skin

Introduction to Acne
Acne is a chronic, inflammatory skin condition caused by a combination of
follicular hyper keratinization, excessive sebum production, and
bacterial colonization. It affects the face, chest, and back and is common
in adolescents, persisting into adulthood.

Papules: Solid raised lesions measuring less than 1 cm

Pustules: Small raised lesions less than 1 cm filled with pustular material

Nodules: Solid raised lesions measuring more than 1 cm

Cysts: Solid raised lesions measuring more than 1 cm containing pustular
material

Open comedone: Small dilated follicle containing black oxidative debris

Closed comedone: Small plugged follicle containing white debris

The stages of acne evolution include the following:
1. Hyperkeratinization of the hair follicle involves the rapid shedding
of skin cells in the upper portion of the hair follicle, causing excessive
cellular material to partially or completely block the follicular pore.

2. Abnormal secretion of sebum from the sebaceous gland may
lead to excessive sebum being trapped in the follicular canal or in the
sebaceous gland.

3. The shift of bacteria from symbiotic to pathogenic occurs when
anaerobic bacteria Cutibacterium acne (previously known
as Propionibacterium acne) multiply in a warm, dark, and inviting
environment. This activates the body’s immune system and
inflammatory response.

4. Rupture of the follicle occurs due to increased pressure inside the
canal; trapped sebum and keratinized hair cells collect and grow,
causing raised lesions (papules) above the skin surface that are at risk
of rupture and spreading material underneath the skin.

Acne lesions manifest as large, painful, inflamed papules. As the
inflammatory response increases, white blood cells rush to the area,
destroying bacteria and creating pustules. Without drainage, pustules

, can develop into larger cysts, which may require manual incision and
drainage.

There are a variety of risk factors that can lead to acne production,
including the following:

 Genetic and familial: There is a higher likelihood of acne severity in
individuals with family members who have experienced similar issues.

 Environment: Sun exposure, high humidity, high temperatures, and
pollution have been found to increase acne due to changes in sebum
secretion related to surrounding air and weather quality

 Lifestyle practices: Improper skincare routines, which may involve
the use of products that irritate or clog follicular pores, can cause
increasing levels of acne. This includes various cosmetic products,
which can modify skin barrier function, including microbiome balance.

 Hormone fluctuations: Puberty, fluctuating menstrual cycles,
excessive androgen production, and pregnancy can all contribute to
increased acne.

 Medications: Corticosteroids, androgens, and other medications can
cause acne production. Topical creams or lotions may clog follicles,
leading to acne.

 Diet: Some diets are considered acne-producing, particularly those
with high-glycemic or dairy consumption. There is insufficient evidence
to recommend a low-dairy, low-weight, high omega-3, or chocolate diet
for acne treatment, but dietary changes can impact acne severity.

Acne is most common in skin areas with large amounts of sebaceous
glands, primarily the face, back, and shoulders. Acne severity is
characterized by the amounts and types of lesions noted. Acne may lead to
psychosocial symptoms such as poor self-esteem, anxiety,
depression, and social withdrawal. Common acne lesions include the
following:

 Open comedones (blackheads): Sebum and keratin block the open
follicle leading to oxidation of the debris, causing a black appearance.

 Closed comedones (whiteheads): Sebum and keratin accumulate
deep within a blocked or closed follicle, causing a white appearance.