You may have been plagued with pimples in high school and are watching history repeat itself through your teenage son or daughter. Or perhaps now, as an adult, you are experiencing breakouts for the first time. No matter what your age, skin type, or skin color, at some point, since you’re human after all, your are bound to get a pimple. No one is immune. In fact, the American Academy of Dermatology reports that nearly 85% of people experience acne at some point in their lives. But take heart: we’ve made it our mission to help acne sufferers take control so that the physical and emotional challenges of this ubiquitous skin condition no longer need be a fact of life.

What Is Acne?

So you think you just get breakouts but don’t have acne? Think again. Whether it’s occasional breakouts associated with your monthly menstrual cycles, blackheads on your nose and chin, a case of teenage acne, or embarrassing pimples on your back, chest, or even more embarrassing places, it's all acne in one form or another. Because a comprehensive plan of attack to clear your skin involves interrupting the processes that create the visible acne breakouts, we believe it behooves us to “put on our lab coats” and provide you with a basic understanding of how acne happens.

Acne vulgaris, the technical medical term, includes everything from a few blackheads, whiteheads, and inflamed pimples to deeper, more painful cysts and nodules. Acne is an inflammatory condition of the skin that occurs inside a pore—the passageway from the bottom of the hair follicle to the skin’s surface. The bump that appears on your face is actually the final step in a silent process that begins deep inside a pore one to two weeks before the pimple is ever visible. Here’s a simplified look at how acne forms:

Step 1: Clogged Pores

During the normal process of skin renewal, skin cells that line pores are continuously sloughed, making room for fresh, new cells. But sloughing doesn’t always happen as it should. Sometimes dead skin cells combine with skin’s natural oil and instead of shedding, they clump together inside of a pore. A hard, firm plug called a comedo is then formed inside the pore (think of it as a cork in a bottle), and the stage is set for acne to begin.

Step 2: Trapping of Oil (Sebum)

Your hormones stimulate oil production in the sebaceous glands, which are attached to the pores. The plug (comedo) impedes the oil from traveling up through the pore to the surface of the skin, as it is meant to do. Instead, this oil is trapped and provides the ideal environment for bacteria to flourish. Keep in mind that this can happen even if you have dry skin.

Step 3: Bacterial Attack

Once your pores are clogged, an airtight environment is created and anaerobic (oxygen-hating) bacteria called Propionibacterium acnes (P. acnes for short) "feeds and breeds" on the abundant oil, releasing inflammatory toxins. (Interesting fact: although P. acnes bacteria must be present for acne breakouts to occur, there is not a clear correlation between the amount of P. acnes on the skin and the tendency to break out.)

Step 4: Inflammation

The body’s response to these toxins is a swarming army of red and white blood cells sent to contain the infection. The end result is intense swelling, inflammation, and pain in the form of a pimple or pustule.

Additionally, some people continue to suffer the aftermath of acne in the form of a pink/brown discoloration (post-inflammatory hyperpigmentation) at the site of the cleared blemish that lasts long after the acne has cleared. The darker your skin color, the more likely you are to experience these marks. Although many people confuse these with actual scars, they are not permanent. However, they can be quite persistent and without treatment may take months or even years to fade. Like the acne itself, these marks can be treated, but preventing acne breakouts in the first place is a double win and is always your best bet.

From Write Your Skin a Prescription for Change by Katie Rodan, M.D. and Kathy Fields, M.D. with Lori Bush.
© 2010 Pair O’Docs Publishing, reprinted with permission.