What causes blemishes? and how do they develop into acne?

There are many, complex factors involved in the development of blackheads, whiteheads and pimples

There are several myths around what causes acne, many of which are untrue. But all doctors agree that acne is a hormonal disease and you can find out more about the relationship between hormones and acne in our article hormones and acne. 

We also know that some of us are more genetically prone to blemishes than others and that certain medications, smoking, stress and inappropriate skincare can all trigger acne. There’s also evidence of a correlation between diet and acne. You can read more about all these potential causes and triggers in the causes and triggers of acne.

This article focuses on the physiological causes of acne - it look at what is actually going on in our skin. We examine the multiple, complex factors involved in the development of blackheads, whiteheads and pimples and how they progress into acne.

A comedo is a clogged hair follicle. A micro-comedone is the name given to a microscopically small, subclinical (not yet visible) comedone. Micro-comedones develop as the number of keratin-forming cells in the skin multiply. This process occurs naturally, without problems, in healthy skin as the micro-comedones dissolve. But, for those with acne, the dissolving process is accompanied by inflammatory reactions known as micro-inflammations.

It all begins with invisible micro-comedones in the skin

Acne is primarily an inflammatory disease. According to the latest research, micro-inflammation is one of the main causes of acne. It is thought to be the result of the body’s immune system reacting to bacteria, lipids and or androgens (male sex hormones).*

*We now know that inflammation is present at every stage of the development of acne, not just when blemishes are visible on skin’s surface.

Dr med. Markus Reinholz, Dermatologist

Internal factors such as hormonal changes (e.g. during puberty or the monthly cycle) and medication, and external factors such as environmental influences, can lead to an increase in the production of both sebum (known as seborrhea) and corneocytes (known as hyperkeratosis) which causes blackheads, whiteheads and pimples. Both these factors also play a role in the growth of bacteria, which ultimately leads to the papules and pustules associated with acne. You can read more about the terms used to describe acne such as papules and pustules and what they mean in blemish prone skin in general.

The build-up of sebum secreted by the sebaceous glands represents an ideal breeding ground for bacteria, particularly P.acnes. It starts to colonise the duct of the plugged sebaceous gland and causes the sebum to decompose. This decomposition produces substances which cause further inflammation and leads to the papules and pustules associated with acne.

In severe cases the follicular wall bursts in the late stages of inflammation. Lipids, fatty acids, corneocytes (cells), bacteria and cell fragments are released and can cause further inflammation to the surrounding skin.

You can find out more about the different forms that acne takes in the different types of acne and you can read about some of the ways that it can affect your skin in acne and hyperpigmentation and acne in scarring. 

* Quelle: Recent Advances in Acne Pathogenesis: Implications for Therapy, Shinjita Das, Rachel V. Reynolds, Am J Clin Dermatol (2014) 15:479 – 488 DOI 10.1007/s40257-014-0099-z

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