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Clearin Understanding Acne

Acne Myths & Truths

Let's first think skin. To understand acne, we must understand human skin. It's not only our largest organ, but it's the most fascinating and mysterious.

 
Truth # 1: The skin, unlike other organs, renews itself repeatedly and has vital functions.

structure of skin


What is a pilosebaceous unit? In medical lingo, acne is defined as a disease of the pilosebaceous units (PSUs). The NIH says these PSUs are found in most parts of the body – face, upper back and chest. A PSU usually has a sebaceous gland which connects to a follicle. This follicle in turn contains fine strands of hair.

 

 

 

(source: National Institutes of Health, US Department of Health and Human Services)

Looking at the numbered items in the diagram, we have:

  1. Hair – this includes the roots of the hair. When hair and sebum produce what the NIH calls a plug, it leads to the early development of acne.

  2. Skin surface – the skin has an upper layer and a lower layer. The upper layer lines the follicles and it undergoes a process called sloughing once every month or so. A problem occurs when the opening of the follicle is obstructed, or if the skin cells multiply too rapidly or too slowly and cannot exit from the follicle properly. The lower skin cells are “stuck” and can't go anywhere. The follicle's oxygen supply is also cut off.

  3. Sebum – this is the oil produced by the sebaceous glands.

  4. Follicle – see (1) above. When the follicle is plugged, bacteria known as Propionibacterium acnes which normally live on the skin surface grow in the plugged follicle.

  5. Sebaceous gland – this is a gland that is located in the deeper layers of the skin that produce oil. When there is unusually high production oil in the sebaceous glands and the skin does not shed off properly, acne results.

Truth # 2: Acne appears as different lesions: microcomedo, open comedo (blackhead) and closed comedo (whitehead).

One thing that's worth remembering is that when you spot a pimple, it did not appear on your skin overnight. It may have taken weeks, and even months to develop before it becomes visible. When a pimple appears, it may go away in a day or two, or it might 'stick around' for a few more weeks and longer.

Clogged or Plugged Follicle

Doctors agree that all acne lesions begin the same way: from a clogged or plugged follicle. A microcomedo is a microscopic comedo (plural: comedones). All acne, no matter what type of lesion it is, begins as a microcomedo. When thousands of dead epidermal cells build up in the follicle, the size of the plug decreases, making the opening smaller. When the follicle swells up because of the amount of oil coming from the sebaceous gland, some of this oil makes it to the surface of the skin while others are trapped inside. Tiny white bumps appear on the skin. At first they may not be visible, but if you look closer, you can see them if you pull your skin slightly.
These tiny white bumps you see are closed comedones - whiteheads. They're like the size of pin heads, and doctors say that they can cause a serious outbreak of acne.

An open comedo, on the other hand, is a blackhead. A blackhead occurs when oil and dead skin cells continue to accumulate. In this accumulation, one of two things can happen: either the oil makes its way to the surface of the skin, or it puts a lot of pressure on the linings of the follicle and then bursts like a balloon. When the pore opens, it produces a black head – an open comedo. The reason it is called a blackhead is because of the black dirt inside. The color of a blackhead varies from one person to another and depends on the amount of melanin each person has. That's the first of the two things that can happen.

The second thing that can happen is actually worse: the follicle wall could explode. This is when acne begins. So when the follicle wall is damaged, dead cells, oil and bacteria invade the dermis causing inflammation, redness and swelling.

Aside from microcomedones and open/closed comedones, dermatologists mention other kinds of acne lesions: papules, nodules (large sized lesions located deep in the skin), pustules (pimples) and cysts. When a person has acne cysts, these are painful and can actually lead to permanent scarring. Papules, nodules and cysts fall under the classification of inflammatory acne.

For more information on acne lesions, you may want to visit Causes of Pimples to find out about what causes acne.

 

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Acne, Separating Fact From Fiction

Truth # 3: People have somehow clung to myths about acne. They're just that – myths. There is no sufficient scientific evidence to support these myths.
When it comes to explaining acne to adolescents and some adults, it is necessary to separate fact from fiction, because having acne can tax a person's nerves and send him or her off to an emotional roller-coaster. The teenage years are a great time to meet new friends and start dating and be accepted by one's peers; being misinformed about acne is due to certain myths.

We'll take the chocolate myth first because that seems to be the most popular.
It's official: chocolate does not cause acne or make it worse. Even the most renowned doctors will insist – and can prove – that there is no direct link between chocolate and acne. A word of caution, however: even if there is no direct link between the two, you must still adhere to a healthy lifestyle that decreases the amount of sweets, salts and fat from your diet. Ensure you consume foods that are rich in nutrients, especially vitamin A.

The trend these days is NOT to blame chocolates or French fries when you break out, because study after study has shown that eating plenty of these does not cause acne – generally. Because diet is a purely individual matter, the advice that doctors give to most of their patients is to do an experiment. If they discover that their skin breaks out after eating chocolate, they must refrain from eating chocolate for a few days. When the pimple goes away, they should try eating chocolate again. If the pimple comes back, then chocolate is to be avoided altogether. If the pimple does not return, then the culprit is obviously NOT chocolate. It's as simple as that.

Another myth is that acne is caused by dirt. This is a myth that is widely held but while it is certainly important to keep the skin always clean because oil and dirt can block pores, dirt does NOT bring about the clumping together of skin cells against the follicle wall. This phenomenon occurs very deep in the skin where cleaning won't reach it.

Third myth – acne is related to sexual activity. Some adolescents actually believe that once they're married or give birth to their first child, their acne will disappear. A variation of this myth is the other side of the argument: that an active sex life causes acne. This link was made only because adolescence is that period in a person's life when sex is of great concern. It may have been also propagated when people in the Victorian era said that masturbation causes severe acne. This particular myth became less popular in the 1940's when the medical community finally declared that sexual activity and acne are not related.

The fourth myth: geography, ethnicity and acne. Some people think that people who live in cold climates are less likely to get acne, while those who live in the tropics are more prone to it. There is no link between where one lives and the incidence of acne. Nor is the color of one's skin a precursor of acne, although it has been observed that dark-skinned people tend to have less severe acne compared to light-skinned individuals. Larger glands and more defined pores are common characteristics of dark skin, and these two attributes are known to protect against acne. Note though that hyper-pigmentation tends to occur more frequently with dark skin after acne is cured, so care must be taken to not irritate dark skin after a bout with acne.

Truth # 4: Boys who shave for the first time will get acne. When a boy reaches the age of puberty, one of the first signs is hair on the face, especially above the lip and on the chin. The hairs are at first sparse but over time, a beard and a moustache appear, making boys want to shave them. After the initial shave, the hair grows back, this time thicker. As the hair grows back after each shave, it grows thicker and is denser resulting in repetitive shaving. Frequent shaving can cause the skin to dry out, because as more hair grows, the shaving becomes more frequent and more forceful. Some of these hairs could turn inward and grow internally which can cause acne. The inside growth, combined with the production of oil in the sebaceous glands can result in frequent skin breakouts. The myth that shaving causes acne is indeed a myth, but it is true that shaving too often and too close to the hair follicles may contribute to the growth of acne.

Truth # 5: Applying sunscreen can cause acne.
This is false. People who get acne after applying sunscreen believe that it is the sunscreen itself causing the breakout; in fact, they could be reacting to an irritant contained in the sunscreen or developing a reaction to the sun. If this happens, it is best to avoid exposure to the irritant – whether it is the sun or to one of the ingredients in the sunscreen that is causing the reaction. Dermatologists say that it is not so much the sunscreen itself or its active ingredient, but the vehicle. A solution would be to switch brands or to try a different form. For example, if you're using a cream sunscreen you could try a lotion. If the lotion is causing a breakout, switch to gel. Today's sunscreen products are manufactured with oil-free preparations. Given the number of sunscreen products on shelves, an acne patient can try any one of them to see which one works best. So to shatter the myth: sunscreen, per se, does not cause acne.  

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