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What Causes Acne?
 

Acne is a disease of the sebaceous hair follicle (see diagram). Each follicle contains a tiny hair and multi-lobed sebaceous glands.
 

((Diagram of the sebaceous gland))

Sebaceous glands get their name from the oily substance they produce - sebum. Under normal circumstances, sebum travels up the hair follicle and out to the skin's
surface.

However, in acne, sebum is trapped within the follicle. Acne develops on those areas of the skin where sebaceous glands are most numerous: the face, scalp, neck, chest, back, and upper arms and shoulders. The acne lesions we know as blackheads are called "comedones" (singular: comedo). Red, swollen, pus-filled lesions are called papules, nodules, and pustules.

Several factors, work together for the development of comedones:

1. Hormones (androgens) resulting in increased sebum production
2. Stress and normal activity resulting in increased sebum production
3. Changes inside the follicle
4. Bacteria
5. Tenacious tissue exudate resulting in blockage
6. Impinged dirt both on a micro and macro level.

Discussion of the causes:

Tenacious Tissue exudate
Normal cellular metabolism produces by-products which tend to be deleterious to skin health. While a necessary part of the ongoing mechanism of cellular life as a cell finishes its life it produces waste materials made up of its own once vital structure which the body must reject and have removed through an exceptional hygienic routine. As cells go though their normal maturation they end up on the surface as dead cells no longer capable of reproduction. This "cellular debris" is made up of cellular remnants of the cell walls and internal structure. In addition, the now useless internal biologicals which once were the life mechanism of the living cell are now chemical fragments, broken isomers which act as toxins. The tissue exudate does not just rinse or slough away but instead clings tenaciously bound by impinged dirt, it's own adhesiveness and sebaceous fluids as well as providing a haven for bacterial growth. Hence the term tenacious exudate. This waste disposed at the end of the cellular life cycle becomes an agent for continuing the cycle of poor skin health.

Hormones (androgens) causing increased sebum production
Acne usually begins when the body starts to produce the hormones called androgens. When androgen production goes into high gear - about age 11 to 14 years - the skin has a greater propensity for acne. Androgens cause the sebaceous gland to enlarge, and this is normal. People who develop acne have sebaceous glands that are over stimulated by androgens as well as other factors. Young women tend to have acne flare-ups that coincide with the hormonal changes associated with their menstrual cycle. These changes affect the sensitivity of their sebaceous glands to androgens.

Other factors causing increased sebum production
After the sebaceous gland is stimulated by androgens, it produces more sebum. The oily sebum accumulate in the follicle, and travels up the hair shaft to the surface of the skin. As it travels up the hair shaft it also mixes with normal skin bacteria and dead skin cells that have been shed from the lining of the follicle. Emotional stress as well as normal activities involving sports or daily routines can cause increased sebum production. Production of sebaceous fluids are a normal bodily function because under ordinary conditions they act to protect and lubricate the skin, and the body will stimulate production if any factor which might cause the skin to, in effect, need that sort of protection or lubrication.

The greater the sebum production, the greater the likelihood that the hair follicle will become clogged and result in comedones.

Changes inside the follicle
As androgen production increases and sebaceous glands enlarge, the inner lining of skin in the hair follicle also changes. Normally, dead cells inside the follicle shed gradually and get expelled onto the surface. However, during puberty these cells are shed more rapidly and tend to stick together. When they mix with sebum, they can clog the follicle and the cells and sebum form a plug in the follicle.

Bacteria
The clogged follicle becomes a breeding ground for bacteria. One type of bacteria specifically involved is Propionibacterium acnes or P. acnes for short. P. acnes ingests sebum and is a normal resident on skin even in people who don't have acne. However, when the sebaceous gland gets clogged, and sebum builds up inside the follicle, P. acnes multiplies rapidly. Chemicals produced by the bacteria can cause inflammation in the the follicle and surrounding skin.

Impinged dirt on a micro level
The air is contaminated with micro particles. The internal combustion engine which powers the automobile and other devices is continuously expelling particulate matter which is unseen by the unaided eye. In any location in the world (even in pristine mountain areas) the air is laden with these micro and macro particles. Also, the world is covered with soil which is blown by the wind and the finest particles are carried everywhere. In addition, the earth is bombarded constantly by meteorite which are destroyed upon entering the earth atmosphere. This tiny, tiny particles are in every breath of air you breathe. They are the cause of rain (hence the tv weathermen are called meteorologists) but they also are continuously being driven into your skin. The air movement from fans and vehicular movement pushes these microparticles from all the sources described into your skin. Microparticles are not easily removed and when they combine with sebaceous fluids and the tissue exudates they contribute to the blockage of the sebaceous glands.

Cosmetics
Cosmetics also can play a role. There is even a type of acne called acne cosmetica, meaning the entire acne process may be the result of using cosmetics with a high mineral oil content. For that reason, especially in young women who wear makeup and have acne, we recommend using oil-free products.

Summary
Clogged follicles develop into two types of acne breakout:
(1) comedones, or non inflamed 'blackheads', or
(2) inflamed lesions defined as papules, pustules, and nodules.

Primary therapy
An ordered program of specialized facial hygiene which will result in the removal of excess sebaceous fluids, eliminates the tenacious tissue exudate and results in normally functioning, bacteria free, sebaceous glands and hair follicles in conjunction with an regular regimen of proper diet, normal exercise and essential fluid intake has been shown to be an effective acne therapy and preventative.