Acne Vulgaris and Its Origin
Since the follicular lining in the pilo-sebaceous unit is intact before adolescence, it has been theorized that if colonization of Proprionibacterium acnes happens in sufficient quantities they produce antigenic molecules that stimulate the initiation of inflammation. Proprionibacterium acnes is able to produce proteinases, lipase, and hyaluronate lyase all of which may act as the accelerators or initiators of the inflammatory infiltrate which is made of neutrophils and lymphocytes.
The key player in the cause of acne in puberty is hormones. At this phase androgens interact with receptors on the sebaceous glands and promote stimulation of the sebaceous gland to hypertrophy and so induce more sebaceous production of lipids and free fatty acids which distend the follicular canal. More specifically, there is evidence for increased peripheral metabolic transformation of the androgen testosterone to dihydrotestosterone at the level of the skin in persons having acne.
How Acne Forms
The basic lesion in this condition called acne vulgaris is the comedo. When exposed to oxygen the comedo turns dark and creates what you know as a blackhead. The comedo is made by retention of layers of devitalized skin called keratin in the lining of the follicles. In addition to hyperkeratosis (which is thickening or trapped layers of keratin), there is an accumulation of sebum. The mixture of the keratin and the sebum produces a plugging of the opening of the follicular canal, and papules are formed by inflammation around the comedones. Depending upon the degree of inflammation, pustules, cysts, cars, granulomatous reactions, nodules, and keloids may develop.
Inflammatory Reaction
Airborne contamination and other harmful materials further aggravate the inflammatory reaction. As bacteria begin to grow within the clogged pore your defensive system responds by releasing granulocytes and macrophages, which are groups of white blood cells that destroy the bacteria. The inflammation process is necessary to eliminate the continuing effects of excess bacteria and signal the body to repair the harm to tissues. Often times the defensive response system can't stop the multiplication of acne bacteria due to lack of white blood cells or an impaired system.
Activity of the Sebaceous Gland
When a comedo is clogging the outlet of the sebum ducts, the sebaceous glands continue to form sebum, which gathers in the sebum canal augmenting the comedo in size. The expansion in size produces pressure and leads to a further intense inflammation reaction in the surrounding skin and produces redness, swelling, discomfort, and a mass (pimple, redhead, acne papule).
Growth of Acne Bacteria
The above factors encourage the growth of bacteria and result in infection within the duct, the sebaceous gland, and surrounding tissue. The commencement of the infection produces further inflammatory alterations, therefore starting a cycle of accentuated obstruction of the outflow of sebum which leads to even more pressure, inflammation, and progressing infection causing cysts and pustules to appear. The effect on skin tissues caused by such infections is very damaging and the healing process usually results in a scar.
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Published February 15th, 2008
