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What is Acne?

Skin cross section showing hair hair follicles at different stages of Acne and inflammation

Introduction

The definition of acne (medically known as Acne Vulgaris) is a skin disease characterized by clogged hair follicles—pores filled with excess oil, bacteria (Propionibacterium acnes, or P. acnes), and dead skin particles that become blocked and inflamed.

Pores are tiny holes in the surface of your skin that are connected to oil glands hidden beneath the skin. Our skin cells are consistently regenerating, sloughing off and revealing fresh skin every thirty days. Should these dead cells combine with oil, they become sticky and can trap bacteria and oil, clogging up your pores.

To keep your skin soft and healthy, your glands produce an oily substance called sebum. The sebaceous lipids in this substance are crucial for waterproofing and lubricating our skin and hair. These secretions are also essential for thermoregulatory processes; when we’re in the heat, sebum helps our bodies delay dehydration. When we’re in colder conditions, our sebaceous secretions help our skin better repel rain. Sebum forms a barrier to help keep microbes out, protecting your skin. However, while sebum can play an important role, the overproduction of this substance can lead directly to a host of skin conditions, including acne.

Our pores are connected to oil glands by a canal called a follicle. In these follicles, sebum carries dead skin cells and bacteria to the surface of the skin. However, if the sebum is trapped under the skin, it can clump together with the hair and skin cells gathered in the follicle. Should this happen, this clumping forms a plug. As the bacteria, skin, and sebum continue to build and press against the skin, your body sends red and white blood cells to the site, resulting in swelling and inflammation. If the bacteria remain trapped, a pimple will form.

How Acne Develops

HORMONAL CHANGES

Acne Vulgaris generally develops during the teen years, when the onset of puberty causes the hormonal level to fluctuate. As hormone levels rise, especially testosterone, the skin glands begin producing larger amounts of sebum.

What causes oily skin? Sebum, which can lead directly to acne bumps or breakouts.

Puberty isn’t the only time we experience hormonal changes. Women experience regular variations in hormone levels, specifically that of estrogen and androgen. Men also experience hormone level fluctuations, especially in their teens, but this usually mellows out by adulthood.

HEREDITARY FACTORS

Acne is also a result of hereditary factors. Children whose parents have dealt with acne are more likely to struggle with this skin condition. While it’s not a genetic disease, hereditary components have been linked to the presence of this skin condition.

Genetics have a huge bearing on how your immune system works; say two individuals experience the same bacterial infection. One might react with painful, pus-filled nodules, while another’s skin may only result in the formation of blackheads.

Similarly, one person may have more sensitive skin that grows raw and inflamed more often due to their genetic predispositions.

STRESS

While stress doesn’t directly cause acne, it can trigger or exacerbate a breakout. We see this occur in students across the globe when they're handling stress during finals. When you’re stressed, your body releases cortisol and androgens. When these hormones fluctuate, your skin secretes more oil, which can bring on a breakout or worsen pre-existing pimples. If you find that your skin is particularly sensitive, be sure to integrate healthy skincare tips to counteract the inevitable stress in your life.

DIET

Similar to the debate on whether stress can cause acne, there is much conjecture regarding the relationship between diet and acne. The research behind diet and acne is varied and vast. But diet plays an essential role in your skin’s health. There is a wide variety of foods for good skin health. Conversely, some foods are bad for the health of your skin—like white rice, sugar, and dairy—which should be avoided in a healthy skin diet. It’s important to eat a varied and complete diet to make sure that you get all the essential nutrients required by your skin.

Furthermore, certain vitamins and minerals can have beneficial effects on your acne, as discussed in our article "The 3 Best Vitamins for Fighting Acne".

How Acne is Categorized

Skin cross section showing hair hair follicles at different stages of Acne and inflammation

Acne Vulgaris presents different types of acne lesions: blackheads, whiteheads, papules, pustules, nodules, and cysts:

  • Blackheads: These are uninfected, clogged follicles that appear as a dark bump on the skin.
  • Whiteheads: Whiteheads are clogged follicles covered by a thin layer of skin that appear as white bumps or spots.
  • Papules: Papules are inflamed lesions that may appear red, and can be sensitive and painful.
  • Pustules: Pustules are inflamed lesions that are generally pus-filled. They may appear white or yellow, and popping pustules can lead to acne scarring.
  • Nodules: Nodules are a severe form of acne lesion that develop under the skin; they don’t generally contain pus but are hard to the touch.
  • Cysts: Cysts are a severe form of acne lesion that is inflamed and filled with pus. They are generally painful and require professional medical treatment.

Non-Inflammatory Acne

Acne is typically categorized into two main types: non-inflammatory and inflammatory acne. Although there are two primary categories, there are many different types of acne that we'll discover later on.

Non-inflammatory acne is characterized by comedones, which can be open or closed. These comedones are more commonly known as whiteheads and blackheads and are generally referred to as different types of pimples.

Comparison image of a healthy hair follicle and a blackhead

Blackheads

If the pore stays open on the surface of your skin, it’s considered an open comedo, also known as a blackhead. Because the pore is open, the sebum inside the pore oxidizes upon contact with the air; this hardens the sebum, and once the air mixes with melanin skin pigment, the blackhead forms a dark coloration that can appear black, brown, or gray.

Blackheads can usually be found on the nose, chin, and forehead, but might also be found on the chest, back, and arms. Blackheads tend to be rampant at the onset of puberty and during times of hormonal change.

Whiteheads

If a pore is not open and covered by a thin layer of skin, sebum and dead skin cells accumulate, resulting in a thick substance that remains stuck under the skin, forming a plug. While these are not usually infected, bacteria can affect the skin cells surrounding the pore. Whiteheads don’t usually last as long as blackheads, with an average cycle of a week.

Whiteheads tend to be found on the face, but may also be observed on other parts of the body.

Comparison image of a healthy hair follicle and a whitehead

Self-extraction of comedones can cause more harm than good. The follicle walls in blackheads and whiteheads can be ruptured quite easily, and this rupture allows bacteria to enter the cells and leads to inflamed acne. That’s why it’s essential to avoid picking the skin, as this can lead to rupturing.

Inflammatory Acne

Inflammatory breakouts are a result of P. Acnes bacteria infecting the pore and causing an infection, and can often be more difficult to treat. There are four types of inflammatory acne, sometimes commonly referred to as different pimple types: papules, pustules, nodules, and cysts.

Papules

Comparison image of a healthy hair follicle and a papule

Papules are small, raised, solid pimples that don’t contain pus and are usually the first type of inflammatory acne to affect the skin. Papules don’t display a visible pore and tend to be red in color and surrounded by swollen and inflamed tissue. They may be tender to the touch.

Pustules

Pustules are pimples that are noticeably white or yellow in the middle and are filled with pus. The marked difference between papules and pustules is that pustules contain white blood cells. When your immune system attempts to fight bacteria that’s made its way into a ruptured follicle, it will set off a buildup of white blood cells, resulting in pus production. The skin around pustules tends to be tender and inflamed.

Nodules

Acne nodules appear during the latter stages of a breakout and are usually seen in severe cases of acne. They present as large, tender bumps underneath the skin’s surface and can feel hard and stiff to the touch. Similarly to papules, nodules form from a buildup of bacteria, skin cells, and sebum in the follicles, but this formation is rooted deeper in the skin. This deep buildup can cause tissue damage to the skin and prompt the immune system to begin an inflammatory response.

While they look similar to papules, nodules are much bigger and more painful. They do not contain any pus but can remain buried within the skin for a long time. They may be dormant and rear up in occasional bouts. If squeezed or ruptured, these nodules can spread over a larger area of the skin and cause deep infections. These lesions can cause damaging and permanent scars to the skin.

Cysts

Cystic acne is one of the hardest types of acne to successfully treat. Unlike pimples, acne cysts form deep below your skin tissue and do not come to the surface. Cysts are similar to nodules, except for the presence of pus. Cysts are almost always painful to the touch and can cause great discomfort, and they don’t necessarily look like a pimple. They may just appear as a large, swollen, and red lump on the skin. They may occur independently, or you may find your skin has large clumps of cysts grouped.

Inflammatory acne takes much longer to heal and can have permanent effects on the skin, so it’s important to determine the best treatment methods for your skin condition. Consulting a dermatologist is recommended.


Written by Alex P.

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