No one knows the exact cause of acne, but we do know that heredity plays a big role in two important factors that cause acne: our hormone activity and the oiliness of our skin.
Another important cause of acne is the buildup of skin cells that haven't shed properly (called retention keratosis), which line the sebaceous follicle and cause sebum (or skin oil) to back up and be trapped, while causing normal skin bacteria to be trapped under the surface as well. The combination of a plugged follicle and the warm, moist environment of your skin allows harmful infections to begin, causing pustules or pimples to form.
Conditions of Normal Skin Biology
Normal skin biology involves three basic processes:
- The manufacture, dying process (keratinization), and shedding of skin cells.
- The production of sebum by the sebaceous glands.
- The control of resident bacteria.
Shedding of Skin Cells
The skin surface is encased in layers of dry, dead cells that are mostly keratin, the fibrous proteins that form the basis of most epidermal tissue. These surface cells have migrated from deeper layers of the epidermis upward over a several-week period during which they have thinned, flattened, keratinized and prepared to separate or shed. This process of shedding is part of the normal, continuous renewal of the skin's surface.
Production of Sebum
A pilosebaceous follicle is the combination of a hair (pilo) follicle and an oil (sebaceous) gland. The skin folds directly inward, forming the tiny tubes (follicles) that encase very small hairs. The deeper part of this follicle receives the opening duct from a sebaceous gland, with the surface of the tube opening onto the skin (what we call a pore). The lining cells of this outlet tube shed in the same manner as normal, surface skin.
The Control of Resident Bacteria
Propionbacterium acnes (p. acnes) and staphylococcus epidermidis (s. epidermidis) are normal residents of the skin. These bacteria produce lipases and other enzymes that break down sebum triglycerides into free fatty acids.
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