Understanding Acne: The 4 Steps

Acne is a subcutaneous (under the skin) inflammatory condition, but its root comes down to a 4-step biological process. Understanding these steps is essential to finding tailored treatments that work for you and developing a healthier relationship with your skin.

Step 1. Excess Sebum Production

Acne often originates when the sebaceous glands (glands in the skin), produce too much sebum (skin oil). The production is largely driven by hormones, genetics and stress.

One significant category of hormones is androgens, a group of steroid hormones present in both males and females that are responsible for many important roles throughout the body. They are at elevated levels during puberty, which contributes to why acne is very common during the adolescent age.

Due to excess sebum production, the skin becomes overly greasy, creating a breeding ground for breakouts.

Step 2. Hyperkeratinization

Hyperkeratinization occurs when dead skin cells do not shed properly. The buildup is caused by the lining of the pore becoming sticky and trapping cells inside. As a result, the trapped cells mix with excess oil, forming a microcomedone (a microscopic plug).

Step 3. Cutibacterium acnes Proliferation

C. acnes is a bacteria that thrives in anaerobic (oxygen-free) environments and feeds on sebum. It multiplies rapidly inside the blocked pore created by the previous step.

The trapped plug then officially becomes a visible whitehead, blackhead, or-early-stage pimple.

Step 4. Inflammation and Immune Response

The pore walls swell and can rupture under pressure, leaking debris into surrounding skin. The immune system detects the bacterial overgrowth and rushes to fight it.

The area becomes red, painful, warm, and swollen, forming deep papules, pustules, or cysts. These are usually the large pimples filled with pus and oil.

Conclusion

Excess sebum production, hyperkeratinization, c.acnes growth, and inflammation and immune response are the 4 driving factors in the process of acne pathogenesis. Developing a better understanding of these steps will help you care for your skin more intentionally and manage your acne in an effective way.

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Sources

Zaenglein, Andrea L., et al. "Chapter 80. Acne Vulgaris and Acneiform Eruptions." Fitzpatrick's Dermatology in General Medicine, 8e Eds. Lowell A. Goldsmith, et al. The McGraw-Hill Companies, 2012, https://accessmedicine.mhmedical.com/Content.aspx?bookid=392&sectionid=41138785.