Lifestyle Choices

Acne is something we all recognize. It is so common that only one person in three may escape and probably everyone has a little, mild acne at times. It is normal to have a degree of acne while growing up but this does not make it any easier to cope with. No one finds it easy to cope with any disfigurement on the face.

The first signs of acne are nearly always in adolescence. The peak for girls is between fourteen and seventeen years and for boys from sixteen to nineteen years. Once it has started there is usually a gradual deterioration for about four years, but in most people the acne disappears in the late teens or early twenties.

Blackheads (comedones)

These are most common on the nose, ears and forehead and may be minute or easily visible. They consist of horn cells from the hair follicle, with melanin producing the colour. It is not clear why the horn cells stick together and fail to scale off the skin surface as they do in other body areas. But their retention in the opening of the hair follicle, as a plug, is not only unsightly but leads to other problems.

Increased greasiness (seborrhea)

Sebum is the name of the greasy liquid produced by the sebaceous glands. Acne sufferers nearly always have seborrhea. On the face there are about 600 sebaceous glands to a square centimeter and a small increase in their production of sebum soon leads to a greasy complexion.

At puberty, in response to rising hormone concentrations in the blood, the glands get bigger and more productive. The most important hormone is testosterone which, despite its more usual association with males, is in fact also found in females.

Papules, pustules and cysts

When sebum is dammed up in a plugged follicle it may leak out of the normal passageway into the dermis.

Bacteria may escape as well, and this combination seems to elicit the inflammation which is seen so often in acne.

The degree of inflammation depends on how much sebum leaked out, how many and which bacteria are present, how much squeezing and picking has been done and the response of each individual. Papules are small inflamed red spots which may last for a few days or a few weeks. Pustules have a yellow head and may develop from a papule. The pus discharges onto the skin after a few days.

Cysts result from severe inflammation and often leave scars when they have settled; they are deep and push up the skin as though there was a marble buried underneath. The center is soft and the outside firm with scar tissue. They may be painful and sore to touch.

Scars

Some individuals are more prone to scarring than others. Generally the deep inflamed papules and cysts are more likely to scar but there is surprising variation between individuals. Scarring is of two types. One is lumpy and the other is due to loss of tissue giving a depressed area.

Hypertrophic scars are raised, smooth, pink lumps ranging from one millimeter to about one centimeter in size. They are most often seen on the upper trunk.

The second type of scarring may leave either a barely visible purple, flattened area which becomes white over a few years or a more obvious indentation. The hollow may either be shallow or deep and the deepest ones are less likely to improve with time. Generally the scars do get better eventually, and sometimes to a remarkable extent.

Bacteria

There are plenty of bacteria on the skin and even more in the hair follicles. Many treatments for acne will also reduce the number of bacteria but that does not mean the bacteria are the main cause of acne.

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