Acne Experience
Facts on Acne
Who's at Risk?
Western Treatments
Chinese Approach
East meets West
Acne Formula
Toxicology
Diet and Acne
Acne Images
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What is Acne?
Acne is the most common of all skin diseases. Statistics show that eighty-five percent of all people between the ages of twelve and twenty-five have some type of acne. It is a combined disorder of the oil glands and the hair follicle in the skin. Contrary to some conventional conceptions, it is a problem suffered not exclusively by teenagers. Some people are plagued their whole lives by constant outbreaks of acne.
How do Acne and Scars Develop?
Each follicle, or pore, in our skin contains a tiny hair and is connected with multi-lobed oil glands called sebaceous glands. These glands produce sebum, an oily substance that lubricates our hair and skin. At the same time, skin cells inside the follicle are shed gradually and both the dead cells and sebum are expelled onto the skin surface.
Diagram of the hair follicle and the sebaceous glands
Most of the time the glands produce the right amount of sebum and the pores are fine.
However, in acne, too much sebum is produced by the over-stimulated sebaceous glands. When excess sebum is mixed with the dead skin cells, a plug is formed in the follicle. The sebum and dead skin cells are prevented from leaving the clogged up pore, while the excretion of sebum and the shedding of skin cells continue to take place. The accumulated sebum in turn causes a build-up of bacteria that live on it. This leads to swelling around the pore and acne is the result. This could happen to anybody, young and old.
However, a few eruptions every now and then are not what concern us. We acne sufferers are concerned with those numerous and serious pimples that dotted our face and neck and never seem to go away.
Another problem that concerns us is scarring. The accumulation of bacteria in acne could trigger our body's defense mechanism. The white blood cell antibodies would enter the clogged up follicle and kill off the bacteria. Only that in the process of destroying the bacteria, the antibodies may severely affect other skin organisms and cells. This is how scars develop. Many unsightly marks would remain on our skin even after the acne is long gone.
4 Stages of the Common Acne.
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Under normal conditions, sebum produced by the sebaceous glands and dead skin cells around the hair follicle are shed onto the skin surface. |
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| 1 |
Whiteheads |
| When the sebaceous glands are over-stimulated, they enlarge and produce more sebum. The follicle is plugged from the inside by the mixture of excess sebum and the dead skin cells. As the mixture continues to accumulate in the follicle, it eventually forms a whitehead (closed comedo). Whiteheads are small collections of pus around the follicle and the sebaceous glands. They usually appear on the skin surface as small, whitish bumps. |
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| 2 |
Blackheads |
| Sometimes, the mixture of excess sebum and dead skin cells serves only to block the pore partially, restricting but not completely sealing off the flow of oil onto the skin surface. This results in solidification of the sebum that fills the hair duct. The dried sebum and the shedded skin cells reach the skin surface at the pore opening and are discolored on exposure to air, forming a blackhead (open comedo). The dark color of blackheads is not due to dirt but is from a pigment, called melanin, of the shedded skin cells.
Both the whiteheads and the blackheads are non-inflamed lesions.
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| 3 |
Pustules and Nodules |
| As we mentioned earlier, the accumulated sebum in a clogged follicle could cause a build-up of bacteria because some bacteria live on sebum. One type of bacteria specifically involved is Propionibacterium acnes, or P. acnes for short. P. acnes ingests sebum and is a normal resident on skin even in people who don't have acne. However, when the hair follicle gets clogged and sebum builds up inside the follicle, P. acnes multiplies rapidly. In addition, it produces an enzyme that breaks down sebum into a substance called 'free fatty acid.' It is this substance that causes inflammation, redness and swelling around the pus-formed area of the skin. These inflamed and generally more serious acne lesions are called pustules (pus-filled yellowish bumps) and nodules (firm, red, painful lumps just under the skin.) |
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| 4 |
Cysts |
| If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin tissues rather than onto the skin surface. Swelling and pain take place as the body's activated defense mechanism sends bacteria-fighting white cells to the area. This deep-rooted inflammation and infection result in cyst formation. Cystic acne is the most severe and stubborn of all types of acne, and carries the biggest threat of scarring. The white blood cell antibodies that are to fight bacteria could destroy other skin organisms and cells, severely affecting the whole follicle. Sometimes, after the acne is healed, permanent scars remain on the skin. |
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What Causes Acne?
Most medical literature still maintains that the exact cause of acne is unknown. Actually, from what we have learned, we already know that acne is the result of excess production of sebum by the over-stimulated sebaceous glands and clogged follicles.
The causes of acne therefore can only come from two fronts:
a) Whatever that drives sebaceous glands to work overtime, and
b) Easily clogged pores.
Easily Clogged Hair Follicles
Let's look at the second front--easily clogged hair follicles--first, as this is the cause of acne that is rarely mentioned.
I have always wondered why my acne condition has been so stubborn and long-lasting. While most people have to bear with it for perhaps a few years, I suffered for decades. One day, it dawned upon me that perhaps I was born with an acne condition. Could it be that my pore openings are smaller than the average?
We know that over-production of sebum occurs in the teen years and, as a result, clogged pores and acne breakouts happen to many during this period. What if I were born with smaller pores? It would explain why my acne continued to embarrass me even after I'd passed my twenties. For people with smaller pores, even normal sebum production could have the pores clogged easily, from teen years on and thereafter.
In addition, my hair follicles may have an innate ability to shed skin cells quicker and more often than normal. It has been observed that during puberty, skin cells are shed more rapidly and tend to stick together. This makes plugging the follicle more likely when they mix with sebum. In cases like mine, the shedding machine may begin working overtime after puberty.
To long-term acne sufferers, it's possible that we are born with smaller pore openings, or a higher rate of shedding skin cells, or both. We may simply be equipped with easily clogged pores. Blame it on heredity.
On top of it, our pores can also be blocked readily by certain oil-based moisturizers and cosmetics that contain synthetic chemicals and vegetable oils. If you are often attacked by acne breakouts, change to a non oil-based moisturizer and similar cosmetics. Test to see if artificial make-up is the suspect to your acne condition.
Over-production of Sebum by the Sebaceous Glands
What drives the sebaceous glands to work overtime is a more complicated matter. It could be because of heredity. It could also be a matter of many other factors.
Why heredity again? We know that when the sebaceous glands are over-stimulated, they will enlarge and secrete more sebum. Western medical researches have identified a number of factors that could cause an over-stimulation of the oil glands. These include:
| increased production of the male sex hormone androgens at puberty; |
| hormonal imbalance in women at menstruation; |
| other factors that cause hormonal changes, such as stress, not enough sleep, etc. |
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While these factors could lead to occassional outbreaks of acne for many people, the long-term acne sufferers may inherit these symptoms. There are people who are born with over-sensitive oil glands that keep on producing a higher level of sebum all the time, stimulated or not. These are the people with oily complexions. They are, therefore, more prone to having acne.
There are also people who are born with a hormonal imbalance, an over-production of androgens, or inadequate estrogen. My daughter is a case of the latter. They too, because of heredity, are more likely to have acne breakouts more seriously and for a longer period of time than most people.
Acne in Puberty
For most people, acne usually begins during puberty when the body starts to produce the male sex hormone called androgens. This is the main cause of acne. The sebaceous glands are very sensitive to androgens. They cause the glands to enlarge and secrete a higher level of sebum. During puberty, the skin cells are shed more rapidly and they tend to mix with the abundant sebum more easily. As a result, there is a greater likelihood that the hair follicle will become clogged and form acne.
Acne due to Hormonal Changes
Young women tend to have acne flare-ups that coincide with their hormonal changes associated with their menstrual cycle. Likewise, stress and insufficient sleep are situations that can cause hormonal imbalance in our body as well as acne breakouts.
Hormone is known to be the main culprit for acne.
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The Eastern Perspective
Despite the advance of Western medical research, there are still instances of acne formations that cannot be fully explained. For example, food is generally considered a non-factor by Western medical professionals for causing acne. However, many of us would suspect otherwise, from our own experience.
I am introducing here part of the Eastern perspective--the Chinese perspective--with their explanation of the causes of acne. I welcome contributors from other cultures to share their experience and knowledge so that one day, we would know about the West, East, North and South's perspectives on this and other subjects.
For acne, traditional Chinese medicine (TCM) generally looks at it as a result of heat. When a person has a weakening digestive system, coupled with a higher dietary cholesterol intake, the body will produce excessive toxic substances that flow into the bloodstream and body fluids. In Chinese medical terms, this condition manifests itself as an imbalance due to the overflow of Yang, causing excessive heat.
Specifically, TCM considers acne as the result of four primary causes:
a) Wind and heat of the lungs;
b) Dampness and heat of the spleen and stomach (digestive system);
c) Stagnation of qi, blood stasis, phlegm accumulation; and
d) Menstrual disorder.
Why should the lungs have anything to do with acne? Well, in the theory of TCM, the lungs are functionally related to the skin and hairs through the direct supplying of the 'essential air of life (jing qi)' to these organs. In turn, the skin and hairs also affect the normal process of respiration as people can get cold or flu (evil wind) through the sweat-pores. As such, any skin problems, acne included, are related to the lungs.
Functionally, the stomach is complemental with the spleen which together serve as messenger in transforming, transporting and distribution of digested food and fluid as well as a transitional storage. In addition, the spleen is also involved in clearing up internal pollution, regulate and master blood, among other functions. The weakening of this system would create excessive toxic substances that could stagnate the qi (energy) and the blood flow.
Now, the qi or energy flow is a very essential concept in TCM. Emotional disturbance or stress could also result in the stagnation of qi. The stagnation in turn transforms to toxic heat that will enter the blood stream. The combined result of all these is often what TCM called the "accumulation of phlegm," causing blockages of the channels. Under such condition, the bodily functions are seriously handicapped, or disharmonized. The qi flow is stagnated, the blood is in a state of stasis, the bodily functions of transportation and transformation are handicapped. Toxic heat and dampness accumulated inside the body.
A higher dietary cholesterol intake under such condition would be like pouring oil on fire. But how does this has to do with acne?
TCM doesn't say much. My theory is that all of the above could directly or indirectly over-stimulate the sebaceous glands, causing an excess flow of sebum. It could also cause an increase shedding of skin cells. Together, they pump up acne.
Same again in menstrual disorder, as it is the result of hormonal imbalance, which in turn stimulates the sebaceous glands.
Why Acne is so Aggravating?
Think about it for a minute. Should acne breakouts appear only on some less noticeable places like the armpits, or the ankles, would we still care? Well, perhaps somewhat, if it's painful, but certainly not as nearly a big deal as we make it today.
So, why does acne has to be on the face, the worst place possible? It's because oil glands around the T-zone on the face, the neck, the chest and the back are more concentrated and more active. Sometimes, a pimple or two may pop up in the armpit, or on the bottom, really. But overall, they show up where it hurts. It's the genes.
Acne's Natural Cycles
Even if you do nothing to the acnes, most of them gradually heal themselves. As each of these pimples heal, new ones appear. The healing pimples usually fade to a pink mark that generally disappears in time. However, some pimples leave scars that look like small pits or bumps. The full cycle of acne generally lasts about 8 weeks.
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