For most people, acne is an inherited condition of the pores. For those who are prone to acne, their pores clog with dead skin cells much faster than normal. Healthy pores shed about one layer of dead skin cells per day inside the pore, but acne-prone pores shed up to five layers of dead skin cells per day. The body just can't keep up with keeping the pore clear. This condition is called retention hyperkeratosis - dead skin cells shedding more quickly than the pore can expel them.

Illustration of a what a normal pore looks like. | Elements Skincare

Illustration of a what the first stage of acne looks like. | Elements Skincare

As the dead skin cells begin to accumulate inside the pore, the cells become sticky and form a plug. Medically, this is called a microcomedone and is the precursor to all acne . Hormonal fluctuations trigger more oil production inside the pore. In a normal pore, the oil and dead skin cells can move freely; in acne-prone skin the plug traps the oil within the pore, creating the perfect environment for the P. acnes bacteria. The oil feeds the bacteria and the bacteria proliferate. This may cause inflamed lesions, also an inherited tendency. It is important to remember: acne is caused by too many dead skin cells becoming trapped in the pore. Bacteria thrive in this environment. Antibiotics may effectively treat the infection, but do not address the fundamental cause of acne.

Illustration of how whiteheads are formed. | Elements Skincare


Some people don't get inflamed lesions. If the dead skin cells and the oil that form the plug don't become inflamed, the plug becomes a whitehead, that is, a non-inflamed lesion under the skin, also called a closed comedone.

Illustration of how blackheads are formed. | Elements Skincare


The plug may become a blackhead, which is a non-inflamed acne lesion where the pore remains open, also known as an open comedone. In the case of a blackhead, the tip of the plug darkens as it is exposed to oxygen in the environment. As the oil in the pore builds up, inflammation can develop in the cells surrounding the pore. Blackheads can be infected or not depending on whether the P. acnes bacteria have affected the cells around the pore.

Illustration of how pimples develop. | Elements Skincare


As the oil and the dead skin cells build up, they put pressure on the cells surrounding the pore. With enough pressure, the sides of the pore rupture and the contents of the pore leak into the surrounding skin. Because this sebaceous material contains a lot of P. acnes bacteria, the surrounding skin now becomes infected, creating a red bump that we know as a pimple. The medical term for this red bump is an inflammatory papule.

Illustration of how pustules develop. | Elements Skincare


A pustule is different from a pimple only in that it contains white blood cells. When the immune system fights off the P. acnes infection, white blood cells - soldiers of the immune system -pile up, creating pus in the pore.

Illustration of how nodules and cysts develop. | Elements Skincare

Nodules and Cysts

Another deeper, inflamed lesion can form called a nodule. It is a solid dome-shaped lesion that extends below the surface, deep into the layers of the skin. Scarring is common with nodules and can sometimes leave an impaction behind, which can flare again and again. When a group of pustules cluster together under the skin, they form a cyst. An acne cyst can appear similar to a nodule, but is pus-filled, and can have a diameter of 5mm or more across. They are usually very painful and scarring is common with cysts.

Conclusion So you see, acne is primarily an inherited disease. Most acne, no matter what form it takes, starts with microcomedones. This means the solution lies in products that penetrate the pore and prevent dead skin cells from building up. That's why your home care routine is so crucial - it's all about preventing the microcomedones (the beginning of acne) from forming at all. © 2012 Face Reality Acne Clinic