Acne Defined:

Acne is an inflammatory disease of the sebaceous glands in the pores that can be caused by drugs, medications, chemicals but most often due to a genetic tendency. It is the most common skin disease. Acne is also known as retention hyperkeratosis or the abnormal build up and retention of cells and debris in the follicle. Normal pores shed about one layer of dead skin cells per day inside the pore. The acne-prone pore sheds up to five layers of dead skin cells per day and the body just can’t keep up. This forms blackheads or congestion under the skin which become pimples or papules; and if bacteria are present (to feed on the dead skin cells and oil), you will get inflamed pimples or pustules .Too much sebum and dead skin cells can clog pores, trapping bacteria. The bacteria thrive in this environment and acne starts.

Acne vulgaris, the medical term for acne, occurs when the pores become clogged with oil (sebum), dead skin cells and bacteria.

Acne affects 85 percent of population at some point in their lives. 25% will be left with permanent scars. It affects around 17 million people in the US alone.

The sebaceous glands produce skin oil or sebum and open up to a pore. The function of sebum is still up for debate but it primarily lubricates and waterproofs the skin. The overproduction of sebum, the overproduction of dead skin cells or the under shedding of these can combine to form a plug or comedone that clogs the pore. These plugs can turn into any of the following:

1. Comedo: a solid plug or impaction that clogs the follicle consisting of sebum and dead skin cells. Common in Grade I acne. It can present as open or closed:

-Blackhead: an open comedo with an oxidized exposed tip.

-Whitehead: a closed comedo commonly seen in Grade II acne.

2. Pimple: the plug becomes infected with Propionibacterium acnes, white cells congest the area to fight the bacteria creating an inflammatory response; the pressure can rupture the follicle and release the contents to adjoining follicles and tissue since it cannot be expelled from the pore. A pimple can present as a papule or pustule which are found in Grade III acne.

-Papule: the impaction breaks the follicular walls and white bloods cells attempt to repair it causing the pore to become inflamed, seen as a red bump or pimple.

-Pustule: after a few days, the pimple becomes further inflamed and the white blood cells migrate to the surface creating visible pus.

3. Nodule: formed when the break in the follicular wall is deep down in the follicle creating a sore red lump that is deeper, larger and firm to the touch. Unresolved nodules and cysts will often flare up again and again.

4. Cyst: a large inflamed and pus-filled lesion, often involving several follicles. Seen in Grade IV acne.

Types of Acne:

Acne can primarily be inflamed or non-inflamed or a combination of the two.

-Inflamed Acne:

Appears red, blotchy, hot to the touch; can have pimples, postules, whiteheads, blackheads, cysts; tends to have excessive oil but often dehydrated; the skin is sensitive and reactive to products.

-Non-inflamed Acne:

Skin appears dull and sluggish with bumps, blackheads, some pimples and postules; often with excess oil and congestion; skin is usually not sensitive or reactive.

Causes of Acne:

According to Dr. James Fulton, the acne cycle begins with the production of testosterone at puberty, an enzyme in the skin changes the testosterone to dihydrotestosterone which stimulates the production of sebum which causes retention hyperkeratosis or acne in the acne-prone follicle. The exact cause of acne is unknown but there are several aggravating or risk factors:

-Heredity: a tendency and/or predisposition has been attributed to genetics

-Age: more common in teenagers due to hormonal changes

-Gender: more common and severe in boys

-Hormonal: can be exacerbated by hormonal changes dues to puberty, menstruation, pregnancy, menopause

-Diet: foods don’t cause acne but certain foods can cause flare-ups

-Drugs: can be a side effect of or aggravated by certain drugs

-Cosmetics: acne cosmetica caused by comedogenic ingredients in makeup and skin care products affects 1 in 3 women.

-Stress: activates the production of hormones that cause flare-ups

-Environment: humidity, industrial chemicals and oils

-Picking: can drive the inflammation deeper and cause scarring and spreading of bacteria

Effects of Acne:


-Depression and social withdrawal

-Poor self-confidence, self-esteem, body image

-Emotional trauma




Acne Treatment:

Acne cannot be cured but it can be treated and kept under control with the right combination of products used correctly. The clogged pores must be treated with products that unclog, control sebum production, maximize dead cell exfoliation and kill the acne bacteria.

-Increasing cell turnover with products such as tretinoin (Vitamin A), benzoyl peroxide, adapalene, glycolic or salicylic acid

-Acne bacteria can be treated with antibiotics, benzoyl peroxide, oxygen, sufur, azelaic acid

-Pores can be opened and unplugged with keratolytics vitamin A, alpha hydroxy acids, salicylic acid (a beta hydroxy acid), adapalene, and resorcinol.

-Other drugs that have been used include Accutane, anti-androgens, and corticosteroids. The side effects of these drugs need to be seriously considered.

-Medical and Surgical treatments include extraction, chemical peels, freezing, punch grafting, and injections.

-Alternative treatments include supplements (i.e. zinc, fish oil) and diet modifications (e.g. avoiding dairy, iodine).

Steps to Successfully Treat Acne:

1.Recognize the problem

2. Avoid Aggravating Factors

3. Find a well-trained Acne Specialist

4. Stick to your skincare regimen


*Don’t pick at your skin — especially your pimples — or you can cause permanent scars

*Continue your routine even when cleared to avoid a breakout

*Don’t use comedogenic products

*Ice inflamed acne to help reduce inflammation



Acne Rx by James E Fulton Jr, MD



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