Acne is complicated, which is one reason there are so many products and so much discussion on how to best treat it. And why there is no easy solution. The bump that appears on your face is actually the first step in a process that began two weeks before. Even though the bump is painful and even if you feel it mars your looks to the point where it causes stress and anxiety, the real damage is happening beneath your skin. The secret to controlling acne is to get deep down into the pore to stop the acne before bumps make themselves visible on the surface of your skin.
Four skin factors that lead to acne
- Clogged pores: Normally, skin cells are in a constant state of gradual renewal. As old cells die, they mix with your skin's natural oils and are sloughed off, making room for fresh, new skin every 30 days. However, this process of shedding dead cells doesn't always happen as it should. Sometimes, the skin cells don't shed evenly or the cell turnover slows down. When that happens, skin cells become "sticky." When they combine with the natural oils of your skin, they clog your pores. A plug called a comedo is formed inside the hair follicle and acts like a cork on a bottle. This plug traps oil and bacteria in the follicle.
- Overproduction of oil (sebum): Hormones stimulate oil production in the sebaceous glands, which are attached to hair follicles. Normally, the oil flows freely to the surface of your skin. If your hormones tell your sebaceous glands to pick up production, they'll churn out sticky oil, which results in potentially clogged pores that then create an environment for the growth of bacteria.
- Bacterial attack: Once your pores are clogged, bacteria that is normally growing on your skin starts feeding on the trapped oil. Like all bacteria, it feeds on the oxygen-free atmosphere and moisture. It digests the entrapped sebum, breaking the oil molecules down into smaller particles. When these broken-down oil molecules leak outside the follicle, it generates a response in your body.
- Inflammation: The body's response to any proliferation of bacteria is to send an army of red and white blood cells to fight the infection. These cells attempt to wall off the follicle, with the result being the swelling, inflammation and pain that we call pimples.
The different types of acne, or comedones
Although all acne starts the same way, the lesions produced look different on your skin.
Whiteheads: If the plug stays below the surface of the skin, it's called a closed comedo, or a whitehead. The white debris is trapped sebum and dead white blood cells.
Blackheads: If a plug enlarges and widens the pore, it's called an open comedo, or blackhead. Blackheads are not caused by trapped dirt, even though that's what they look like, and you can't simply wash them away. The black spots are from a buildup of melanin, the pigment that colors your skin, and oxidized oil.
Papules: These types of acne are small, pink, domed bumps that are tender to the touch.
Pustules: These are small, round, pus-filled lesions. They appear swollen and red at the base, with a yellowish to whitish center.
Nodules and Cysts: These are large, deep and painful bumps filled initially with blood, then with pus. Persistent nodules can harden into deep cysts, and both may leave deep scars.
