What is Acne?

There is one certainty that most people of all ages deal with, (especially teenagers), and that is acne – the most widespread skin disorder that affects people all over the world. Call it by any name – Blemishes, bumps, whiteheads, zits, pustules, blackheads or papules – and chances are that you have had a breakout at some point in life. Both men and women can get equally affected by acne – however, the breakout is more severe in young men than in young women.

The Hair Follicle

In order to know what is acne, we must know a little bit about the hair follicle of the skin. Each hair follicle comprises three parts: sebaceous gland, sebaceous duct and hair. The sebaceous gland produces sebum an oily substance that is essential to coat and condition the hair and skin. Sebum is made up of fatty chemicals (lipids) that keep the skin protected, lubricated and waterproof. Sebum also carries dead skin cells through the hair follicles to the skin’s surface where they flake off.

The sebaceous duct is a tiny canal that conveys sebum and dead skin cells from the sebaceous gland to the exterior. The hair is the actual hair that grows out of pores on the skin. Hair follicles are found all over the body, except the palms of your hand and soles of your feet.

What Causes acne?

Very simply put, acne is caused when the sebaceous gland produces excess oil. It is not caused by eating greasy food, nor when you forget to wash off excessive oil from your skin. It is not the oil on your skin but excess oil produced in the skin.

During the process of ferrying dead skin cells to the surface, the exit route for the sebum is blocked by excess oil. This causes the pores to get clogged and the hair canal to narrow. The exit route for oil is also blocked by abnormal follicular keratinization when keratin and dead skin cells bunch together with oil and further block the hair canals and sebaceous ducts.

This causes a literal ‘traffic jam’ at the surface of the skin. All this matter that needs to be excreted does not find an exit route. Trapped sebum starts to build pressure and the hair follicle blows up and turns into different types of acne.

Types of acne

The ballooned out hair follicles form comedones of which there are 2 types – blackheads and whiteheads.

Blackheads: When the comedo becomes big and emerges on the surface of the skin, it looks dark due to melanin (dark pigment that makes the skin turn black when it is exposed to oxygen) and is called a blackhead. The other name for blackheads is open comedones.

what is acne

Whiteheads: These are closed comedones. They remain below the skin’s surface and are whitish colored tiny bumps.

Now, comedones may remain as blackheads or whiteheads or they could become inflammed lesions. This inflammation is caused due to a bacterial infection called propionibacterium acnes. The following are some of the common types of inflammatory acne lesions:

  • Papule: The common name for a papule is the dreaded ‘pimple’ or ‘zit’. A pimple is a tiny, firm bump that is reddish in color. It does not contain pus but is the result of blood cells getting inflamed.
  • Pustule: Pustules are called ‘pus pimples’. They contain a white, gooey substance called pus. Pus is actually a lot of white blood cells bunched together.
  • Nodule: When a pustule becomes big, it is tender, inflamed and lumpy. This pus-filled eruption is a nodule and is embedded deeper into the skin than either a papule or a pustule. Sometimes a nodule is called a cyst.
  • Macule: A macule appears later in the life cycle of an acne lesion and often erupts from the leftovers of an inflammatory acne lesion. It is flat and is brown, purple or red in color. A macule is normally formed in the same spot where a pustule or papule was formed. It remains for a while even after the initial acne lesion has healed. 

Who is prone to acne breakouts?

The people most at risk are those who go through hormonal changes in the body. Hence, the groups more prone to acne breakouts are:acne breakouts

  • Teenagers
  • Girls and women within 2-7 days before the start of their menstrual cycle
  • Pregnant women
  • People on medications such as androgens, corticosteroids or lithium

Other factors can result in acne breakouts:

  • Certain cosmetics that irritate the skin
  • Direct contact of the skin with oily substances
  • Family history of acne
  • Pressure on the skin (that prevents the skin from breathing) caused by telephones, tight collars, helmets or backpacks
  • Stress can make existing acne worsen

Popular Acne treatments

There are many ways that acne can be treated.

Self-Care: There are many self-care tips that can contain acne breakout and clear them. Clean skin with a non-drying soap that is mild. Make sure you cleanse your skin thoroughly after a workout and at night to remove all makeup. If you have oily skin, make sure you shampoo your hair daily and keep hair away from your face.

Over-the-counter medication: If self-care tips do not help, then try over the counter medications that contain sulfur, benzoyl peroxide, salicylic acid or resorcinol. These can kill bacteria and cause skin to peel by drying up surface skin oil. 

Prescription medications: If the symptoms of acne persist, then consult a doctor who will prescribe antibiotics. These could be topical creams or gels to be applied on the acne or oral antibiotics that can kill the bacteria and reduce skin inflammation. Retinoids are vitamin A derivatives and very effective in the treatment of whiteheads and blackheads. Antibiotics combined with retinoids and benzoyl peroxide are more effective.  Certain antibiotics and retinoids are meant for people only with severe nodular acne. They are effective for they shrink the source of the acne – i.e. the oil glands – therefore effectively killing the origin of acne. However, side effects like elevated cholesterol and birth defects are possible. Hence, always consult a doctor before taking any form of prescription medication especially if you are pregnant or are of childbearing age.

Hormone Therapy: Women with thinning hair or irregular periods could be suffering from excessive male hormone – androgen. These women are more prone to acne breakouts and are given hormonal therapy in the form of progesterone and low-dosage of estrogen – both these are found in birth control pills. 

Alternative medicine: These medications are effective, but must be taken only after consulting a professional. Gels made from tea-tree oil combined with benzoyl peroxide; foods containing alpha hydroxyl acids such as citrus fruits, apples, sugarcane and grapes unclog pores by removing dead skin when they are applied locally; creams made using azelaic acid found in animal products or whole-grain cereals; zinc supplements taken internally or as creams or lotions help to reduce inflammation and heal acne wounds and brewer’s yeast (CBS 5926) that helps decrease acne.

Once acne clears, the treatment regime must be followed for sometime to prevent a new breakout. Most acne lesions heal with simple remedies and strong medication is rarely required.