Understanding Acne and Its Causes

Acne is an inflammatory disease of the sebaceous or oil glands and hair follicles of the skin. It is characterized by plugged pores and outbreaks of lesions commonly known as pimples or zits. Acne can occur on the face, neck, back, chest, shoulder, and upper arm areas.

Affecting more than 17 million people in the United States, acne is the most common skin disease. For most people, acne is associated with adolescence - indeed, most young adults have acne. For some, however, acne can last well into adulthood. While it is not a life threatening condition, it can have significant emotional effects. Severe and even moderate acne can lead to permanent scarring.

What is acne?

In acne, the oil producing sebaceous gland produces excessive amounts of oily secretion, which drains into the hair follicle. This secretion, called sebum, hardens into a plug called a blackhead, which blocks the follicle opening. Blocked pores allowed bacteria called Propionibacterium acnes (P. acnes), which normally live on the skin, to grow in the trapped sebum and cause inflammation of the surrounding area.

Acne lesions (comedones or singular comedo) come in two basic forms - whiteheads and blackheads. A comedo that stays below the skin surface produces a white bump called a whitehead, whereas an open comedo that reaches the skin surface produces a black plug called a blackhead. The black color of the blackhead is not caused by dirt.

Neither whiteheads nor blackheads should be squeezed or "popped" without proper medical supervision under sterile conditions. This is because injured lesions can become infected and/or scarred.

Other Types of Acne Lesions

Sometimes acne lesions can turn into these various forms of lesions:

	Papule A papule is a small (less than 5 mm), inflamed solid lesion that appears as small, pink bumps on the skin. A group of small papules may not be visible to the eye, but can have a "sandpaper" feel and be tender to the touch.
	Pustule (Pimple) A pustule is a dome-shaped lesion filled with pus containing a mixture of white blood cells, dead skin cells, and bacteria. Often red at the base, a pustule that forms over a hair follicle usually has hair in the center. Normally, pustules that are resolved without turning into cysts do not leave any scars.
	Nodule Similar to a papule, a nodule is a dome-shaped or irregularly shaped lesion. However, a nodule is deeper than a papule, and can cause pain and/or scarring.
	Cyst A cyst is a deep and painful lesion filled with pus containing a mixture of white blood cells, dead skin cells, and bacteria. It is usually larger than a pustule and can lead to scarring. This condition is usually referred to as cystic acne.

After the Acne Goes Away: Spots and Scars

After the acne lesion goes away, sometimes you are left with:

	Red Spot (Macula) Red spots or maculae are usually flat, pinkish red in color at first, with a well-defined border. Untreated, maculae normally go away on their own after 4 to 6 months, and may change into a darker brownish red color before clearing up. Maculae typically disappear without any trace or scars. You can speed up this process by using a topical application containing zinc (See ActivClear Acne Treatment for more info).
	Post-Inflammatory Pigmentation This form of pigmentation occurs at the site of the healed or healing acne, especially in people with darker skin tones. Some post-inflammatory pigmentation can last up to almost 2 years, especially with excessive sun exposure.
	Acne Scars Scars caused by injury to the skin tissue and the subsequent repair process. In cases of acne, especially deep acne, tissue injury is the result of the body's inflammatory response to the dead cells and bacteria in the plugged sebum. In most cases, only nodule and cystic acne are associated with scarring. In people who are prone to scarring, however, common acne lesions may result in permanent scars. There are two types of scars: those caused by increased tissue formation and those caused by loss of tissue. In the first type, called keloids, skin injury from acne inflammation causes the cells to overproduce collagen, resulting in increased tissue formation. Typical keloid scars are a series of solid, irregular bumps about 1 to 2 mm in diameter. This form of scar is rare, and usually only affects people with a family history of keloid scarring. A more common scarring associated with acne is that caused by tissue loss, such as the ice-pick scar. Usually occurring in the cheeks, ice pick scar forms when deep and shallow indentations or holes are left by acne.

Who Gets Acne?

Acne is found in people of all races and ages. Almost all adolescents and young adults develop acne - indeed, nearly 85% of people between the ages of 12 and 24 have acne. For most, acne goes away by the time they reach their thirties. However, for some, acne can develop well into adulthood.

Acne affects young men and women about equally. However, young men are more likely to suffer from more severe and longer lasting forms of acne. Young women are more likely to suffer from intermittent acne caused by hormonal changes associated with their menstrual cycles or from acne caused by cosmetics.

Causes of Acne

Although the exact cause of acne is not known, it is thought that one or more of the following factors are involved in causing acne:

	Genetics The predisposition to acne is inherited from either parents - that is, you are more likely to suffer from acne if one or both of your parents also suffered from acne.
	Hormones The increase in the production of male sex hormones called androgens in young men and women during puberty is thought to cause the sebaceous glands to enlarge and produce excess sebum. The oily sebum often forms hardened plugs that lead to acne. For women, pregnancy, menstruation or period, starting or stopping taking birth control pills, can cause drastic changes in hormonal levels and lead to acne breakouts. For some women, elevated hormone levels tend to make them breakout 2 to 7 days before their period.
	Prescribed Medicines Certain drugs, such as androgens, lithium (for psychological conditions), and barbiturates (to control seizures), can cause acne. Usually, the acne only lasts as long as the drugs are taken.
	Cosmetics For some, cosmetics or makeup can plug pores or cause follicles to stick together and thereby cause acne.
	Stress Although the experts disagree on whether stress actually causes acne, it certainly can aggravate existing acne conditions. In particular, severe stress or prolonged emotional tension, can make acne worse.
	Humidity and Environmental Pollutants High humidity as well as environmental irritants such as pollution can make acne worse.
	Physical Irritations Acne condition can worsen if the skin is rubbed hard, or pustules are picked and squeezed. Handling of acne with unwashed hands can also introduce bacteria, which can get inside the acne lesion and cause infections. Friction from collars, backpacks, or helmets worn too tightly can also cause acne to flare up.

It is important to keep in mind that the causes of acne above are not absolutes - different individuals are susceptible to different causes (or combination of causes) of acne. Furthermore, factors cause acne in some people may only aggravates existing acne conditions in others.

See also:
Acne Myths
Acne Treatment Review
ActivClear Acne Treatment

Acne Resource On the Web:
Acne.org
More Resources on Acne and Acne Treatment

DISCLAIMER: The information contained in this website is intended for general reference purposes only and has not been evaluated by the Food and Drug Administration or other medical institutions. It is not a substitute for professional medical advice or a medical exam. Medical information changes rapidly and while ActivClear.com makes reasonable efforts to update the contents on this site, some information may be not be current. Always seek the advice of your physician or other health care provider before starting any new health program or treatment.