Introduction to Acne
Part 1:
Acne is a skin condition. A skin condition refers to a temporary happening or occurrence in your skin. It can be caused by both internal and external factors, such as the environment, stress levels, medication, hormones, and age. Unlike a skin type, a skin condition can be changed and treated.
Acne is the most common skin condition in the United States, in any given year 50 million people are experiencing problems with acne. Acne originates in the pilosebaceous unit, this is the structural unit where acne occurs. The pilosebaceous unit consits of the hair shaft, the hair follicle, the sebaceous gland, and the erector pili muscle (this is the muscle that causes hair to stand up when it contracts.) The job of the sebaceous gland is to make sebum. Sebum is an oily, almost waxy substance that carries Vitamin E to the surface of the skin to act as an antioxidant and includes a large amount of lipids which are moisturizing to the skin which is essential to the skin’s barrier function. It’s a very important aspect to our skin but sometimes, however as in acne, the sebaceous gland can become overactive. When this happens a problem occurs.
The grades of acne describes the increasing severity of acne, measuring grades 1-4. Treatment is dependent on how severe the acne grade is.
Grade 1 Acne is the least severe stage of acne, it has open and closed comedones and can have a few papules. A comedone is a skin pore or hair follicle clogged with oil, dead skim cells, and bacteria. A comeodone is a problem rooted in the pilosebaceous unit and occurs because of an overproduction of sebum. Comedones are also called whiteheads and blackheads. Whiteheads are not oxidized by exposure to air and blackheads are discolored in either a brownish or blackish color and it’s been exposed to the air. Both whiteheads and blackheads are basically the same type of skin lesion. Comedones are the least severe lesion.
Grade 2 Acne has open and closed comedones and many papules. Papules are a small raised, tender bump on the skin. Papules occur when the clogging of a pore/hair follicle becomes inflamed and pus develops.
Grade 3 Acne has open and closed comedones, many papules and pustules. In this grade there’s a progressive increase in the inflammatory process. Pustules are red, tender bumps on the skin that contain fluid or pus. Pustules accumulate inflammatory cells that can border on an infection process.
Grade 4 Acne has open and closed comedones, papules, pustules, nodules and cystic lesions. A nodule is a papule that has undergone more inflammation and has become more severe and has become bigger. These lesions can develop so large that they become cystic lesion. A cystic lesion is an area that is globular in shape and has a significant amount of pus, the surrounding tissue is also extremely inflamed.
Oxidized sebum is very pro inflammatory so it indues an inflammatory event. This in turn causes on overgrowth of bacteria that already lives on the skin. These lesions then become infected. Inflammation is an ongoing process that increases through the acne grades. Why do we get increased sebum production? There is a sebum over production in acne related to androgens. Androgens are testosterone, this hormone is present in both females and males. Testosterone tells your sebaceous glands to make more sebum, in fact to overproduce sebum. Women with PCOS (poly cystic ovary syndrome) have an increase of androgen production, due to this increase there’s a higher rate of acne in women with PCOS.
Untreated acne will progress through the grades. It’s best if you can treat acne in Grade 1. As the inflammatory process continues with overproduction of sebum and growth of bacteria, there’s a plugging of the pore that becomes obstructed. Acne is an up regulation of the inflammatory process. Again, acne is a skin condition that can be treated but it takes patience, perseverance, and consistency. I’ll cover more about the connection between acne, hormones, and sebum production in my next post!