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 occurs 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 serve 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 adolescence is hormones. At this stage androgens interact with receptors on the sebaceous glands and cause stimulation of the sebaceous gland to hypertrophy and so form more sebaceous synthesis of lipids and free fatty acids which distend the follicular canal. More specifically, there is evidence for increased peripheral metabolic conversion of the androgen testosterone to dihydrotestosterone at the level of the skin in persons having acne.
How Acne Forms
The first lesion in this condition called acne vulgaris is the comedo. When exposed to oxygen the comedo turns dark and forms what you know as a blackhead. The comedo is created by retention of layers of dead skin known as keratin in the lining of the follicles. In addition to hyperkeratosis (which is thickening or trapped layers of keratin), there is an aggregation of sebum. The combination of the keratin and the sebum leads to a plugging of the opening of the follicular canal, and papules are made by inflammation around the comedones. Depending upon the degree of inflammation, cars, granulomatous reactions, pustules, cysts, nodules, and keloids may appear.
Inflammatory Reaction
Airborne contamination and other harmful elements further exacerbate the inflammatory response. As microbes start to grow inside the clogged pore your immune system reacts by releasing granulocytes and macrophages, which are types of white blood cells that eliminate the microbes. The inflammation process is needed to eliminate the continuing effects of excess bacteria and signal the body to repair the harm to tissues. Often times the immune response system can't stop the reproduction of acne bacteria due to lack of leukocytes 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 accumulates in the sebum canal increasing the comedo in size. The expansion in size produces pressure and leads to a further intense inflammation reaction in the nearby skin and produces redness, swelling, discomfort, and a mass (pimple, redhead, acne papule).
Growth of Acne Bacteria
The above factors encourage the growth of microbes and result in infection inside the duct, the sebaceous gland, and nearby tissue. The commencement of the infection makes further inflammatory alterations, therefore starting a cycle of accentuated blockage 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 harmful and the healing process commonly results in a scar.
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Published February 15th, 2008
Filed in Teen