Introduction to Acne

Course Author—Alexa Kimball, M.D., M.P.H.• Nu Skin Professional Advisory Board Member.• Director, Clinical Unit for Research Trials in

Skin (CURTIS); Mass General and Brigham and Women's Hospitals; Harvard Medical School.

• Has contributed significantly to medical literature with articles and abstracts published in journals such as Archives of Dermatology and Journal of the American Academy of Dermatology.

• Graduated Phi Beta Kappa from Princeton University and received her medical degree from Yale University School of Medicine.

ObjectivesAfter viewing this course, you should understand the following:

• Types of acne breakouts• Acne life cycle• Effects of acne• How to treat acne

Did You Know?

When you’re under stress, your body produces stress hormones, such as cortisol. These stress hormones may stimulate an overproduction of oil in the skin, a main cause of acne breakouts.

What Is Acne?

Definition of Acne

Acne is an inflammatory skin condition that occurs when sebum (oil) and dead skin cells block the pore opening, causing sebum to build up inside the pore.Although acne is a common skin condition, if left untreated it can lead to severe inflammation and permanent scarring.

Who Is Affected by Acne?

• Acne affects people regardless of age, gender, or race.

• More than 80 percent of people suffer from acne at some point in their lives, many into adulthood.

• 20 percent of all adults suffer with active acne.• Of the 85 percent of young adults (between ages 12

and 24) that suffer from acne, 25 percent will have permanent scars ranging from mild to severe.

Acne Life Cycle

Acne Life Cycle

Stage One: Clogged Pores

Each pore in your skin is essentially a hair follicle lined by cells from the epidermis (the upper most layer of the skin). The hair follicle is connected to multi-lobed sebaceous glands (oil producing glands). Sebaceous glands produce sebum, a natural substance that lubricates the hair and provides essential fatty acids and lipids that are necessary to maintain the skin’s protective moisture barrier.

Acne Life Cycle

Stage One (continued): Clogged Pores

As part of the skin’s healthy processes, cells that line the pore are continuously shed. They mix with sebum and flow out of the pore onto the surface of the skin. If the sebaceous glands produce too much oil, generally in response to hormones, the mixture of dead skin cells and sebum form a plug, blocking the pore opening.

Acne Life Cycle

Stage Two: Bacteria

Dead skin cells lining the pore continue to be shed and oil is still produced by the sebaceous glands, both of which build up behind the plug. The accumulated mixture of sebum and dead cells attracts the bacteria found naturally in the skin (known as P. acnes or propionibacterium acnes), which feeds on oil and multiplies rapidly inside the pore.

Acne Life Cycle

Stage Three: Inflammation

The bacterial overgrowth triggers the body’s natural inflammatory immune response: blood vessels become leaky, allowing white blood cells to flood the area. This causes swelling and redness in the region, which can ultimately lead to the discoloration and scarring associated with acne.

Types of Acne Breakouts

Types of Acne Breakouts

There are many types of acne breakouts, all of which result when oil and dead skin build up and clog the pore opening. Blackheads, whiteheads, pustules (or nodules), and cysts are the four most common types of acne breakouts.

Healthy Pore Blackhead Whitehead Pustuleor Nodule

Cyst

Types of Acne Breakouts

Blackheads (or open comedones) are clogged pores that are only partially plugged, allowing some of the trapped sebum and oil to escape the pore. The sebum within the hair follicle solidifies. The dark color associated with blackheads is due to the oxidization of sebum and melanin in the dead skin cells when they come into contact with the air. Blackheads are generally not inflamed or infected with bacteria, and do not cause scarring.

Types of Acne Breakouts

Whiteheads (or closed comedones) are the result of completely clogged pores. Below the skin, excess oil and dead skin cells fill the pore and begin to create a small, whitish bump. Limited bacterial growth and a low-grade immune response create the white pus associated with whiteheads. They are not highly inflamed and do not generally cause scarring.

Types of Acne Breakouts

Pustules (or nodules) are red, inflamed acne breakouts that occur when clogged pores become infected with bacteria (P. acnes).A pustule is similar to a whitehead, but is highly inflamed, and appears as a red bump with a white or yellow center. Because of the inflammation and swelling, pustules cause the distinctive discoloration associated with acne and may also cause scarring.

Pustule or Nodule

Types of Acne Breakouts

Cysts are severely inflamed and pus-filled acne lesions that occur when the contents of a clogged pore seep into the dermis (lower layer of the skin). The deep inflammation and infection cause a severe immune response: white blood cells flood the area, which then becomes swollen and sore. This results in the formation of a cyst. Acne cysts are painful and often cause scarring. The white blood cells can overreact and damage the pore and surrounding area. After the cyst heals, a permanent scar may remain.

PastTextural damage

HyperpigmentationAcne Scars

PresentBreakoutsRednessIrritationOiliness

FutureMore acne

Potential for more scarring, hyperpigmentation, and

textural damage

Effects of Acne

Treating Acne

Treating AcneBecause acne can begin 2–3 weeks before blemishes are visible on your skin, the secret to controlling acne is prevention. Prevention includes eating a balanced diet, exercising, and reducing stress, as well as cleansing with a proper treatment system. Acne can take 8–12 weeks to treat.

Treating Acne When treating acne topically, dermatologists recommend a three-pronged approach:

• Unclog pores and keep them clear.• Control oil, which helps to limit bacterial

growth.• Reduce inflammation.

Treating Acne The skin takes time to adjust to a new system. During this time, breakouts may appear worse before they get better; this is not uncommon as pre-existing blemishes are beginning to surface. Improvements should be visible within a few weeks and continue throughout the next eight to twelve weeks.

Acne MythsMyth #1: Scrub face clean to treat acne. Vigorous washing and scrubbing can actually irritate the skin and make acne worse. The best approach to good hygiene and treating acne is to gently wash your face twice a day with a mild soap, pat dry, and use an appropriate acne treatment.Myth #2: You have to let acne run its course. The truth is acne can be cleared up. Using a high quality, efficacious acne treatment system can address the stages of acne: clogged pores, bacteria, and inflammation.

Acne MythsMyth #3: Acne is just a cosmetic condition. While acne poses no serious threat to one’s health, it does affect the way people look and can affect the way people feel about themselves. Acne should be taken seriously and treated to prevent permanent physical scarring. Myth #4: Acne is not related to diet. While thus far science has not found a solid connection between diet and acne, research is being revisited in this area. Some studies indicate a relationship between acne and high-glycemic foods such as sodas, pastries, and breads. Other studies have looked at the impact of dairy-rich diets on skin health. Many people insist certain foods affect their acne. When controlling acne, eating a balanced diet is always a good idea.

Acne MythsMyth #5: There is no correlation between stress and acne.Acne not only causes significant stress, but is also made worse by stress. In a recent study, Stanford University students with acne were analyzed before and after exams. The study showed that students’ acne worsened when under pre-exam stress.When you’re under stress, your body produces stress hormones such as cortisol, which stimulate an overproduction of oil in the skin. When this excess oil mixes with dead skin cells, it promotes bacterial growth and can cause acne to develop or become worse. This can, in turn, lead to more stress, plunging you into a stress-acne cycle.

Review

Definition of acne: Acne is an inflammatory skin condition that occurs when oil and dead skin cells block pores. Types of acne breakouts: Blackheads, whiteheads, pustules (or nodules), and cysts.Acne life cycle: Clogged pores, bacteria, inflammation.Effects of acne: Past, present, future.How to treat acne: Unclog pores, control oil (which helps to limit bacteria), reduce inflammation.

Test Your Knowledge

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