cases where hormonal influences are suspected, additional evaluations may be warranted to rule out underlying hormone disorders.

Diagnosing acne early is important to prevent scarring. Scarring occurs when acne lesions, such as cysts or nodules, become inflamed and damage the skin. These inflamed areas may result in post-inflammatory hyperpigmentation (dark spots) or deeper scars in more severe cases. In addition, diagnosing the root cause of acne, such as hormonal imbalances or skin care habits, can help implement a more effective treatment plan. Regular follow-ups and appropriate acne treatments, including topical or oral medications, can significantly reduce the risk of scarring and improve the overall skin health of patients.