Acne 101


What is Acne?

Acne is a skin condition that occurs because there is some malfunctioning of the normal system. The oil glands in the skin produce oil that is intended to lubricate the skin. At the same time new cells are being born, and the old skin cells die.

During puberty excess oil is produced. This excess oil mixes with the dead skin cells and clogs the pores of the skin, which are openings through which hair protrudes. When this happens, oil becomes trapped and attracts bacteria that are usually present in the skin. As the bacteria feed on the oil they multiply and may eventually cause an inflammation.

Types of Acne

Research has shown that there are two types of acne, inflammatory and non-inflammatory. Non-inflammatory acne are said to be –

  • Blackheads – which develop when the pores open to the surface and the oil, which has melanin, mixes with air, thereby oxidizing, and changes to either a brown or a black color. Some persons, thinking the black bumps are dirt, scrub them very hard in an effort to be free of them. Blackheads can be around for a long time, since its contents drain, very slowly, to the skin surface.
  • Whiteheads – which come into existence when the trapped oil and bacteria remain beneath the surface of the skin. They appear as very small white spots, or the whiteheads may be too tiny to be seen with the naked eyes.
  • Milia – which are small white bumps which form when skin that is being shed becomes trapped in little pockets in the skin’s surface. They are mainly seen on the nose and upper cheeks of newborn babies. Milia sometimes appear on the skin of adults, at times. As the surface of the skin is renewed, the dead skin is shed, and the bumps disappear. This disappearance can occur during the early weeks of a baby’s life. In adults, however, they may exist indefinitely.


The follicle walls of whiteheads may rupture and become inflammatory. There are four types of inflammatory acne. Progressively, they are –

  • Papules – which occur when the walls of the follicles break. This causes white blood cells to pour in, and the pores become inflamed.
  • Pustules – which form many days afterwards when the white blood cells travel to the skin’s surface. Other names for pustules are zits or pimples.
  • Nodules – which form when follicles break at the bottom, resulting in a total collapse. The collapse causes a large inflamed bump to form, which can be painful when touched.
  • Cysts – which are very big lesions filled with pus. They may occur because of severe inflammatory reactions.


How Acne Forms

Acne comes in different flavors: whiteheads, blackheads, and pimples. Each type of “acne” is a bit different.

Acne Formation

Acne results from the malfunctioning of the pilosebaceous unit of the skin. This Unit is made up of the hair follicle, the hair shaft, the sebaceous gland which produces sebum (oil), and the erector pili muscle that is responsible for the hair standing up whenever it contracts. The cells in the hair follicle divide themselves at a very fast rate.

The sebum that the sebaceous glands produce, moisturizes the hair and the skin. During puberty, androgen hormones cause the glands to expand and so manufacture more oil. The excess sebum mixes with dead skin cells and rise to the surface of the skin. More dead skin cells tend to be at the top of the pores, which are the openings through which the hairs protrude. As the skin cells become sticky, they gather inside the pore rather than flow onto the skin. This situation attracts the bacteria which are normally present in the pores. As they feed on the sebum, the bacteria increase within the pores.

The bacteria’s presence causes white blood cells to rush to the follicle. The enzyme that the white blood cells produce, damages the wall of the follicle, causing its contents to spill into the dermis. When this happens, inflammation, as seen in papules (that is, red bumps), pustules and nodules, occurs.


Blackhead Formation

Blackheads are also called open comedones. This is because the follicle has a wider opening than normal. Comedones are little flesh-colored, dark, or white bumps on the skin, which cause the skin to feel rough. A blackhead is an acne lesion that is non-inflammatory, and is recognized by its characteristic black or dark brown plug at the pore’s surface. The dark color should not be mistaken for dirt. It results from a combination of sebum and dead skin cells that have mixed with air, or oxidized, through the pore’s opening.

Whitehead Formation

Whiteheads, on the other hand, are also referred to as closed comedones or pimples. Pimples are small papules or pustules that are infected with bacteria, fill up with pus, rupture and become inflamed. Whiteheads have plugs of sebum and dead skin cells. However, because their openings do not allow air to mix with their contents, the contents remain white.



Open comedo Closed comedo
A type of acne A type of acne
Has a wide opening Has a microscopic opening
Non-Inflammatory Inflammatory
Not a pimple A pimple


Dirt, dead skin cells, and sebum may clog the pores found on the skin’s surface, causing little bumps to appear. Because its opening is wide, air is allowed to combine with the contents of the pores. This combination results in a black or dark brown color at the pores. No inflammation occurs, however. Dirt, dead skin cells, and sebum may clog the pores found on the skin’s surface, causing little bumps to appear. Because its opening is not wide, air is not allowed to combine with the contents of the pores. The pores may rupture, however, spreading infection to the surrounding tissues, and resulting in an inflammation.


Treating Acne

There’s quite a few different ways to go about treating an acne problem, depending on the severity of the acne. Simple topical medication over the span of a few months may reduce the acne problem or one may require  oral medications. In some cases, acne cannot be effectively cured.


The Severity of Acne and its Treatment

Research has shown that there are three stages, or levels, of severity where acne is concerned: Mild acne, moderate acne, and sever acne. Each stage really requires different treatments.


Mild Acne

Small lesions, like blackheads, whiteheads, or pustules, are usually found during the mild stage of acne. These lesions tend to be at or close to the skin’s surface. Because of their location, mild acne can be controlled at home, sometimes. This involves:

  • Washing the affected areas, gently, using a mild soap and warm water two times per day. This treatment helps to remove excess oil, as well as dead skin cells.
  • Applying a topical acne treatment which has salicylic acid or benzoyl peroxide. These can be acquired over the counter.

Chemical Treatments for Mild Acne

Treating skin problems requires a bit of  time.  This is because many of the treatments take quite a few weeks or months to effect any noticeable change. Some chemical treatments that have been proven effective are:

Benzoyl Peroxide

Benzoyl peroxide is said to have an antibacterial effect on the condition. It may reduce, as well, the chemical reaction that causes the lining of the hair follicle to change. The plugging at the pores, which results in the formation of comedones, may also be limited. This could therefore help to stop other comedones from forming.


Tretinoin is said to be the main treatment for blackheads and whiteheads. Derived from vitamin A, tretinoin increases the turnover rate of the cells, and reduces the sticky condition of the dead cells. It also helps to force out the material plugging the pores, thereby returning the pores to normal operations. Since it can irritate the skin, the instructions for using tretinoin should be carefully followed.


Extraction is a method that may be used on blackheads by a physician. A device known as a comedone extractor is used to push down on the skin surrounding the blackhead. That action forces out the plug.


Home Remedies for Mild Acne

The best remedy for preventing the occurrence of blackheads and whiteheads is to keep the skin clean and oil free. There are a few home remedies that are floating around however. We can’t verify if these will work though. Anecdotal reports from users (and reports scattered across the web) say these treatments are effective and do help, but understand there is certainly NO guarantee that you will be able to treat your skin problem. There is no scientific evidence these treatments will work.


The face may be held over a steaming bowl of water, with a towel over the head, for some minutes. The steam has the effect of opening the pores so that blackheads can be extracted easier, and whiteheads can absorb topical solutions.


A layer of toothpaste may be spread on the affected area, twice weekly, before retiring to sleep at nights. The paste effectively draws bacteria out of clogged pores.

Corn Flour Paste

Corn flour may be combined with vinegar to form a paste, and this may be spread over whiteheads. This helps to remove the whiteheads, as the paste is useful for drying out the oil on the skin.

Lavender Oil

Lavender oil, which is an astringent, may be brushed onto blackheads and whiteheads every time the face is washed. The oil should remain so that the skin may absorb it.


Moderate to Moderately Severe Acne

When acne is in its moderate or moderately severe stage, there are many more whiteheads, blackheads, papules, and pustules. These can cover between one quarter and three quarters of the face and other areas that may be affected. At this stage, a dermatologist may be consulted, and combination therapy may also be employed. Combination therapy means there are two or more treatment options being used at the same time. The treatments used at this level are:

  • Physical strategies, like the extraction of comedones, or light therapy.
  • Prescription medications, such as topical antimicrobials, topical retinoids, oral antibiotics, and oral contraceptives.
  • Topical acne medications that can be acquired over the counter.

This stage of acne appears to be a crucial one, since at this level scarring is possible. For this reason, dermatologists recommend early treatment as a preventive measure. Acne scars may appear as either raised thickened tissue or in the form of a depression, like pits or pock marks. Treating acne early and over a long period reliably prevents or limits the extent of scarring. Persons who are prone to scarring and who have acne should be carefully supervised by a dermatologist.

Severe Acne

The characteristics of severe acne are deep cysts, inflammation, widespread skin damage, and scarring. A dermatologist should be involved at this level, because an aggressive treatment program is required. Although there may be failures, for the most part success has been achieved. The physical processes and prescription medicines used by dermatologists include the following:

Drainage and Surgical Excision

Large cysts that are not helped by medication may need to be drained and extracted. This is a type of acne surgery, and should only be performed by a dermatologist.

Interlesional Corticosteroid Injection

Severely inflamed cysts are prone to rupturing and so may cause scarring. In order to treat them, dermatologists may inject a corticosteroid that has been diluted greatly. This effectively reduces the inflammation and promotes healing by melting the cysts.


This potent drug is available in pill form, and is the most effective acne treatment around today. However, it has some serious side effects.

Oral Antibiotics

These drugs effectively decrease inflammation. Treatment usually begins with a high dosage that is gradually reduced as the condition improves.


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