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Acne gives the combination of symptoms like greasy skin, white heads, black heads, pimples, inflammation and scar formation. Acne mostly affects young people in the age 14 - 25, but also sometimes older persons, like women in their menopause. Most teenagers experience outburst of acne, some only little, but for others acne may develop into a serious skin ailment with great cosmetic impact.
THE SKIN ANATOMY
To understand the acne process, some knowledge about skin anatomy and physiology is essential:
The skin has there layers: The outer layer, called epidermis, consists of epithelial cells. Under this lies the dermis consisting of connective tissue. At the bottom there is a layer called the hypodermis consisting mostly of fat cells.
The skin has narrow pores extending from the surface down to the top of the subdermis, called hair follicles. A hair extend from a growth zone in the bottom of each hair follicle and out at the skin surface. Around the hair in the dermis, there are small glands called sebaceous glands. These glands produce a fatty substance, sebum, which empty through the follicle opening and lubricates the hair and the skin.
THE ACNE PROCESS
Acne starts by the glands in the hair follicles increasing their sebum production. This will in the beginning only cause greasy skin. Eventually the sebum in the entrance of the follicles mixes with dead epithelial cells from the epidermis. This mix reacts chemically to forms hard props, comedones, that close the pore entrances. According to the color of the comedones, they are called black heads or white heads.
Then the closed hair follicle gets filled with sebum and swell. The swollen follicle then gets infected by bacteria. The bacteria and the accumulated sebum cause the follicle and the surrounding skin to get inflamed, forming a pimple. At last the inflamed follicle burst and empties its content. Eventually the affected area heals. Sometimes the inflammation reaches deep into the skin surrounding the follicle and destroys skin tissue. This will cause more or less distinct scars that may reside permanently. Typically an affected person will have follicles in all these stages of the process at any given time.
THE CAUSES OF ACNE
The increased hormone production in the puberty stimulates to increased sebum production. The male hormone, testosterone, seem to contribute most. Also girls begin to produce more testosterone in the puberty. Also in other periods, altered hormone production may give acne, for example by women in the menopause.
Since not all teens get acne in any degree, the increased hormone level cannot be the whole cause of the increased sebum production. The follicles of affected persons must for some reason react stronger upon the higher hormone level.
Dietary factors, like eating too much fat, too much sugar or the wrong kind of fat may aggravate acne by some individuals. Lack of vitamins, minerals and essential fatty acids may also contribute to development of acne.
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