Acne is a skin condition that occurs when hair follicles are plugged with oil and dead skin cells. Sebaceous glands are tiny glands found just below the surface of the skin. The glands are attached to hair follicles, which are small holes in the skin that an individual hair grows out of.   The sebaceous gland is a small gland in the skin which secretes  lubricating oily matter (sebum) into the hair follicles to lubricate the skin and hair to stop it drying out. This is done by secreting an oily substance called sebum. In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a form of called whitehead.

Alternatively, the plugged follicle can be open to the skin, creating a blackhead.Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.  The follicle wall may swell and produce a whitehead. Or the plug may be open to the surface and darken, causing a blackhead.

A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.

Pimples are raised red spots filled with thick creamy substance and with a white center that develops when blocked hair follicles are inflamed or infected with bacteria. Hair follicles blocked and inflammed produces  cystlike lumps underneath the surface of the skin.


Four main factors cause acne:

*Excess oil production

*Hair follicles clogged by oil and dead skin cells


*Excess activity of a type of hormone (androgens)

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.


Age. People of all ages can get acne, but it’s most common in teenagers.

Hormonal changes. Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.

Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.

Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.

Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.

Stress. Stress doesn’t cause acne, but if you have acne already, it may make it worse.


The following types are possible:

*Whiteheads: These remain under the skin and are small

*Blackheads: Clearly visible, they are black and appear on the surface of the skin

*Papules: Small, usually pink bumps, these are visible on the surface of the skin

*Pustules: Clearly visible on the surface of the skin. They are red at their base and have pus at the top

*Nodules: Clearly visible on the surface of the skin. They are large, solid, painful pimples that are embedded deep in the skin

*Cysts: Clearly visible on the surface of the skin. They are painful and filled with pus. Cysts can cause scars.

Fig 1.1: Various forms of acnes

Fig 1.2: Nodule acne


*Wash your face no more than twice each day with warm water and mild soap made especially for acne.

*Do not scrub the skin or burst or pop pimples, as this may cause more blocking, swelling, and redness.

*Refrain from touching the face.

*Wash hands frequently, especially before applying lotions, creams, or makeup.

*Clean spectacles regularly as they collect sebum and skin residue.

*If acne is on the back, shoulders, or chest, try wearing loose clothing. Avoid tight garments, such as headbands, caps, and scarves, or wash them regularly if used.

*Choose makeup for sensitive skin and avoid oil-based products. Remove makeup before sleeping.

*Use clean electric shaver or sharp safety razors when shaving. Prep the skin and beard with warm soapy water before applying shaving cream.

*Keep hair clean, as it collects sebum and skin residue. Avoid greasy and sticky hair products, such as those containing cocoa butter and gel.

*Avoid excessive and direct sun exposure, as it can cause the skin to produce more sebum.

*Avoid anxiety and stress, as it can increase production of cortisol and adrenaline, which exacerbate acne.

*Try to keep cool and dry in hot and humid climates, to prevent sweating.


These factors can trigger or aggravate acne:

*Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and produce more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.

Certain medications. Examples include drugs containing corticosteroids, testosterone or lithium.

*Diet. Studies indicate that certain dietary factors, including skim milk and carbohydrate-rich foods — such as bread, bagels and chips — may worsen acne. Chocolate has long been suspected of making acne worse.

*Stress. Stress can make acne worse.

*Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.

*Hygiene. Acne isn’t caused by dirty skin. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.

*Cosmetics. Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (noncomedogenics) and remove makeup regularly. Nonoily cosmetics don’t interfere with the effectiveness of acne drugs.

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