What Is Acne

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Acne: what is it?

Acne (Acne vulgaris = "common acne") is the most common skin disease worldwide and is not contagious. It is particularly common during puberty. Around 70 to 95 percent of all adolescents have acne-related skin changes. The incidence peak of the disease is between the ages of 15 and 18 years. Boys and young men are affected somewhat more often and usually more severely than their peers. Acne is characterized by increased sebum formation (seborrhea) and a cornification disorder in the area of the sebum follicles. The face, neck and décolleté, chest and back are particularly affected. Sometimes variants of acne also occur under the armpits as well as in the genital, buttock and groin regions. In most cases, the symptoms will resolve on their own.15 to 30 percent of acne patients require medical therapy because of the severity or duration of the illness.

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Normal skin pores excrete sebum, sweat and other substances from the skin. The sebum (sebum) flowing to the surface of the skin is responsible for ensuring that the skin is always well supplied with oil and moisture and does not dry out.

What are the symptoms?

The following skin changes are characteristic (*):

Pimples (small pus vesicles),
Blackheads (comedones),
Papules (usually reddened skin protrusions),
Pustules (larger pus-filled vesicles) as well
oily skin.

In acne, there is an increased production of sebum in the sebum follicles and increased cornification (*). Increased dead skin cells from the sebum follicle form a stable horn plug at the follicle exit. This prevents the sebum from flowing off to the surface of the skin, builds up and expands the sebum follicle. This leads to the formation of a blackhead as the primary skin lesion in acne.

At first a closed comedo usually develops. This sebum-horn plug is recognizable as a skin-colored, pin-head-sized, hemispherical protrusion and offers a good breeding ground for bacteria. It is prone to inflammation and the accumulation of pus because the pressure cannot escape to the outside. A closed comedo can also transform into an open comedo. The follicle opening opens up, making a black center visible. This is not dirt, as is often assumed, but a pigmented horn lipid plug that has been oxidized by oxygen.

Blackheads can recede, but mostly inflammatory changes occur. This is partly due to the metabolic activity of bacteria, especially Propionibacterium acnes, which is also found in healthy skin flora, in the sebum follicle. The germs break down fatty substances from the accumulated sebum, and the metabolic products that are created in the process attract inflammatory cells. As a result, papules and pustules can develop in the area of the sebum follicle.

Oily skin occurs when the sebum glands produce too much body fat (sebum). The top layer of the skin (horny layer) thickens and the skin pores expand. The skin often looks pale and poorly supplied with blood. It also has an oily sheen and is prone to blackheads and pimples as the sebum pores are often clogged.

If the skin pore is healthy, the sebum produced by the sebum can drain away. When the pores are clogged with flakes of skin, sebum builds up. This results in inflammation and the accumulation of pus in the pore.

How does acne work?

For most people, acne will go away on its own after puberty (*). In about two to seven percent, however, the scars caused by the inflammatory skin changes remain. In around ten percent - mostly women - the disease persists beyond the age of 25.

Attempts to fight acne alone usually lead to an aggravation of the skin disease: This is the case, for example, if the pimples and blackheads (comedones) are pressed out incorrectly, the skin is cleaned or disinfected too intensively or skin blemishes are concealed with unsuitable make-up will.

What are the factors influencing the development of acne?

Traditionally it has been assumed that acne development is caused by increased activity of the sebum glands (seborrhea) and increased cornification (hyperkeratosis), resulting in an increased colonization of the skin with bacteria and inflammatory reactions. Today, however, it is believed that many different internal and external factors can be involved in the disease process (*):

According to current knowledge, the inflammation is not a secondary reaction, but with a high degree of probability the origin of the skin change. Acne is therefore an inflammatory disease from the start.
Hereditary factors are believed to play an important role in causing acne.
In women, an irregular menstrual cycle and pregnancy affect the course of acne.
The climate - including humidity and UV radiation - as well as other environmental factors can play a role in individual cases.
Acne can be triggered or made worse by numerous medications.
The influence of psychological factors such as stress on the development of acne has not yet been proven. However, they are often of concern as the disease progresses.
Male sex hormones (androgens), skin fats (skin lipids) and regulating neuropeptides (messenger substances released by nerve cells with hormonal and non-hormonal activity) seem to be significantly involved in the development of acne.
In some patients, nutritional factors are said to influence the disease. A diet rich in sugar and carbohydrates with, for example, chocolate, honey and jam causes high levels of insulin to be released, which can possibly worsen the complexion. A high consumption of (cow) milk and milk products is said to have the same effect. Overall, the role of diet in acne remains debatable. According to current knowledge, a special "acne diet" is not recommended.
The influence of cigarette smoke is controversial, as different studies have come to different results.
Probionibacterium acnes (P. acnes) is part of the healthy skin flora in most people and seems to be more involved in a later stage of acne development. When a pore is clogged due to increased sebum production, this anaerobic bacterium multiplies and excretes substances that destroy the pore wall. This allows other bacteria (e.g. Staphylococcus aureus) to invade the skin pore and cause an inflammatory acne lesion.