The Acne Series: Understanding Acne (Part 1)

The Acne Series is meant to be a basic guide for acne sufferers. When I was in high school, I had terrible skin. What was most frustrating about having terrible skin was all the misinformation floating around. All of the competing and conflicting views, most of them old wives tales, made it hard to understand how I could best help my skin heal. I hope that this guide will provide knowledge that can help keep your skin clear. Part 1: Understanding Acne

The skin is comprised of three layers: epidermis, dermis, and hypodermis. The epidermis is the outermost layer, the surface of your skin. The skin is composed of basal cells which are generated in the hypodermis.   Over a basal cell's life, it will move from hypodermis to the epidermis.

Shier, D. Butler, J. Lewis, R. (2010). Holes: Human anatomy & physiology. Location: McGraw-Hill

Basal cells have a shelf life of approximately one month, any treatments should be tried for at least one month because of this cycle. By the time a basal cell reaches the epidermis, it is dead. These dead skin cells will slough off to make way for new cells. The epidermis's dead basal cells are hydrated by sebaceous glands.

Sebaceous glands are housed in the middle layer of the skin, the dermis, and produce an oil called sebum which hydrates the epidermis. In order for sebum to properly hydrate the skin, it needs to get to the surface, this is where pores come in. Pores are the opening at the surface of a sebaceous follicle which form a pathway for sebum to reach the epidermis.

The video "Acne In Motion" illustrates how sebum hydrates the epidermis and what happens if the pores become blocked.

Sebum is absolutely necessary for healthy, hydrated skin. It is only a problem when it becomes clogged in the pores.

Shier, D. Butler, J. Lewis, R. (2010). Holes: Human anatomy & physiology. Location: McGraw-Hill

There are different types of acne that describe different types of clogs. Blackheads (also known as an Open Comedone) are caused by partially blocked pores, while white heads (also known as a Closed Comedone) are caused by a completely blocked pore. If a whitehead becomes inflamed it is known as a pustule. Papules are similar to blackheads but have no black center. Papules are small firm inflamed red bumps that have no visible pore.

More severe forms of acne include nodules and cysts. Nodules are severely inflamed bumps that are firm to the touch. The inflammation in cysts and nodules are usually caused by the pore bursting near the base of the sebaceous follicle. Cysts are also large and inflamed, but they are not hard to the touch. Cysts are filled with pus and usually have inflammation in more than one layer of the skin. With cysts, the pore has often burst underneath the epidermis which causes inflammation to radiate out and away from the pore making it larger than other forms of acne.

The most severe form of acne is called acne conglobata and it is very rare. The acne series cannot help with acne conglobata, but it is an excellent illustration of what is happening under the skin's surface. When a nodule or cyst forms, the pore bursts in the dermis causing inflammation. In patients with acne conglobata, the pores can actually heal attached to other busted pores in the dermis. This creates an under-the-skin tunnel system that does not allow sebum to drain properly out to the epidermis. Acne conglobata must be treated by a dermatologist in a timely fashion.

While most acne cases are not as severe as acne conglobata, more mild cases of acne may need to be treated by a dermatologist as well. In the next part of The Acne Series, Part 2: Preventing Acne  I'll talk about the ways you can help prevent acne before it begins.