At the heart of the matter acne is an inflammatory disorder. Interaction between a whole series of physical triggers creates redness and swelling that ends in the eruption of a blemish. Understanding how to stop this sequence of events from taking place, along with reducing inflammation, will let you begin to create a successful skin-care routine. (Source: Expert Opinions in Pharmacotherapy, April 2008, pages 955-971.)
The five major factors (and one minor one) that contribute to the formation of blemishes are:
1. Hormonal activity (primarily androgens, male hormones)
2. Overproduction of oil by the sebaceous (oil) gland (the oil gland is an important formation site of active androgens, which control oil production)
3. Irregular or excessive shedding of dead skin cells, both on the surface of skin and inside the pore
4. Buildup of bacteria in the pore
5. Irritation
6. Sensitizing reactions to cosmetics, specific foods (rarely), or medicines.
Fundamentally, this is how a blemish occurs: Inside an oil gland a type of bacteria called Propionibacterium acnes (or P acnes) finds a perfect environment for growth. Dead skin cells and excess oil in the oil gland provide just the kind of conditions that P. acnes needs to thrive. As P. acnes settles in, thanks to an abundant supply of sebum, it reproduces, which causes irritation and inflammation. That’s why most blemishes are red and swollen. (Source: Cutis, January 2008, pages 81-86.)
Each hair follicle grows from a sebaceous (oil) gland that secretes an oily, firm wax called sebum. The structure that the oil gland and hair follicle share is called the pilose – baceous duct or unit, more popularly referred to as a pore. When things are going well, the sebum smoothly leaves the pore and imperceptibly melts on the skin’s surface, helping to keep the skin surface moist and smooth. When things aren’t going well, as when the pore becomes plugged with sebum and dead skin cells and bacteria run amok, a blemish is the outcome. Surplus sebum is generated primarily by hormonal activity. (Source: Journal of the American Academy of Dermatology, December 2001, pages 957-960.) When too much oil is produced, it can become mixed with dead skin cells from the skin’s surface, with poorly sloughed skin cells from the pore’s lining, and with small pieces of hair debris from the follicle. This combination of sebum, dead skin cells, and small pieces of hair can clog the pathway out of the hair follicle/oil gland, creating quite a backup. Now you’ve got problems. (Source: International Journal of Cosmetic Science, June 2004, pages 129-138.)
When your body produces too much oil, and dead skin cells on the surface of skin or inside the pore aren’t shed normally, they can join together in blocking the exit from a pore. All the excess oil and dead skin cells solidify as a soft, white substance that plugs the pore. If the surface of the pore is covered by skin, it is called a whitehead (milia). If the pore is open, without any skin covering, the top of the plug is exposed to air and darkens from the oxidation, causing a blackhead.
Whiteheads and blackheads become pimples when P. acnes begins growing inside the plug, causing irritation and inflammation. Finally the inflammation and excess oil cause the wall of the oil gland to rupture, spilling the contents (oil, cell debris, bacteria, and all) into the surrounding skin tissue. The body’s immune system then responds, sending lymph to the inflamed area to help with repair (and causing swelling), and you now have a pimple.
Now that you know what causes the problem the all-important question is, what can you do to control these symptoms? Can you slow down oil production? How do the skin cells build up and clog the pore, and how do you stop that from happening? How do you kill and inhibit the bacteria that cause the inflammation and redness?