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Understanding Acne

By: Lydia Sarfati
Posted: January 30, 2009, from the February 2009 issue of Skin Inc. magazine.

Nearly 85% of people will experience some form of acne during their lifetimes. According to the American Academy of Dermatology (AAD), acne is the most common skin disorder in the United States, affecting 40–50 million Americans at one time.1 When people think of acne, they think of teenagers, but acne can affect many people throughout adulthood, as well. Some estimate as many as half of all adult women experience some form of acne due to an increase in androgen and a decrease in estrogen during perimenopause.

Looking good and feeling good go hand in hand—this is why it can be so difficult for clients who suffer from acneic skin. Acne can have a devastating effect on self-esteem and confidence, and many acne sufferers withdraw socially and even experience depression. The good news is that most acne can be treated with outstanding results. Treating acne can be one of the most rewarding experiences for you as an esthetician

Acne is an inflammatory lesion of the sebaceous glands and the first signs usually show up during puberty when there is an increase in the hormone androgen, which is especially active in stimulating the amount of oil produced by the sebaceous glands in the skin. This results in the extra production of sebum that combines with dead skin cells and other debris and becomes trapped, creating a plug that blocks the hair follicle. As the ducts of these glands become plugged with the waxy oil, comedones (blackheads) and milia (whiteheads) form. They are frequently infected with bacteria, causing welts, deeper lumps and pimples.

Sebaceous glands are the glands situated at the root of the hair follicle in the dermis. They can be found all over the body, except on the palms of the hands and the soles of the feet. These glands secrete sebum or oil. When the oil is mixed with perspiration, the skin’s surface becomes slightly acidic. This keeps some bacteria and fungi from embedding in the skin and, at the same time, helps to retain water in the tissue by slowing down evaporation from the skin. When the sebaceous glands are stimulated, a process known as retention hyperkeratosis occurs. This may be triggered by the onset of puberty, hormonal fluctuations, pharmaceutical agents, stress, heat and humidity.

In acne, the dead cells stick together, along with excess sebum and bacteria, to form an impaction plug. This first stage impacted follicle is often referred to as a microcomedone. As the bacteria digest the sebum, they produce fatty acid waste products that irritate the lining of the follicle, causing a proliferation of cells to accumulate in the impacted follicle. At this point, the disease may result in noninflammatory lesions, and simply produce closed comedones. When they eventually turn into open comedones and expel their contents, inflamed lesions may also result, whereby the follicle wall ruptures forming a papule. White blood cells invade the area and inflammation ensues. If the break is close to the surface of the skin, a pustule results—if it is deeper, a nodule forms. In some cases, a membrane entraps the infection and a cyst forms.