What is acne vulgaris?

Most people who read this will almost certainly think they know what acne (aka "acne vulgaris") is. In reality, the question “what is acne?” is far more complicated then you may think.

If you struggle with acne yourself, you have “learned” what causes acne from various sources, most likely commercials and infomercials selling acne products. Also, you may have heard from your friends or family members that claim they know what causes acne and how to prevent it. Please read on, you may find that you know less then you think you do…

The acne cycle begins with the production of the hormone testosterone in our bodies, something that begins at puberty. This hormone is then converted to dihydrotesterone by the skin and this stimulates the pore to secrete oil (sebum). In the skin of someone with acne, the oil blocks dead skin cells from being shed and these dead cells stick together within the pore.

Acne is actually a defect in the skin called retention hyperkeratosis. Retention hyperkeratosis is a process by which skin cells are being produced at an abnormally fast rate (4-5 times faster then normal) and are not being shed properly. As you might have guessed, this leads to the ‘plugging’ of our pores and the development of acne lesions or blemishes.

How do acne blemishes form from the process of retention hyperkeratosis? Well, not just oil and cells get stuck in the pore- bacteria and other debris are also trapped there. This mass is destined to turn into one of the different types of acne blemishes- a whitehead, blackhead, pimple or cyst.

The different types of acne blemishes can be separated into two categories- inflamed or non-inflamed. The two types of non-inflamed acne blemishes are commonly referred to as a whitehead or a blackhead. The whitehead is a clogged acne follicle that is not open at the skin’s surface and so the dead cells have no way of escaping. The mass that clogs the poor is mainly dead skin cells. The blackhead is simply the whitehead that has opened up due the pressure of the growing mass. The black color is not caused by dirt but by oxidation of the skin’s oils and bits of melanin from dead skin cells.

Inflamed acne blemishes are the classic red pimple that we all know as well as the more bothersome, larger cyst. The process of inflammation occurs when the whitehead does not develop into a blackhead, allowing the plug to be expelled. Instead, the wall of the pore breaks down and our internal body can now “see” this mass of oil, skin cells, bacteria and other debris. Our body the reacts as though it were a foreign invader and begins the inflammatory response to kill it. This is when the redness, swelling and pain of a pimple or cyst set in. The cyst has a deeper break in the pore and tends to be larger, harder and more painful then a pimple. A cyst can also flare up again and again, even after it has healed, until the break has been resolved (for more information see Cystic Acne).