WHAT IS ACNE?
Informative Section

WHO GETS ACNE?

Acne is the most common skin disease of the human race. It affects only human beings. Approximately 85% of adolescents and 45% of adults experience acne breakouts to various degrees at some time or another. Although acne usually starts at puberty or adolescence, it can stay with many people through adulthood, or it can skip adolescence and first appear in adults. Having acne is not your fault. It does not come from being unclean, nor is it infectious. It is hereditary and fluctuates with hormonal levels and life’s stresses. (Note: You may get acne even though your parents didn’t. Genes have a tendency to skip generations; it’s referred to as genetic predisposition. You might have had a great-grandfather or a long-lost uncle who had acne.)

UNDERSTANDING OUR SKIN: Valuable Educational Material

The skin is composed of two layers, the dermis and the epidermis. The dermis is underneath the epidermis. The dermis contains blood vessels, nerve fibers, elastic muscle fibers, and collagen embedded in fat, which provides cushioning and insulation. The surface of the skin, the epidermis, is composed of 14 single cell layers that are stacked one on top of the other. The upper-most layers are composed of dead cells containing keratin (hard protein). Some cells are flat, others are shaped like horns, the reason this layer is sometimes referred to as the horny layer.

The base of the epidermis is lined with the basal layer, also called the germinative layer. This is a single cell layer capable of dividing to produce new cells. It is important to remember that this is the only layer of the epidermis that can divide to form new cells and can, therefore, prevent scars.

Every day the uppermost layer of dead cells are sloughed off (shed or exfoliated) and replaced by the layer underneath it, leaving the skin with a somewhat fresher appearance. The basal layer produces new cells that gradually change as they travel up to the surface, collect keratin, die and eventually are sloughed off. Thus, the skin renews itself in a 28-day cycle.

The skin has tens of thousands of tiny pores, also connected to follicles, tiny ducts or canals. Some canals, the pilo follicular canals, contain a hair follicle. Others have rudimentary hair or no hair. Sebaceous glands open into all of the follicular canals, secreting sebum (a complex oil-wax material) to nourish the hair and lubricate the skin. The canal walls are also lined with the epidermis, however, instead of 14 layers, they contain only five layers. In the canal, the epidermis retains its structure and the characteristic of shedding cells. The dead cells shed into the canal and the sebum pushes them to the surface and out through the pore. This is the regular course of events that occur daily in our skin.

ACNE

In general, acne is a disease of the sebaceous (oil) glands and ducts. To oversimplify it, acne is plugged pores and plugged canals ready to explode.

During puberty, a hormone called androgen stimulates the sebaceous glands and causes them to enlarge and secrete more sebum. Androgen is present in both males and females but in different amounts and proportions.

In an acne prone individual, an increased number of dead cells shed from the canal wall into its lumen at a faster rate (5 to 20 times faster). The increased amount of sebum secreted into the canal sticks to the dead cells and forms a small plug called a micro-comedo.

The Non-Inflammatory Phase Of Acne

As the sebum pushes towards the skin surface, it accumulates more dead cells in a snowball fashion and eventually blocks the pore. This plug is then called a closed comedo, or a whitehead. If the pore is slightly open, the plug can be seen as a black spot and it is then called an open comedo or a blackhead (due to its black color resulting from oxidation and melanin-pigmented cells). This phase of acne is called comedonal acne or non-inflammatory acne. It takes about three months for a micro-comedo to become a comedo.

The Inflammatory Phase Of Acne

As the pressure in the canal increases, the plug has two ways to go. The plug may push through the pore and get out or break the wall near the pore and get out to the surface where it forms a red raised bump called a papule (pimple). Soon white blood cells (the body’s defense mechanism) travel to the area and engulf this “foreign” material, appearing as pus on the top of the papule. This pus-head is called a pustule. This phase is referred to as the inflammatory phase of acne.

NODULES AND CYSTS

If the pressure of the plug breaks the tiny canal wall at a lower (deeper) level, an inflammatory reaction occurs underneath the skin surface in the surrounding tissues. It feels like a lump or bump and is sore and red. This is called a nodule and is similar to a papule, but is located deeper within the skin; it is larger and feels firm to the touch. If the inflammatory response is intense, many white blood cells migrate to the area, creating a pus-filled lesion that is soft and large due to accumulations of fluid, blood, and pus. It is almost like a boil. Since the follicles are close to each other, the destructive process may involve more than one follicle and a cyst might form, which is usually painful due to the pressure caused by the accumulated fluid on the surrounding tissue.

SCARS

Cysts can cause scars if the break occurs at the base of the canal wall and destroys the germinative (basal) layer. A scar is formed because no new cells can grow in that spot. Hence, the typical cone shaped acne scar or pit is formed.

WHAT CAN WE LEARN FROM THIS?

  1. It is much better for a plug to come out to the surface of the skin and eventually resolve than to have the plug go to the opposite end and destroy the basal layer. As long as the basal layer is intact, it can produce new cells and prevent scars from forming.
  2. Superficial scars can heal since the basal cell layer is intact – UNLESS one scratches (excoriates) and picks the pimple, which can form a crater, or even cause the canal wall to burst. A HANDS-OFF attitude should be adopted when it comes to pimples.

A HARD FACT OF LIFE: THERE IS NO CURE FOR ACNE. BUT THERE IS GOOD NEWS; ACNE IS CONTROLLABLE AND SCARS CAN BE PREVENTED.

As we have seen, a clogged pore is a potential source of trouble. The goal of treatment is to help get the plug to travel towards the skin’s surface and come out, rather than leave it in the pore and risk permanent scarring. Unfortunately, when we see these plugs coming out in the form of pimples, we get upset and understandably so. But, it is far better to let the plugs come out and tolerate temporary embarrassment knowing that they will eventually resolve, heal, and most importantly, not cause a scar.

The aim of all acne treatment is to control acne and its symptoms. Since there is no cure for acne and the treatment for controlling acne can be of long duration, especially in chronic cases, common sense tells us that we ought to use products that do not have adverse side effects. Acne-Statin is such a product.

 
Mfd for P.P.R.L. Inc.
Physician's Physiological
Research Laboratories Inc.
Beverly Hills, CA 90213