Teen Center

Several factors contribute to the start of an acne lesion:

• Corneocytes, or skin cells, become more “sticky” as they are shed and accumulate in the pore instead of flowing out onto the skin.
• More skin cells are shed at the top of the pore than the bottom.
• Sebum production is increased.

During this stage, the pore looks normal on the outside but there are distinct changes in the cells surrounding the pore. As the material in the pore builds up, it creates a bottleneck that prevents sloughing. The medical term for this stage is a microcomedone.

The bacteria Propionibacterium acnes, often shortened to P. acnes, normally resides in the pores. It uses sebum as a nutrient for growth. As sebum production increases, the number of P. acnes bacteria increases in the pore. In the microcomedone stage, the bacteria do not cause infection because they are only in the material inside the pore, not infecting the skin.

Medications that help at this stage include:

• Over-the-counter benzoyl peroxide kills bacteria and helps prevent P. acnes from overgrowing.
• Prescription tretinoin products like Retin-A, Retin-A Micro, and Avita reverse the “stickiness” of the skin cells, allowing them to slough normally.
• Over-the-counter salicylic acid 2% lotion is a beta hydroxy acid that also reverses the “stickiness” of the skin cells.

All acne is a disorder of the pilosebaceous unit, which is made 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 number of pilosebaceous units is greatest on the face, upper neck, and chest.

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.

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 it an oily appearance. When this process works correctly, the skin is moisturized and remains healthy.

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