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Acne Prone Skin

The term acne refers to the process which results in as little as one blackhead or severe cystic acne. Acne is believed to be an inherited condition caused by a genetic defect and can be affected by other factors, such as hormonal changes and stress. This defect results in a kind of cellular glue being over produced in the follicle. This is how the process occurs. The outer layer of your skin is constantly shedding/exfoliating thousands of cells. We are unaware of this shedding because the cells are microscopic in size.

The surface of the face is covered with sebaceous follicles. The walls of the follicle are lined with the same dead cells that are on the surface of the face. As a result, there is the same constant shedding/exfoliation taking place in the follicle. Normally, oil carries these cells out of the follicle to the surface where they eventually shed or exfoliate. However, in people who are genetically prone to acne, these cells cannot reach the surface because of the glue-like substance which causes them to stick together in the follicle.

At the very beginning of the acne process, this glue-like substance initiates a microscopic clump of “stuck together dead cells” called a “micro comedone”. At this stage, the process is developing in the follicle only, and the surface of the skin may appear entirely clean and unaffected.

As the cells continue to stick together, oil begins to get trapped in the follicle. The oil is “eaten” by Acne B and Acne C bacteria. The bacteria then excretes a nasty inflammatory fatty acid by-product. Eventually, over a period of time ranging from several weeks to many months, the follicle becomes completely clogged. At this point, various acne lesions may begin to surface, but not necessarily in this order:

1. OPEN COMEDONES OR WHAT IS COMMONLY REFERRED TO AS BLACKHEADS: These are a result of the follicle forcing the opening wider in order to accommodate the accumulation of the dead cells, oil and fatty acid by-product. The result can be visible as “blackheads” or sometimes merely enlarged pores. Remember that anything clogging the follicle can stretch the opening, making it appear larger. In order to make the opening relax, or appear smaller or more refined, the retention in the follicle must be cleared away. Without intervention, the process that caused the retention will continue, so something must be introduced into the follicle on a continuous basis that will prevent the follicular buildup from occurring.

2. CLOSED COMEDONES: The good news about open comedones is that usually, as long as the follicle has an exit or opening, the condition will probably not progress beyond that stage. However, when the opening is closed, either due to a hard plug or pressure, closed comedones may develop. Closed comedones are often visible as very small flesh colored bumps under the skin. Even though they may not appear inflamed or particularly active, they signal the probability that a more serious stage of the acne process is taking place.

3. PAPULES, PUSTULES, NODULES AND CYSTS: If the follicle is closed at the opening, the follicle itself will begin to expand to accommodate the increasing accumulation of dead cells, oil, fatty acids and bacteria, and may progress into a papule, pustule, nodule, or cyst. The follicle will continue to expand until it looks like a little bulging round ball. A follicle in this stage can only stretch so far and can be categorized as a “time bomb” waiting to explode. Stress, menstrual cycles, lack of sleep and other factors can provide the trigger that causes the “time bomb” to explode. One or several follicles can rupture. This is one reason why acne can be frustratingly inconsistent by appearing to be less active and suddenly flaring up in intensity unexpectedly.

When a “time bomb” ruptures, the contents of the follicle leak or spew out of the follicle into the surrounding tissue creating an inflammation that results in a surface or sub-surface lesion. Where the break occurs in the follicle largely determines the type and severity of the lesions. For example, if the break occurs at the top of the follicle just under the surface, a papule or red bump might erupt, which usually turns into a pustule in 24 to 36 hours and resolves fairly rapidly. If the break occurs in the middle or lower part of the follicle, the inflammation is deeper, resulting in an inflamed, larger lesion often referred to as a nodule. A nodule can be very sore and can take much longer to resolve. Frequently, they do not “come to a head”, but may gradually shrink over a period of time varying from days to weeks.

The most severe eruption is a cyst, which occurs when the follicle ruptures near its lowest point. Not only can cysts be very large and painful, but because inflammation can take place in the dermis, collagen and elastin may be destroyed, resulting in pitted scars or “ice-pick” type scarring.

Acne can be present at any time and any age and can persist throughout ones life. Whether it is influenced by hormones, stress, cosmetics, or other factors, the process that causes acne is the same. While there is no absolute cure for the disease of acne, it can be “controlled”, and with consistent and constant care, total clearing can usually be achieved and maintained. This is accomplished through the use of skin care products or maintenance treatments that expedite the shedding/exfoliation process. Products such as physician strength glycolic acid and tretinoin, and treatments such as facials and microdermabrasion will enhance the exfoliation rate and reduce the acne process.

The glycolic acid product line Dr. Rasmussen prefers has a significantly higher concentration than any “over the counter” glycolic acid product, and there by attains significantly better results. In addition,
Dr. Rasmussen’s glycolic acid product line is considerably more affordable than those purchased at the cosmetic counter. Twice daily use is recommended.