Acne is believed to derive from the increased activity of endocrine glands that occurs during the period of adolescence. It is the sex hormones that are mainly implicated in acne, particularly androgen—a “male” sex hormone that is also present in females. Acne is prompted by an overreaction of the body to essentially normal amounts of this hormone. Androgen levels rise in all adolescents.
However, the disease is no more prevalent in boys than in girls. So the key is not the actual amount of androgen in the body, but how the body reacts to whatever amount is present. Possibly hereditary factors may play a part in determining the body’s reaction. In any case, the acne process seems to begin when increased androgen levels stimulate an enlargement of the sebaceous, or oil-producing, glands in the skin of the face, neck, chest, shoulders, or back. The increased size of the glands promotes a corresponding increase in their capacity for oil production, and this is why the “oily face” is so typically associated with acne.
Sebum, the product of the sebaceous glands finds its way to the surface through the pores of the skin. Each follicle also contains the root of a fine hair that grows through the sebaceous duct and also surfaces through a pore. (This is true in girls as well as boys. In boys, the facial hairs eventually become coarser as the beard begins to develop.) The hair-sebaceous gland unit is referred to medically as the pilosebaceous apparatus.
In the acne-prone individual, there is a malfunctioning of this pilosebaceous apparatus. At the same time, or possibly as a consequence, dead skin cells accumulate along the walls of the duct, partially blocking the passage of sebum. In time a sebaceous plug” is formed but it is eventually pushed to the surface by the constant pressure of the oil being produced by the gland below. At the surface of the skin, the sebum turns black, forming the well-known “blackhead,” or come- do. The black color of the comedo is not related to the presence of dirt, as is often supposed by teenagers (or their mothers), but derives purely from the chemical reaction that takes place between the sebum and the air.
When the sebum is prevented from reaching the surface by a particularly tenacious plug, it can be seen through the skin as a “whitehead,” or papule. A “pimple,” or pustule, develops when there is a bacterial infection within the sebaceous duct or the hair follicle, causing pus to accumulate beneath the surface of the skin. At times, the pressure built up within a plugged and infected sebaceous duct by the constant production of oil, sebum, and pus may cause the walls of the duct to rupture, allowing infection to spread through the surrounding skin area. This will be evidenced by a reddish and obviously inflamed area occupying a
An oily substance, sebum, normally rises from the sebaceous glands through the hair follicles to the surface of our skin. Since sebum often carries with it dead skin cells and other debris, its passage may become blocked, and a “plug” is formed which is then pushed toward the surface by the constant pressure of oil produced in the gland below. If the plug reaches the surface, it reacts with air and darkens to form a comedo, or blackhead. If it remains beneath the surface, it is a papule, or whitehead. If it becomes infected, it is a pustule, or pimple.
portion of the skin. The duct walls may also be ruptured, and the infection spread, by the teenager’s deliberate efforts to get rid of the pimple by squeezing it.
Acne most commonly appears on the face, but often is also present on the back, chest, shoulders, and neck. And though it is not a serious threat to life, it is a problem since it usually develops at the time of life when the individual is becoming most sensitive about his appearance. When it is severe, it can cause serious and permanent scarring.