Acne: The What, Why And How?



Acne is a self-limiting inflammatory disease that involves the sebaceous glands that empty into hair shafts (the pilo-sebaceuos unit) mainly of the face and shoulders. It is the most common skin disorder of teenagers, occurring slightly more frequently in boys than girls. The peak age for the lesions to occur in girls is 14 to 17 years; for boys, 16 to 19 years. Although not proven, genetic factors may play a part in the development of acne. Cigarette smoking may also increase the number of inflammatory lesions.

Before the rapid increase in androgen secretion with puberty, the sebaceous glands that enter into hair follicles are small and relatively inactive, so acne is nonexistent.



1. As androgen levels rise in both sexes, sebaceous glands become active.

2. Abnormal keratinization (cell growth) of the lining of the ducts occurs; this overgrowth obstructs the ducts.

3. The output of sebum increases. Sebum is largely composed of lipids, mainly triglycerides.

4. If all of the material formed cannot be eliminated to the skin surface due to the narrow gland ducts, the glands enlarge, and trapped sebum causes whiteheads, or closed comedones.

5. As trapped sebum darkens from accumulation of melanin and oxidation of the fatty acid component on exposure to air, blackheads, or open comedones, form.

6. Bacteria (generally, Propionibacterium acnes) lodge and thrive in the retained secretions, forming papules.

7. Leakage of free fatty acid from triglycerides causes a dermal inflammatory reaction.

8. If glands rupture, sebum is extruded into adjacent skin, which produces reddened inflammatory cysts.

Acne is categorized as mild (comedones are present), moderate (papules and pustules are also present), or sever (cysts are present). The most common locations of acne lesions are the face, neck, back, upper arms, and chest. Flare-ups are associated with emotional stress, menstrual periods, or the use of greasy hair creams or makeup that can further plug gland ducts.

Lesions are less noticeable in summer months, probably because of increased exposure to the sun, which increases epidermic peeling, and the reduction of stress, possibly as a result of being out of school.



The goal of therapeutic management of acne is threefold: (1) decrease sebum formation, (2) prevent comedones, and (3) control bacterial proliferation. Although acne may be treated, some degree of scarring may result. Hence, laser therapy is a follow-up possibility to reduce the effect of scarring.

Acne treatment, especially in its early stage, can stop the disease from getting any worse, and can also prevent further damage and possible scarring. And in most cases, acne treatment does not just cure the physical dilemma but it also alleviates the emotional and psychological effects of the disease, thus boosting the sufferer’s self-esteem and confidence.

It is important to respect what acne means to the adolescent. The actual extent of the condition often is not as important as an adolescent’s feelings about it. When one’s face is constantly covered by red marks, it is extremely difficult for an individual to feel good about oneself.