Is defined as a common skin disease which occurs when the pores of the skin become clogged with oil, dead skin cells and bacteria, causing inflammation and infection – i.e. spots/pimples!!!

To understand this more we have to know a little bit about normal skin. The small holes in your skin (pores) connect to sebaceous glands in the dermis layer of the skin, these produce sebum (an oily substance which keeps the skin supple and smooth). This canal is called a follicle, through which sebum carries dead skin cells to the surface. There is also a thin hair growing through it.

Sometimes the hair, sebum and dead skin cells clump together to form a plug presenting as a spot/pimple (whitehead or blackhead). These can become infected by bacteria found naturally living deep within healthy follicles and pores. The bacteria most commonly associated with acne are propionibacterium acnes . They can grow and multiply in this mixture which can then cause the follicle to inflame, swell and rupture infiltrating the surrounding tissue causing redness, inflammation and pus (this consists of dead white blood cells and bacteria with tissue debris and serum).

There are different types of pimples/spots;

· Whiteheads: These stay closed under the surface of the skin.
· Blackheads: These rise to the skin’s surface and look black. The black colour is not from dirt but from sebum which turns brown or black when it oxidises.
· Papules: These are small pink bumps that can be tender.
· Pustules: These are red at the bottom and have pus on top.
· Nodules: These are large, painful, solid pimples that are deep in the skin.
· Cysts: These deep, painful, pus-filled pimples/spot can cause scars.

When these lesions rupture, the material spilling out into the skin is irritating and cause inflammation which presents as redness, tenderness and sometimes thick white fluid that can be expressed from the acne lesion. Acne scars are a result of the body’s natural attempt to heal itself in response to this inflammatory rupture by producing new collagen fibres to provide strength and cushioning of the skin. Raised acne scars occur when the skin overproduces collagen, while pitted acne scars result when not enough collagen is produced.

Both males and females of all races and ages can develop acne but it is most common in teenagers and young adults, with an estimated 80% of people aged between 11 and 30 having an acne outbreak at some time. Some people can however get these in their forties or fifties, although in such cases a diagnosis of Rosacea should be considered. Acne lesions most commonly occur on the face but can also occur on the neck, chest, back, shoulders and upper arms.

The causes of acne are not fully understood but there are risk factors such as:

· Hormones – there is an increase in both sexes during puberty causing the sebaceous glands to enlarge and make more sebum which causes more plugs to form. These hormones can also be affected by pregnancy and use of contraception.
· Certain medications.
· Diet – studies indicate that certain food groups such as dairy products and carbohydrate rich foods may trigger acne.
· Family history – genetics appear to play a role in acne.
· Stress – Although it does not cause acne it can make it worse.
· Greasy or oily substances which come in contact with the skin.
· Friction or pressure on the skin from items such as cell phones, tight collars or backpacks.

In the next article we will talk about treatment for Acne.
Article written by Nurse Niki Medlock.

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