Two types of acne exist: inflammatory and non-inflammatory.
Non-inflammatory acne lesions are not painful; they are merely collections of dead
cells and oil that clog the follicles.
Comedogenic products can cause clogging similar to clogging caused by other environmental
factors. The follicle is open (blackhead) or closed (no head or a white head), but
is not inflamed or sore.
Inflammatory acne is caused by an imbalance of androgen and estrogen hormones, specifically
in the pilosebaceous unit.
The normal pilosebaceous unit is composed of a sebaceous gland, a rudimentary hair,
and a wide follicular canal lined with stratified squamous epithelium. During the
skin’s normal turnover process, desquamated cells from the follicular epithelium
are carried up the follicular canal by sebum secreted from the sebaceous glands.
In an imbalanced environment, such as an overabundance of male hormones (androgens)
around the sebaceous gland or reduction in female hormones (estrogens), the aggressive
androgens cause a surge in the production of sebum, which is deposited into the
follicle. They also stimulate dead cells to increase desquamation (shedding) from
the walls of the follicles.
This condition of increased sebum and debris in the follicle provides an excellent
environment for propionibacterium acnes bacteria (P. acnes) in the follicle to proliferate
in the papillary area of the follicle. This produces an imbalance in the flora of
the follicle. The resulting inflammation instigates a white cell response from the
lymphatic system as well as a collection of dirt and cellular debris due to the
imbalance, which results in a pimple. Inflammatory acne lesions are always sore
because of the inflammation. The white suppuration (pus) is a mixture of inflammatory
response materials from the surrounding cells and lymphatic system, cellular debris,
and oil.
Anatomy Of Acne - Non-inflammatory
Clogged pore impactionsgrow from microscopic proportions
to visible size. The purpose of anti-acne skincare products is to prevent these
impactions from becoming visible.
A microcomedois a small impaction of dead cells, bacteria,
and fatty acids from sebum and debris in a follicle, not visible without magnification.
Sebaceous Filamentsare the small filaments that form a
“worm-like” exudate upon extraction. They usually appear around the nose and in
oily areas.
Comedonesare visibly obstructed follicles. They are non-inflammatory,
but can become inflammatory under certain conditions.
Miliais a pearly-white closed comedone which usually occurs
around the eye, nose and cheek area in adults. This type of comedone is difficult
to extract and usually requires an incision in the skin in order to remove the impaction.
Removal of milia must be performed by a skilled professional, for improper removal
can lead to tissue damage.
Whiteheadsare a type of closed comedone, formed by deposits
of sebum just below the very small opening of the follicle.
Open comedonesare classic “blackheads” with distinctly
dilated follicle openings. They are a mix of keratinized cells and solidified sebum.
The black appearance is caused by oxidation of the keratinized sebum at the opening
of the follicle and melanin.
Anatomy Of Acne – Inflammatory
This is the acne which millions of dollars are spent every year to com- bat. The
lesions are classified according to their placement in, above, or surrounding the
follicle.
A papuleis a red, sore bump caused by the beginning of
a lesion - the collection of sebum and debris in the mid or lower follicular channel.
No pus has developed yet, but the follicle is tender to the touch due to the surge
of sebum and the collection of debris.
A pustuleis a raised, inflammatory acne lesion with pus
in the higher portion of the follicle, including above the surface, and a head filled
with pus. It is a mature papule with developed infection through the entire length
of the follicle.
A noduleis similar to a papule, but much deeper, very solid
and very sore. If the inflammation stops due to cessation of the sebum surge, this
sore bump beneath the skin will disappear. Nodules cannot be extracted and should
not be manipulated in any way.
A cystis a closed sac with a deep encapsulated infection,
and a massive invasion of white blood cells, possibly the full length of the follicle.
It exhibits a shiny, slick covering on the surface of the skin. It can also be described
as a swelled, hardened, deep infection. A nodule has burst out of the wall of the
follicle, spilling infection into the surrounding area. The body’s defences have
encapsulated the infection, and it is now a cyst. Cysts destroy the surrounding
dermal tissue, leaving pock marks and scarring when they heal.
A note on Nodulocystic acne
Many people consider this a third type of acne when actually it is the most severe
form of Inflammatory Acne. It is an overwhelming infection involving many cysts
and nodules deep within the skin, as well as pustules and comedones. This type of
acne is treated only under a physician’s care. Please email us for further assistance
treating this degree of Acne.