Acne vulgaris is the most common skin disease in industrialized countries. It usually begins during puberty, at the same time as hormonal changes, and can persist into late adulthood. About 80 to 90% of young people are affected to some extent by impurities, and between 20 to 30% of these people will seek medical support. The number of adults, especially women, who experience acne late in life is also increasing.
In acne, the skin is oily and open and closed comedones (black-headed and white-headed) appear on the face and often also on the neck, shoulders, chest and back. In moderate and severe acne, the skin becomes red and swollen papules and pustules appear. Acne can be emotionally distressing, untimely persistent, and can lead to post-inflammatory hyperpigmentation (HPI) and / or long-term scar retraction.
Post-inflammatory hyperpigmentation is a flat area of color change on the skin in response to inflammation such as acne or eczema, especially in people with darker skin complexions. Although it may disappear over time, dermatological treatments and depigmentation procedures can be useful.
There are four fundamental causes that contribute to the formation of acne:
It is the hyperproduction of sebum. Physiologically, the sebaceous glands secrete an oily substance known as sebum to lubricate hair and skin.
Sebum production can be triggered by a number of elements, such as hormones, weather, certain medications, and the genetic factor.
An altered sebum secretion can also trigger Seborrheic Dermatitis, a common inflammatory skin process in which white to yellowish scales form on fatty areas, such as the scalp or the inside of the ear. Read more about Seborrheic Dermatitis .
Hyperventilation consists of a thickening of the outer layer of the skin (stratum corneum), irregular detachment of dead and cornfield skin cells (cornerstones), occlusions of the sebaceous gland duct, and disorders or interruptions in the release of sebum.
When the skin produces an excessive amount of sebum (seborrhea) and the dead skin cells remain attached to the skin (hyperkeratinization), both can accumulate in the hair follicle and together form a soft plug. This plug can cause the follicle wall to bulge and produce a closed comedon (white-headed) or, if the plug is close to the surface, an open comedon (black-headed).
Bacteria that normally live harmlessly on the skin (propionibacteria) accumulate and can colonize plugged follicles, causing papules, pustules, nodules, and cysts.
The consequence is a reddened and inflamed skin. In cases of severe acne, the follicular wall bursts in the last phase of inflammation. Lipids, fatty acids, corneocytes, bacteria, and cell fragments are then released causing widespread and deep inflammations in the adjacent tissue.
Main causes and triggers of acne
Hormones are considered to play an important role, making acne more common in teens (although acne can affect people of all ages). The increase in androgens, in both boys and girls, at puberty, causes the sebaceous glands to produce more sebum than the skin needs.
Apart from the amount of circulating hormones, the increased sensitivity of the sebaceous glands is also important for the development of acne.
Most cases of acne disappear spontaneously after puberty. However, effective treatment is necessary to prevent the formation of persistent scars.
Since the sebaceous glands are especially sensitive to hormones, adult acne can appear in women with hormone-related processes, such as polycystic ovary syndrome. Psychological stress can also be a trigger for adult female acne.
Bacteria In people with acne-prone skin, excessive sebum production creates an ideal environment in which normally harmless acne bacteria (Propionibacterium acnes) can multiply. This triggers irritation and the formation of red or pus-filled spots.
Contrary to what certain myths would like us to believe, this is not because people affected by acne are unhygienic. Conversely, excessive cleansing with aggressive cleansers is actually more likely to irritate the skin.