Acne Disorder

All acne is a disorder of  of the pilosebeceous unit  which is made up of a hair follicle, sebaceous gland, and a hair. These units are found everywhere on the body except on the palms, soles, top of the feet, and the lower lip.

The largest number of pilosebaceous units is on the face, chest and upper neck.   Sebaceous glands produce a substance called sebum, which is responsible for keeping the skin and hair moisturized. During adolescence sebaceous glands enlarge and produce more sebum under the influence of hormones, also called androgens. After about age 20, sebum production begins to decrease.

Acne & Bacteria
A bacteria, known as Propionibacterium acnes, is a normal inhabitant of the skin. It uses sebum to promote its growth, therefore increases in follicles during puberty. People with acne have more Propionibacterium acnes in their follicles than people without acne. The presence of bacteria attracts white blood cells to the follicle. These white blood cells produce an enzyme that damages the wall of the follicle, allowing the contents of the follicle to enter the dermis  This process causes an inflammatory response seen as papules  (red bumps), pustules and nodules.   The bacteria encourages the formation of free fatty acids, that are irritating and increase the inflammatory process in the follicle.

Clear  Follicles
Sebum produced by the sebaceous gland combines with cells being sloughed off within the hair follicle and "fills up" the hair follicle. When the follicle is "full", the sebum spreads over the skin surface giving the skin an oily appearance. When this process works correctly, the skin is moisturized and remains healthy.

Obstructed Follicles
Problems arise when the sebum is trapped in the hair follicle. For reasons that are still unclear, some hair follicles become obstructed. The sebum is produced but gets trapped on the way out, and the cells that are normally sloughed off become "sticky", plugging up the follicle. The process of obstructing follicles is called comedogenesis. It causes some follicles to form a type of acne called comedones , also known as blackheads and whiteheads. 

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