What are the causes of Acne?

How does Acne occur?

Acne vulgaris or common acne (also known as pimple and zits) is actually a disease of the hair follicle and its associated oil producing

Acne Cause: Hair Follicle
Acne Cause: Hair Follicle

sebaceous gland, as we have already discussed. The oily liquid produced by the sebaceous gland is known as sebum.

The sebaceous glands remain relatively small during infancy and childhood. At puberty due to the action of hormones known as androgens (which include testosterone and dihydrotestosterone), increase the size and activity of the glands. As a result, there is increased sebum production from the sebaceous glands.

How Acne Occurs
How Does Acne Occur?

A bacteria known as Propionibacterium acnes(P.acnes), which is a normal resident of the hair follicle and which thrives on a fatty food, increases in number during puberty due to the increased ‘food supply’ in the form of sebum!

The combined effects of activities of the increased sebum secretion and the P.acnes is the cause for the disease we commonly recognise as acne.

Let us examine how these two conspire together to disturb the normal milieu interior of the skin and damage the clear complexion of millions of teenagers around the globe.

How Acne Develops
Stages of Acne Development

Depending upon severity, there are 4 types of acne.

Grade 1: Mild (Comedonal) Acne

We have already seen that the combined effects of activities of the increased sebum secretion and the bacteria Propionibacterium acnes(P.acnes) is the cause for acne.

Comedonal Acne
Acne Grade 1: Comedone

Certain enzymes produced by the bacteria cause chemical changes in the composition of sebum, converting the triglycerides into free fatty acids.

These free fatty acids are potentially irritating to the epidermal cells lining the inside of the hair follicle. Some chemotactic factors are also released due to the action of the P.acnes on the sebum. These in turn attract certain white blood cells known as neutrophils to the vicinity of the hair follicle. This starts another chain of chemical and physiological reactions that results in what we know as inflammation.

The net result of all those changes are these:

How Acne Develops
How Acne Develops
  • The lining of the hair follicle above the sebaceous gland become thickened.
  • Because of changes in the keratinization of the follicular cells, there is accumulation of abnormal cornified cells inside the follicular lumen.
  • This sticky cells become adherent to the top of the sebaceous gland to form a plug known as microcomedone.
  • When this plug enlarges just beneath the small hair follicle(pore) opening on the surface of the skin, it become visible to our eyes. This is nothing but the (in)famous whitehead or the closed comedone!
  • An open comedone or blackhead occurs when, because of the pressure from the plug beneath, the hair orifice enlarge to reveal the black “dirty looking” plug. This black color is not due to dirt, but due to the action of atmospheric oxygen on the free fatty acids, the after products of sebum.

This, then, is how the comedones come into existence during puberty.

Some comedones are not as innocuous as they look. For many unfortunate teens, they are time bombs ticking, with impending catastrophe in later years to break into scar forming nodules and cysts.

Grade 2: Moderate(Papular)Acne

As the sebum continues to accumulate, the hair follicular wall become stretched and larger skin colored papules become evident on the skin surface. There is minimal inflammatory reaction due to the neutrophils attracted to the area in this moderate type of papular acne.

What is Grade 2 Moderate Acne?
Grade 2 Moderate Acne

The lesions are more pronounced and more in number than in the comedonal acne.

Grade 3: Severe(Pustular) Acne
Severe Inflammed Acne
Grade 3 Pustular Acne

When the sebum secretion is increased and the chemical breakdown of the sebum occurs due to the action of the bacteria P.acnes, neutrophils are attracted to the area. Neutrophils are the white cells involved in inflammatory reaction. These release certain chemical mediators and enzymes which further weaken the follicular walls. The wall and the sheath of the sebaceous gland thins and become inflamed leading to pustule formation.

These are numerous red, tender, pus filled lesions on the affected areas.

This is the severe grade 3 acne or pustular acne.

Grade 4: Very Severe (Nodulo-cystic) Acne

Acne Cyst
Acne Cyst Formation

When the follicular walls further weaken and get inflamed gradually the walls expand and become deep seated nodules. Further action of inflammatory mediators cause rupture of the wall and sebum, part of the wall and cornified cells and bacteria are released into the dermis. This causes an intense reaction known as foreign body reaction within the dermis resulting in the formation of deep seated cysts.

Nodulocystic Acne
Very Severe Grade 4 Acne: Acne Conglobata

This is known as the very severe scarring type of nodulocystic variety of acne.

Note: The grading is only facilitatory. There may be more than one or two kinds of lesions (comedone, papule, pustule, nodule) present at any time in acne patients. The grading is done when a particular type of lesion out numbers others.

Published by Dr Hanish Babu, MD on 23rd May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis

should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Acne 101: The Acne Basics

 

Acne 101 will discuss the acne basics in general. A basic knowledge of acne is important to learn how to effectively treat acne in its varied clinical presentations and avoid complications like acne scars.

The course of acne is punctuated with frequent flare-ups in the affected and hence acne is to be approached as a chronic disease which requires active treatment intervention and a maintenance program for optimal control of the inflammatory pimples. During the adolescent years acne can cause untold heartbreaks and psychosocial impacts, which makes it a disease to be handled with proper care and knowledge.

Is Acne a Disease or a Normal Physiological Problem of the Adolescence?

Acne is a disease of the pilo-sebaceous unit which includes the hair follicle and the associated sebaceous gland. It is not just a normal age related phenomenon, as hormone related pathological changes assisted by the bacteria propionibacterium acnes occur in acne and result in long lasting effects on the skin, like pigmentation and scars. The Global Alliance to Improve Outcomes in Acne in their report presented as a supplement to the May issue of Journal of American Academy of Dermatology advocates approaching acne as a chronic disease requiring initial aggressive therapy followed by maintenance therapy to avoid the complications and minimized the social and psychological fallouts of the acne.

When it is very mild and limited to a few numbers of comedones, acne can be considered physiological. The presence of inflamed papules, pustules or presence of nodules and acne cysts calls for active treatment of the acne.

How Common is Acne?

Acne is the commonest skin disease. It affects approximately 85% of young people. Previously thought to be a disease of the adolescents, acne is also common in adults from 20 to 35 years of age. The common acne is called acne vulgaris. There are many variants of acne like neonatal acne, drug induced acne, chloracne, acne excoriee, keloidal acne etc.

How Does Acne Occur?

Many factors play a role in the causation of acne, including a hereditary predisposition, effect of androgenic hormones and many other external and internal factors. After puberty, androgen hormones stimulate the sebaceous glands to increase their size and produce more sebum, an oily liquid intended to keep the skin smooth and supple. The sebum is a good growth media for certain bacteria, which in turn produces inflammation within the hair follicle and the surrounding dermal structures. Depending upon the severity of the inflammation, the types of acne also vary in different individuals and at different times in the same individual.

What is the Age Incidence of Acne?

Contrary to popular belief, acne can occur at any age, from neonates to old age. Mostly acne is seen in early puberty to early adulthood, i.e., the ages of 12 to 25 years. About 50% of teenage acne can continue to adulthood. Some people, especially females, tend to have an occasional flare ups into their 30s. At the age of 40, 1% of males and 5% of females still have active lesions of acne.

Does Acne Differ in Males and Females?

Males and females are affected equally in acne, though the severity of acne is more in males. Almost all boys and 90% of girls will have had an attack of acne during their teen age. Acne conglobata or nodulocystic acne is more common among males.

Moderate Acne: Type 3
Moderate Acne


What are the Common Areas of the Body Affected by Acne?

Acne can develop on any hair bearing area, though it is most common on face, as this is the area with the maximum density of sebaceous glands. In the face, the cheeks, nose, chin and forehead are mostly affected, in that order most of the time. Acne on face is most commonly known as the pimples or zits. Acne also occurs on the chest, shoulders, upper back, buttocks and thighs.

Is it True that Excess Dandruff is the Cause of Acne, especially on the Forehead?

Dandruff and acne has got some common features as their causes, like increased seborrhea, oily skin and the effect of the androgenic hormones. Hence both are complimentary; one is not cause of the other.

What are the Common Signs and Symptoms of Acne?

Whiteheads and blackheads are the earliest skin lesions in acne. Depending upon the severity acne is divided into different types of acne, the comedonal, papular, pustular and nodulocystic.

In presence of inflammation, in the pusutlar and nodulocyctic variety, the acne eruptions can be red, painful and hot and tender on touch.

The skin of acne sufferers is usually greasy and oily and most of them suffer from concomitant dandruff during the acne attack or later in their life.

Oiliness and sudden eruptions can sometimes cause an itchy feeling on the acne affected area.

Though the commonest skin disease affecting more than 85% of world’s population at least once in their life time, there are many misconceptions and myths regarding acne vulgaris.

Published by Dr Hanish Babu, MD on 23rd May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis

should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

What is Acne?

 

What is Acne?

Acne, or pimples, is the commonest skin disease affecting almost 85% of teens at least once in their lifetime. It is a disease of the hair unit of the skin involving the oil producing sebaceous glands situated beside the hair. The sebaceous glands discharge their oily secretions into the hair canal.

 

Grade 3 or Papulopustular Acne
Moderate Acne: Grade 3 or Papulopustular Acne

Androgen hormones act on the sebaceous glands at puberty and increase their size and sebum (oil) production. The normal function of sebum is to keep the skin smooth and supple by providing an oily environment. Increased sebum secretion and the action of certain bacteria inside the hair canal results in acne formation.

The following series of articles will discuss about different types of acne and modalities of treatment of acne and its complications.

The links will become active as new articles are being added. Please visit this page regularly.

All About Acne

  1. Acne 101: The Acne Basics
  2. Causes of Acne
  3. Pathogenesis of Acne or How Does Acne Develop?
  4. Acne Triggers
  5. Who is at Risk of Developing Acne?
  6. What are the Different Types of Acne?
  7. Acne: Best Treatment Practices: Why Acne Should be Treated
  8. Acne: General Advices from Dermatologist
  9. Mild Acne: Frequently Asked Questions
  10. How to Treat Mild Acne
  11. Moderate Acne: Frequently Asked Questions
  12. How to Treat Moderate Acne
  13. Severe Acne: Frequently Asked Questions
  14. How to Treat Severe Acne
  15. FAQ on Very Severe Nodulocystic Acne
  16. How to Treat Very Severe Nodulocystic  Acne
  17. Food and Acne: Are They Related?
  18. Acne in Teens
  19. Acne in Adults: What it is and how to treat.
  20. Body Acne
  21. Acne Butt
  22. Skin Types
  23. Acne Mimics
  24. Acne: Frequently Asked Questions
  25. Topical Treatment for Acne
  26. Complications of Acne
  27. Acne Scar : Causes
  28. Acne Scar: Treatment
  29. Acne Scar: FAQ
  30. Acne Scar Solution
  31. Stress and Acne: Is it Real?
  32. Acne: Home Remedies: Are they Useful or Just Grandma’s Tales?
  33. Acne: Alternative Treatments: Are they Effective?
  34. Acne Myths
  35. Acne Products
  36. Acne during Pregnancy
  37. Skincare during Acne
  38. Chronic Acne: How to Deal with it
  39. Acne and Depression
  40. Acne Glossary
  41. Acne: Disclaimer

Published by Dr Hanish Babu, MD on 23rd May, 2018

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.