All About Acne

If you skinned an adult, you would have enough material to make a 4-by-5 foot (1.2-by-1.5 meter) area rug that weighed upward of 10 pounds (4.5 kilograms) [source: Chudler]. That skin rug is your body's largest organ, although it varies in thickness. The thinnest part of your skin, your eyelids, are only half a millimeter thick, while the thickest skin is found on the soles of your feet, which have pads that are about 1.5 millimeters thick [source: Amirlak, et al].

When you look at someone, you're looking at eyeballs, hair, teeth, clothes and millions and millions of skin cells that are dead. That's it. Every inch of skin you see is old, dead skin. This is the outermost layer of the skin's outermost layer, the epidermis. The new skin is being formed beneath it, in the innermost layer of the epidermis. As new skin cells are produced, they begin traveling outward toward the surface of your skin. Older, dying skin cells that exist between the new cells and the skin's surface are pushed up and out by these new cells. It can take as long as a month for a skin cell to make the journey from the inner layer of the epidermis to the outer layer. While this seems like a long time for one cell to travel such a short distance, anywhere from 40 million to 60 million of these cells are reaching their destination every day, where they then leap from your skin to freedom [source: KidsHealth]. While humans have fairly good vision, it is perhaps a blessing that we can't see the 40,000 dead skin cells a minute that fall off each of us.

Let's go beyond the surface.

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Beneath the epidermis is a layer of skin called the dermis. This layer has sweat glands and sebum glands. Sebum is an oil that makes you waterproof. The sweat and sebum from the glands travel to the surface of the skin through narrow channels called pores. So, every second of the day, your body is outwardly radiating thousands of different cells through your pores, and your pores deserve a lot of credit for providing safe passage for these cellular nomads and enabling them to exit your body. All of these dead skin cells, oily sebum and sweat form a protective mix (along with other lipids, such as linoleic acid) on the skin's surface. This shield stops your skin from drying out and prevents harmful bacteria from infiltrating your skin. Males actually produce more sebum than females, but both genders crank up the sebum levels during puberty. This spike in sebum production is why puberty and acne form a­n evil alliance.

­The innermost layer of skin is called the subcutaneous layer. This is where your hair begins its growth, in the bottom of a porelike tube called a follicle. As hair grows out of this follicle, it makes its way through the other layers of skin and collects a coating of sebum in the process. This keeps it shiny and water-resistant. This is also why your hair gets oily and sticks out from your head in crazy directions if you go a few days without washing it.

­Just like a car crash in a tunnel will cause a major traffic blockage behind it, so too does a jam-up in a pore or follicle. We'll talk about these cellular crashes and oily wipeouts in the next section.

Where there is lots of sebum, there is a fertile home for acne vulgaris, the most common form of acne. Your face, upper back, shoulder and upper chest have more sebaceous follicles than other parts of your body, making these areas targets for acne. More than eight out of 10 people will become acquainted in their lifetimes with acne vulgaris [source: Harper].

There's not one single factor that can take all the blame for acne vulgaris. The following all se­em to play a part:

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­Depending on the exact course of events, blockage, infection and inflammation can result in different types of lesions on your ski­n. The two most common are whiteheads and ­blackheads.

­Whiteheads may seem like they appear overnight, but they can actually take up to two months to form before they're visible. Whiteheads form when the pore is totally blocked, and the growing matter has forced the comedo (blockage) to just beneath the surface of the skin.

If there is a plug of cells in the pore and the pore opening expands, so that it's not entirely blocked off, then a blackhead appears. The portion of the comedo­ that is nearest the surface has a concentration of melanin, giving it its appearance and appropriate name.­

If a pore becomes blocked and the wall of the pore collapses and releases the bacteria-ridden clog of skin cells and sebum into the dermis layer of the skin, it leads to other, more severe forms of acne lesions. Among these:

Now that we know about acne vulgaris in all its forms, we'll learn about other kinds of acne in the next section.

It's possible to be afflicted with acne in one form or another from the cradle to the grave. Fortunately, most of us only suffer from it for a period of several years in our lives, and then move on. Others, however, have to deal with it before, during and long after puberty.

Babies (as well as kids and grown-ups) can develop a form of acne called milia. This appears in the form of little white bumps across the face, usually on the nose or around the eyes. This is extremely common, occurring in about half of all babies. If your infant has milia, it's nothing to freak out about -- in fact, if your pediatrician confirms it is just milia, the doctor's orders will be to do absolutely nothing about the condition. It will clear up in its own good time. Researchers believe milia in infants is the result of undeveloped sebaceous glands, which causes these little cysts to develop in the pores and hair follicles.

A considerably more rare form of acne is prepubertal acne. This is nonmilial acne that forms in children before the first physical signs of puberty, such as the growth of pubic hair. Prepubertal acne may be caused by an imbalance in androgens, which are sex hormones such as testerone. While these hormones greatly increase at puberty and signal the body to initiate its growth changes, a premature release of androgens may cause sebum levels to also increase before puberty. Children who show signs of prepubertal acne should be checked out by a doctor.

Persistent and returning bouts of acne are sometimes caused by a condition called rosacea. Rosacea tends to show up and disappear on its own time table, and months can pass between flare-ups. When it does become active, it passes through several stages. As these stages progress, the condition worsens and will usually continue to worsen until medical treatment is sought.

­A person experiencing prerosacea will notice an increased amount of what appears to be blushing, or getting flushed easily. This is because blood vessels in the face are dilating more than they should. Worse, this redness tends to center itself in the face, so that, come December, your nose may very well be guiding the sleigh. Rosacea ultimately caus­es outbreaks that look a lot like acne vulgaris: pimples, bumps and a rashy redness. However, it can cause dilation of blood vessels in the nose (so that it looks like you've been drinking heavily) and even swelling of the nose.

Knowing as we do that acne is caused by too many skin cells, too much sebum, bacteria and inflammation, let's take a look at what doesn't cause it. These acne myths have been circulating throughout high schools for decades:

So if avoiding pizza doesn't prevent it, what does? On the next page, we'll take a look at some acne prevention strategies. Here's a hint -- take a yoga class, or at least a deep breath.

The easiest thing you can do is start cleaning your face (gently!) with warm water and soap. Twice a day should do the trick -- more than that, and you might just agitate your skin into a breakout. This will help clear the pores of dead skin cells and excess sebum.

If you break a sweat, be sure to shower as soon as possible afterward to prevent excessive oil buildup on your skin.

Loosen up -- with your attitude and your clothing. Nobody is insisting you turn into a laid-back hep cat, but tight clothing, straps, bandages and the like can all irritate the skin. Stress -- while not a primary culprit -- does seem to contribute to acne breakouts, perhaps by disrupting your hormone levels.

Try using some over-the-counter acne medications. These often come in creams, gel tubes or medicated pads and often contain either benzoyl peroxide or salicylic acid. These two substances help prevent acne in different ways:

Both of these substances are available in varying strengths. You should start out with just a little bit of the weakest kind available, and see how your skin reacts. Many people find that one or the other works miracles, but of course all of us are different and react in different ways to medications.

With any luck, these measures will prevent you from having an acne breakout. If not, head on over to the next section to learn how to get rid of acne once it's crashed the party.

If you have acne, don't pick at your face! Clean it, get a facial, go see a dermatologist (who can pop those pesky pimples for you), just don't take matters into your own hands. A zit that sticks around for a week or more is far better than a scar that sticks around forever.

Here are some other things that might help:

­Nobody likes acne, and fortunately there are a lot of good resources out there to help you deal with yours. Talk to your doctor or dermatologist to find the best solution, and with a little luck and effort, you may just find the solution that's right for you.

For more articles on acne, skin care and hormones in general, see the links on the next page.