Hormonal Acne and Its Causes
Since the follicular walls in the pilo-sebaceous unit is intact before puberty, it has been theorized that if colonization of Proprionibacterium acnes happens in sufficient numbers they produce antigenic molecules that stimulate the initiation of inflammation. Proprionibacterium acnes is able to produce proteinases, lipase, and hyaluronate lyase all of which can serve as the catalysts or promoters of the inflammatory infiltrate which is composed of neutrophils and lymphocytes.
The key player in the cause of acne in puberty is hormones. At this stage androgens interact with receptors on the sebaceous glands and cause stimulation of the sebaceous gland to hypertrophy and so induce more sebaceous production of lipids and free fatty acids which dilate the follicular canal. More specifically, there is evidence for enhanced peripheral metabolic conversion of the androgen testosterone to dihydrotestosterone at the level of the skin in people suffering from acne.
How Acne Forms
The basic lesion in this condition called acne vulgaris is the comedo. When in contact with oxygen the comedo turns dark and forms what you know as a blackhead. The comedo is made by retention of layers of dead skin known as keratin in the walls of the follicles. In addition to hyperkeratosis (which is thickening or retained layers of keratin), there is an aggregation of sebum. The mixture of the keratin and the sebum leads to a blocking of the opening of the follicular canal, and papules are made by inflammation around the comedones. Depending upon the degree of inflammation, cysts, cars, granulomatous reactions, nodules, pustules, and keloids can develop.
Inflammatory Reaction
Airborne contamination and other toxic elements further exacerbate the inflammatory response. As microbes start to proliferate within the blocked pore your immune system reacts by releasing granulocytes and macrophages, which are types of white blood cells that destroy the microbes. The inflammation process is needed to eliminate the continuing consequences 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 produce sebum, which accumulates in the sebum canal increasing the comedo in size. The expansion in size results in pressure and leads to a further intense inflammation response in the surrounding skin and produces discomfort, redness, swelling, and a mass (pimple, redhead, acne papule).
Growth of Acne Bacteria
The above factors encourage the growth of microbes and result in infection within the duct, the sebaceous gland, and surrounding tissue. The commencement of the infection makes 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 occur. 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
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