Acne is caused by hormonal changes, for example, as children reach puberty the levels of androgens or male hormones increase. This in turn may cause the sebaceous glands, present in the hair follicle, to secrete an oil that forms a solid white substance called sebum. During puberty, skin cells in the follicle shed and mix with the sebum causing a blockage in the follicle.
As more sebum is produced the follicle swells up. A bacteria normally present in the skin, called P.acnes, multiplies in the clogged follicle and results in an inflammation. This inflammation can cause acne lesions such as blackheads, pimples, nodules and cysts. It is an inflammatory skin disease which affects the tiny pores which cover the face, arms, back and chest and the oil glands attached to them.It is an abnormal response in the skin to normal levels of the male hormone, testosterone, in the blood.
Both men and women have testosterone circulating in the blood, but in the acne sufferer, this hormone has a profound effect on the skin. This abnormal response is self limiting and eventually acne does get better without treatment, but there is no way of predicting how long this can take, and it may take years or even decades! Acne can also leave scars which are permanent and are easier to prevent than to treat.
In the skin, the disease attacks two structures: 1 the pore through which the hairs emerge from the skin -here dead skin cells become more “sticky” and partially block the pore.2 The oil or sebaceous gland -more oil is produced, which gives rise to a generally oily complexion.The partial blockage in the pore restricts the flow of oil onto the skin surface. This results in solidification of the oil which fills the hair channel forming a blackhead. The black of the blackhead is not due to dirt, but a change in pigment in the blockage in the pore.
If the partial blockage becomes complete, the oil builds up around the hair and hair root and becomes infected with bacteria normally present on the skin. The bacteria break down the oil to very inflammatory chemicals which cause redness, pus formation and pain -the “zit”.If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin rather than onto the surface. This deep-rooted inflammation and infection results in scarring and cyst formation.