Acne is the most common skin disorder in the United States. It affects nearly 100% of all teenagers, and 40% of these individuals will require the help of a physician to manage it. Acne can be devastating to teenagers and is often a cause for loss of self-confidence, depression, embarrassment, and anger. Patients who suffer from acne are many times stereotyped as having bad hygiene and this may lead to social withdrawal.
Although acne typically occurs during our early teens; adults can develop acne as well. Because acne is due to several factors (bacteria on the skin, overproduction of skin oils, blocked pores, and hormones), it’s not hard to see why many individuals find it difficult to get control of their acne.
In order to understand acne, one must first become familiar with the simple anatomy of hair follicles. Every hair on our body grows from a single hair follicle, and attached to the hair follicle are sebaceous oil glands, responsible for secreting oil onto the shaft of growing hair.
Lining the inside of each follicle are keratinocytes that secrete a waxy protein called keratin. This keratin serves to naturally protect the inside of the hair follicle from the growing shaft of hair. Excessive keratin and sebaceous oil are naturally excreted through the opening pore of the hair follicle.
During our teenage years, an increase in hormone levels (called androgens) leads to over-stimulation of the oil glands and keratinocytes.If too much waxy keratin is produced, then the hair follicle may become plugged and a subsequent build-up of sebaceous oil accumulates in the follicle.
This is what we all know as a white-head (comedone). The visible white plug is the accumulated keratin wax, and the underlying bump is the trapped sebaceous oil. If the white keratin plug ruptures and is exposed to oxygen, it oxidizes and turns gray or black (black-head). It is important to understand that the formation of white-heads and black-heads is independent of bacterial involvement.
There are certain bacteria that live on the skin surface called Propionibacterium acnes (P. acnes). This bacteria loves sebaceous oil and if it manages to find its way into the trapped areas of sebaceous oils, it will use the oil as a food reservoir and a breeding ground. It is at this point that simple white-heads and black-heads become inflamed and acne comedones now take on a cystic appearance (cystic acne vulgaris).