What role do hormones play on acne?

It is good to know that hormones (i.e. a chemical substance formed in one organ of our body that can be carried to another organ or tissue where it has a specific effect), specifically androgens and stress hormones do play a critical role in acne on many levels on us. However, we need to know that these hormones alone are not the sole cause of acne, many other factors are also involved in the process, for example bacterial overgrowth, the manner in which our skin cells differentiate and the stickiness of our skin cells.

There are two ways that these hormones affect acne, i.e. i) too much hormone is circulating in the blood that triggering acne and ii) an increased and inappropriate responsiveness of the pilosebaceous unit (i.e. the grouping containing the hair follicle and sebaceous gland) to a normal amount of circulating androgen. Hence, it is no surprised that even though all our blood tests on acne come back normal, our body, at the level of the sebaceous gland (i.e. oil-producing glands located in the deeper layers of our skin, and are attached to the hair follicle), when overly accepting hormones that are circulating in our blood will cause acne to occur.

When androgens levels increase in greater quantities in both boys and girls during puberty, this will cause the sebaceous glands to enlarge and increase in the production of sebum (i.e. oily substance produced that will end on the surface of our skin). In fact, the increased of sebum production because of androgens acting at the sebaceous follicle is always the prerequisite for acne even after our teenage years. This is the reason why acne is generally worse in areas where there is a higher density of sebaceous glands, i.e. the face and upper back, and generally absent in areas where we don't have any sebaceous glands in our elbows and feet.

Before the onset of puberty, i.e. between the ages of 7 and 8, the adrenal glands (i.e. small, hormone-producing organs that are found near the kidneys) of both boys and girls will produce increasing amounts of types of androgen called DHEAS (short for dehydroepiandrosterone sulfate) and testosterone (i.e. a male sex hormone), that can metabolize to more potent androgens in our skin and cause our sebaceous gland to enlarge and increase in sebum production. When girls mature, the ovaries take over this role from the adrenal glands, for the most part. We may want to know that our serum level of DHEAS correlates with the severity of comedonal acne (i.e. mostly blackheads and whiteheads. To know more about different types of acne, please click here) in prepubertal girls. In addition, acne severity increases with sexual maturity in both boys and girls along with the increased presence of androgens in their body.

Also, both boys and girls may have acne that is related to an increased sensitivity of the sebaceous gland to androgens. For girls and women, excess ovarian and adrenal production of androgens may also cause acne if it is persistent, or is associated with an increased hair growth on the face. In girls with acne caused by high circulating androgen levels, free testosterone and DHEAS in particular may be present. At the same time, low levels of a protein called sex hormone-binding globulin may also be observed. We may want to know that sex hormone binding globulin is attached to testosterone and will help keep it from affecting our skin; hence, a lack of this globulin will translate into greater amounts of androgen circulating in our blood and thereby affect our skin.

On the other hand, when our body is under stress, it releases a hormone called cortisol. This hormone actually helps us through whatever situation is at hand, however, cortisol also leads to suppression of our immune system (i.e. a collection of cells and structures in our body that fight disease or infection, for example, white blood cells, lymph nodes, and lymph vessels are the primary components of the immune system), which gives P. acnes (i.e. short for Propionibacterium acnes, a bacterium that grows and flourishes under certain condition and is the main culprit for inflammatory acne) an opportunity to flourish, leading to a flare of inflammatory acne in some people.

From the acne clear and acne care point of views, severe acne is usually a clue to a potentially serious hormonal influenced which should be diagnosed and treated early and appropriately both in terms of general health and for better results in treating our acne.

How can I prevent acne scarring or help my acne scars heal faster?

We may be surprised to know that the best way to prevent acne scars is not to pick at or squeeze our pimples. In short, the trauma to the skin caused by our fingernails or other sharp, non-sterile objects is bad. In fact, our dermatologist should be the only person who should extract a blackhead or inject cortisone to help an inflammatory acne lesion resolve more quickly.

In general once an acne lesion is traumatized, it will take longer to heal and will be more likely to leave behind a mark. We may notice that sometimes lesions that are not traumatized may also take weeks or months to resolve with the possibility to leave red or brown marks too. What that means is that through no direct fault of us, i.e. didn't pick at it, but of our skin more genetically prone to acne scarring or hyperpigmentation (i.e. darkening of skin caused by higher amounts of melanin in a particular spot). Also, different skin types respond differently to acne during and after a breakout and that breakout may last longer in some people than in others, and some people tend to have red or brown marks left behind for sometimes months after an acne lesion has cleared. In fact, there are factors beyond genetics and skin type that remain unknown.

Usually people with fairer skin often have red marks that remain red for a long time before they clear up and turn brown, whereas those with more olive or darker skin tones will start with increased pigmentation when the acne finally clears. We may notice that there are also many people have an overlap with some of both kinds of marks.

If one of the above describes us, we shouldn’t worry much as those red and brown marks left from our acne lesions is just discolorations and not true acne scars. Hence, if there is no accompanying acne scarring resulted from depression of the skin or change in texture of the skin, the discoloration will eventually go away, or lighten significantly over time though we may choose to treat it to expedite the clearing.

The good news is there are creams that are designed to lighten the skin; this is especially useful for hyperpigmentation that resulted from acne. Also, laser and other treatments can help the redness too. Nevertheless, it is important for us to prevent new acne lesions and to treat early any lesions that occur to minimize new marks.

We may want to know that the active ingredient found in most lightening creams is a class of chemicals called hydroquinone. Those over-the-counter and prescription acne formulations may combine hydroquinone with glycolic acid, tretinoin (the active ingredient in Retin-A), sunscreens, antioxidants (i.e. a substance that binds to free radicals to prevent skin cells from damage), moisturizers, and many other proven ingredients to make their form of hydroquinone better and more appealing. The main difference between those over-the-counter versus prescription acne medications is that the former can have a maximum of 2% hydroquinone while the latter can use up to a 4% concentration of hydroquinone.

Do you worry that those lightening agents will bleach the color of our skin and make us look like Michael Jackson? The answer is not at all if the concentration we are using is to a maximum of 4% and that we used the products as advised that shall include for a specified amount of time, generally 4 to 6 months before taking a break. Other products used to help lighten the skin include licorice extract, yeast ferment, rosmarinic acid, glucosamine, vitamin C, and chamomile extract. What follows are some of the prescription lighteners for reference:

Alphaquin HP - Hydroquinone, glycolic acid, sunscreen
Eldopaque Forte - Hydroquinone, sunscreen
Eldoquin Forte - Hydroquinone
Epiquin - Hydroquinone
Glyquin - Hydroquinone, glycolic acid, sunscreen
Lustra - Hydroquinone, glycolic acid
Lustra AF - Hydroquinone, glycolic acid, sunscreen
Melanex - Hydroquinone
Solaquin Forte - Hydroquinone, sunscreen
Tiluma - Hydroquinone, Retin-A, hydrocortisone

We will notice that most of the above lightening products contain 2% to 4% hydroquinone along with other agents such as up to 10% glycolic acid, a sun protection factor (i.e. SPF) of 15 in those containing sunscreen as well as they all come in various forms (from creams to lotion to solutions) to make them appealing to different skin types. However, some formulations may be more irritating than others. In fact, these products take time to work, and results typically begin to be noticeable approximately 1 month after starting treatment.

Should we use the product on our entire face, a larger area or as spot treatment? It is good to use it on our entire face or a larger area in order to avoid the "halo" effect (i.e. a ring of lighter skin around the spot though it is usually reversible but often disconcerting as it often take weeks to months to resolve by itself).

The complications from using hydroquinone products are minimal and uncommon and usually have to do with the product ingredients rather than the hydroquinone. In general, glycolic acid and retinoids can be irritating to the skin, not to mention the liquid or gel that comes with it.

Nevertheless, an uncommon complication called exogenous ochronosis from using hydroquinone have been found more commonly in African Americans and those with longer-term use of hydroquinone or higher concentrations of the product. Exogenous ochronosis is a condition of the skin that leaves dark brown or black spots that are mostly in the areas of treatment. It often reverses when the treatment is discontinued but can in some cases be permanent. Another noticeable reaction when using higher concentrations of hydroquinone (i.e. at 10% or higher) for an extended period of time often resulted in permanent and unpredictable bleaching of the skin.

So, do you now have some ideas on how to prevent acne scarring or help your acne scars heal faster?

What role does heredity play?

We need to know that heredity does play an important role in both the age of onset of our acne. In fact, it is also possible that severity and risk of scarring from acne is heredity (also known as genetics).

Studies suggest that our tendency to develop acne, especially severe acne, can be inherited from our parents. Statistics have shown that many school-age boys with acne have a family history of the condition. However, this does not mean that if one or both of our parents had acne that we are destined to have acne. But it does mean we have a higher chance of getting acne than someone without a family history of acne.

In families with strong histories of severe acne, it is very helpful to let our dermatologist know our family history and consider very close and regular follow-up of our acne treatment and acne control procedure.

Do remember that early evaluation and early acne treatment mean that severe scarring acne can be diagnosed earlier and that the sometimes disfiguring acne scars can be avoided or at least greatly minimized.

Is acne contagious?

It is learnt that acne is not known to spread from person to person and is not considered contagious.

The bacterium P. acnes which plays an important role in the inflammatory types of acne is lived deep of our hair follicle and is not easily accessible, even by close contact. P.acnes is active when the opening of our pore (i.e. openings of the follicles to the surface of the skin) is blocked off from the surface of the skin that cuts off the oxygen supply, i.e. under condition of very low oxygen concentration. In a way, this also makes the chances of spreading P.acnes bacterium less likely because there is less access to the outside world.

By the time we see a pustule (i.e. inflamed or red and swollen lesions that are topped with pus), that is the stage where our body has reacted to the infection and the pus is mostly a mixture of a lot of dead bacteria, white blood cells and skin cells, along with other complicated and minute factors that create inflammation.

Even though P. acnes can colonize our nose and be responsible for local spread of acne to our face and back through contact, such as from touching our nose and then touching our face or back, it is not known to spread from person to person and is not considered contagious.

You may want to view here for details about what does acne look like?

What is neonatal acne and infantile acne?

Neonatal acne

Occurring in approximately 20% of newborns and appears at approximately 2 to 3 weeks of life. Looks like small, red bumps and pustules that are scattered over the cheeks. The forehead, eyelids, chin, neck, and upper chest may also become involved. This type of rash is not harmful to the child. Comedones, which are the typical lesion seen on adolescent acne, are not seen in acne of the newborn.

Underlying cause: Temporary hormonal imbalances, or the involvement of a yeast called Pityrosporum rather than P. acnes (i.e. a bacteria responsible for inflammatory acne). Can be difficult to diagnose accurately due to different, usually temporary and harmless conditions of the skin that often look very similar but have different underlying causes.

Treatment: Can be treated with a topical antifungal or a combination of antifungal creams that the baby's doctor prescribes, however, the condition will most commonly resolves on its own.


Infantile acne

This type of acne is relatively uncommon. Will present as comedones and inflammatory lesions and is similar to the way adolescent acne would look. Usually occur at anywhere from 2 months to 2 years of age or more. Most commonly found in baby boys than girls and the face is typically involved.

Underlying cause: Hormonal factor or a family history of severe, scarring acne.

Treatment: Unlike with neonatal acne, early treatment is important in even mild cases, as there is a significant risk of scarring. Infantile acne is usually treated with appropriate oral or topical antibiotics in conjunction with topical benzoyl peroxide (i.e. BP, an antiseptic commonly used topically in the treatment of acne and does not induce bacterial resistance) and low concentration of tretinoin (Retin-A, i.e. a vitamin A family medical compound commonly used to treat acne vulgaris). Tetracyclines (i.e. a class of antibiotics used in the treatment of acne vulgaris) are not used in this age group.

Is picking at my pimples really bad for my skin?

Do you think once we get the contents of the pimple out, the pimple will go away and our skin will heal? The reality is that picking does not solve the problem and the result of the act will often leave us with acne scarring. In fact there is a medical name for the type of acne that occurs from the constant picking at or squeezing the lesions (i.e. a mark in the skin), it is called acne excoriée.

It is good to know that picking makes matters only worse, i.e. the scarring that is left behind. No matter how much we wash our hands, bacteria still exists on our hands and under our nails and will transfer to our facial skin. Also, picking or squeezing at will irritate the surrounding skin to some extent and has to heal itself. Again, this make us feel like there is a hard substance under the skin from the scab that forms, or from the scarring process within the skin that is trying to recover.

What is the solution then? The solution is to treat the acne with appropriate acne medications and to avoid touching the lesions at any cost. Also, our dermatologist can help us extract the contents of the pimples, or inject the lesions with a dilute solution of cortisone (i.e. anti-inflammatory drug often used to inhibit allergic reactions or to treat severe inflammation) to help individual lesions resolve more quickly. The result of this will be, as the acne lesions heal and fewer new pimples occur, our skin will feel naturally smoother and will look healthier as well.

We may not aware that there are several processes involved for acne to happen. For instance, the part that causes the acne and the part that heals the acne. In active acne, there is the follicular plug (i.e. blockage of the opening of the follicles and is one of the first steps in all types of acne), the comedo and some degree of inflammation. This can feel hard (usually last for days or even weeks) and tempted us to pick, squeeze or scratched it repeatedly. On the other hand, the healing part often make us feel like there is a bump or somewhat hard substance under the skin, this can last from weeks to months too.

What are the factors that can make acne worse?

The answer to this question is varied from one person to another as much overlap exists from one person to another in terms of acne triggers. In fact, it is amazing how different the triggers can be and how many triggers there are.

True to believe, many factors can lead to acne flares. For example, it could be just the change of seasons or moving from one state to another, from one home to another, from losing a loved one, from one job to another, from getting married or getting divorced, or a myriad of other psychologic issues and so on.

Nevertheless, below is a list of factors that play its role for causing an acne flare:

• Squeezing or picking at blemishes
• Irritation from hard scrubbing of our skin
• Changing hormone levels in adolescent girls and adult women, usually 2 to 7 days before the menstrual period starts
• Poor skin hygiene
• Occlusive products that block the opening of the pores
• Friction caused by leaning on or rubbing the skin
• Pressure from backpacks, bike helmets or tight collars
• Environmental irritants such as pollution and high humidity

Why does my face feel greasier throughout the day?

It is good to know that our sebum production is at its lowest at night but will increase throughout the day.

The reasons why our face feel greasier throughout the day is due to several factors as mentioned below:

Sebaceous glands - Highest concentration of sebaceous glands on our face, especially in the "T zone," that caused the increased in production of sebum during the day is one of the main reason why our face feel greasier during the day. Besides, sebaceous gland activity also increases in response to hormonal changes, stressors and irritants.

Product we used on our face and in our hair – It is good to know that the heavier the product we used, the more likely it is to be occlusive and cause buildup of sebum on our skin.

Sweat glands on our skin – In times of increased heat or stress, our sweat glands will increase production of sweat which, when combined with sebum will make our skin look shinier and feel oilier.

Menstrual period (i.e. the monthly, cyclical bleeding cycle women experience when they are not pregnant, irregularities in this cycle signal hormonal imbalance that can be an aggravating factor in acne) - For women, sebum production will tend to increase approximately 1 week before the menstrual period, this will make the women face feel oilier. It is suggested to carry some blotting pads that are specifically designed to absorb this oily mixture off our skin, though the relief is said to be temporarily.

What are the solutions then?

It is of great help if we could address the underlying issue by controlling our body temperature as much as possible, managing stressors well and try using products that will not substantially increase the sebum production whenever possible. These shall include products that contain salicylic acid (i.e. ingredient that helps exfoliate the upper layers of our skin, and is commonly found in over the counter acne treatment products) or retinols (i.e. Vitamin A).

At what age do adolescents (teens) start to get acne?

Basically, girls will start to get acne at the age of 11 to 13 when their hormones start to kick in, which is about the time that they start their period. Boys start to get acne at the age of approximately 12 years, with a range of 9 to 15 years old.

Early on in the onset of the teen acne, the main lesions are blackheads and whiteheads but when they reached puberty, it will easily become inflammatory lesions. It is noted that early lesions usually occur around the center of our face and on the forehead.

Fortunately, the advanced of medical knowledge has produced many effective acne care and acne clear treatments that can be applied to help control the acne and prevent acne scarring and others from happening. Result shown that a combination of oral and topical treatments usually work very well in these young adults.

Since acne can be a very serious disfiguring condition that teens may or may not outgrow it, hence, acne treatment and acne control for teenagers must be simple, efficient and ideally can travel well in order to encourage their compliance. Results must also come in relatively quickly for this age group, more than any other, because their self-esteem often rides on the latest zit that has come or gone. Because teenagers are minors, they deserve special attention and counseling in order to maximize the benefits of acne treatment. In fact, it is very important for parents and dermatologists to have a good dialogue to promote better understanding and for parents to treat acne in teens very seriously.

Believe you will agree with me that social stigma of acne and the risk of permanent acne scarring are the two biggest compelling reason why the acne condition in teens must not be ignored. In fact, survey conducted among teens showed that one pimple can make the difference between popularity and outcast in the mind of many teens.

Fortunately, easy to use yet effective acne care and acne clear treatment are readily available to help.

What is pomade acne?

Do you confused about what is pomade acne?

From the point of acne care and acne clear, it is good to know about the different type of acne. Pomade acne is a type of acne due to ingredients used in our hair. Pomade acne is consisted of blackheads and whiteheads and mostly appears on our temple and forehead.

It was first reported in 1970 in African-American men who tend to use scalp creams and oils regularly. It was reported that several products were implicated in the studies, e.g. products that contained mineral oil and Vaseline or other petrolatum-based ingredients.

Statistics shows that pomade acne is now a more common problem as it is commonly seen in all skin types now. This happens largely as a result of hair or hair care products as well as hair styling have become more complicated than ever.

One of the acne care tips is to evaluate and be careful about the hair products that we are using, and also that if we have longer hair that sits against the sides of our neck, more so when we find that the distribution of our acne is more concentrated at the edges of our face. Doctors advise that those with pomade acne should use hair care products that are non comedogenic or less comedogenic, such as those products that are water or glycerin (i.e. an additive use in soaps and moisturizers to increase the moisture content of our skin) based.

Generally, once we stop using the offending product, the acne will eventually clear up on its own. On the same note, topical anti-acne therapy is considered as one of the acne solutions that is proven effective to expedite the resolution of the acne and to minimize any potential acne scarring.

It is important to know that no matter what we put in our hair, by the end of the day, some of it will end up on our face.

How long should a typical pimple last?

We may notice that some people will have their pimples last for months, for example comedones can last for weeks or months or longer if not treated. Generally inflammatory lesions will usually clear within days to weeks. However, marks of red and eventually brown can be left behind that remain for months.

Do note that acne can recur in the same spot, which makes us think the acne lasting for months. In this respect, cysts tend to be recurrent in the same spot and will increase and decrease in size over time.

The best acne clear and acne care way for an acne sufferer is to firstly try to prevent the pimple from forming. If it does come up, what we could do for getting an acne lesion to clear more quickly and not to have acne scarring is to avoid picking at it.

At the same time, we should treat it early on with an appropriate acne antibacterial or anti-inflammatory medication. It is advisable to minimize putting anything on it or doing anything that can excessively irritate the pimples.

Also for acne control purpose, it is good to find out what are the acne causes that we think might be behind the breakout. We could ask ourselves:

• Was it because of or around an exam or a particularly stressful project?
• Did we use any new creams or lotions lately?
• Did we start or stop any medications or oral contraceptives? and
• What other factors that could have possibly contributed to the breakout?

In the event that the lesion does not seem to go away, it is time to consult a dermatologist to make sure it is simply a pimple that is slow to heal and not something else that should be addressed differently.

Also the trauma and irritation caused from the picking or squeezing may give us an immediate feeling of satisfaction that we have cleared the acne contents. In actual fact, it will make the affected area become redder and more prone to having a brown mark, worst still a depressed acne scarring left behind.

In short, picking or squeezing will not help from the point of view of acne clear and acne care, i.e. to stop the pimple from coming back in the same place next time.

What are the different types of acne?

It is good to know that there are several subtypes of acne, and identifying them is an important step towards our acne clear and acne care. This is because they often have different underlying causes that require different acne treatments for better acne control and acne solutions, i.e. in terms of type of acne treatment, evaluation of risk of acne scarring, and prevention of future breakouts.

Do note that these different types of acne can occur in various combinations in any given individual, and sometimes can look similar and confusing too. Acne vulgaris is the most common type of acne consisting of papules, pustules, and comedones in various combinations. There are several subtypes:

1. Acne conglobata - is considered an unusually severe form of cystic acne of large abscesses with interconnecting sinuses, cysts and grouped of inflammatory nodules.
   
   
2. Acne cosmetica - caused by occlusive makeup and skin-care products.
   
   
3. Acne keloidalis - This is most common at the nape of our neck but can also occur on the arms, chest, and the back. However, acne keloids is unlikely to be seen on the face, although they can sometimes occur at the jaw line and under the chin and may grow to become itchy, painful and disfiguring. In short, a type of acne in which healing results in keloidal scarring.
   
   
4. Acne excoriee - even mild acne may be severely disfiguring when accompanied by extensive excoriations, i.e. picking at lesions.
   
   
5. Comedonal acne - mostly blackheads and whiteheads.
   
   
6. Cystic acne - scattered cystic lesions in common acne areas.
   
   
7. Inflammatory acne - mostly papules, pustules, cysts.
   
   
8. Neonatal acne - an acne like eruption that can occur in newborns or infants.
   
   
9. Nodular acne - scattered nodules mostly concentrated on the face, chest or our
   back.
   
   
10. Pomade acne – is caused by occlusive hair products.
    
    
11. Steroid acne - is the results from long-term use of oral or topical steroids.

Why and what can I do to prevent my pores to become bigger?

Do you think your pores are always too big when they are on our face as opposed to someone else’s?

Based on survey, the answer is yes though pores are supposed to be there. In fact, everyone has them except that they are more obvious in some people than in others due to many influences that are affecting the follicles, its contents and size.

Nevertheless, treatments are available that can temporarily help to minimize the appearance of pores. Regular exfoliation along with the use of topical treatments, i.e. retinoids, prove to be effective in helping our skin regenerate or turnover more normally as to control the activity of the sebaceous glands that contribute to the enlarged appearance of our pores. Other factors that affect pore size include genetics, sun exposure, and hormones. Sadly to say that our pores will appear larger and more prominent with the increased of age.

What we can do is:

• Start with a sun protection as this is the easiest way to eliminate one factor that leads to increase in our pore size.
  
  
• Topical treatments such as retinoids are useful to control the activities of sebaceous gland that affect the appearances of our pores. However, this treatment may not be suitable to everyone as it caused dryness and may irritate our skin.
  
  
• Cosmetics treatments such as lasers (i.e. machine that produces bands of light to target various elements in our skin to help improve the skin texture, tone and quality as well as to treat acne) and intense pulsed light treatments (i.e. using a broad band of near infrared wavelengths of light to penetrate various depths of skin to target both red and brown lesions and to treat acne), but the results may vary from person to person.
  
  
• Oral isotretinoin medications – this is known to be effective to temporarily decrease the sebaceous gland activity but should not be the first-line treatment without the presence of severe and scarring acne.
  

Do note that:

• Facial (i.e. usually done by an aesthetician) skin treatment if done properly can temporarily help to reduce pores.
  
  
• There is no permanent way available today to eliminate pores, because pores are a natural part of our skin.
  
  
• Appropriate powders and creams may camouflage the pores.

What role does sebaceous gland play on Acne Vulgaris?

It is learnt that excessive sebum production is the first abnormality that occurs in the onset of acne. This is usually followed by abnormal sloughing of our skin cells lining the pores, leading to the microcomedo (i.e. the first stage of any type of acne lesion that is so tiny to be visible). Sebum, known to be comedogenic (i.e. that induce open or closed comedones) and a type of lipid or fat, is the major product of sebaceous glands.

Acne occurs in areas where the density of active sebaceous glands is the highest, a reason why it is usually found on our face, back, chest, and upper arms, though may extend to the buttock in some cases.

It is known that one of the sebaceous lipid composition called “Triglycerides,” and that some of the Triglycerides in the sebum will convert to free fatty acids by P. acnes (a bacterium) that helps create an environment for P. acnes to grow and flourish. Another lipid composition with the named of “Squalene,” and certain free fatty acids also play an important role in the causation of acne. Unfortunately, the sebum of people with acne has relatively little linoleic acid (a kind of free fatty acid), which is vital for our skin to slough off properly.

We can think of acne lesion as one large scale existing inside the follicle, and that people with acne will have larger sebaceous glands that make them produce even more sebum, as a consequence this will dilute the linoleic acid in the follicle, thus disrupt our normal skin sloughing and lead to the formation of mirocomedo. It is good to know that excess sebum production is mainly due to the differences of pilosebaceous unit (i.e. the grouping that containing the hair follicle and the attached sebaceous gland) to the local environment or the circulating of androgens (i.e. a class of hormones that can cause the sebaceous gland to enlarge and produce more sebum), or both.

For people who are prone to acne, the overall size of the sebaceous gland will increase and become lumpier in response to an increased in production of androgens which at the same time caused an increased in the secretion of sebaceous oils, i.e. sebum. This may happen even when we are at the age of 7 to 9. It is noted that women with no measurable abnormalities in hormone levels often find their acne improves when they take oral contraceptives.

In fact, the hormonal changes at puberty will lead to changes in both the sebaceous glands and our skin cells lining the hair follicle opening (i.e. pore). We may notice that some people are more affected by hormones than others; this is because there are factors that control how sebaceous glands handle our hormone, a factor of heredity (i.e. the traits that we get from our parents, such as the tendency to height, hair color, acne, etc).

Therefore, acne care and acne clear need to be addressed from several different angles to achieve better acne control and acne solutions.

What causes acne?

When looking at the underlying acne causes, we have to consider two general categories from the angle of acne care and acne clear, i.e. the intrinsic nature of the person and the extrinsic circumstances.

What follows are the definitions of and a summary of the differences between them:

Intrinsic – this is related to genetics or factors that are out of our direct control, such as:

• Family history of severe acne;
• Androgens circulating issue;
• Hyper responsiveness of follicles to androgens; and
• Local abnormalities of the pilosebaceous unit.

Extrinsic – this is related to factors that we may have control over, for example:

• Stress;
• Changes in our body due to changes in sleep cycles, foods, exams, relationships, etc, be it good or bad as the shift in various hormones will affect our skin too;
• Oral contraceptives - for example, hormonal changes related to pregnancy or when taking or stopping birth control pills can improve acne in some women but may cause acne or make it worse in people already prone to acne;
• Medications;
• Other hormonal treatments;
• Makeup;
• Irritants;
• Pollution;
• Occlusive products;
  and so on.

The current thought of acne vulgaris is that acne resulted from several, if not many, related factors. But the good news is that, the underlying acne causes can sometimes be addressed even before the acne becomes obvious on our skin surface if proper acne control has been followed.

In fact, medical studies have led to a revolutionary change in the way topical acne (i.e. cream, gel or lotion) treatments for acne was recommended. In the past, we use to receive acne spot treatment, meaning treating only the pimple themselves; however, the new acne care and acne clear recommendation is changing to one in which the entire area should be targeted, even if our skin appears normal on the surface, because the acne can be brewing underneath. It is noted that certain areas should be treated prophylactically (preventatively where a treatment or medication in the absence of active disease) in order to avoid the acne from occurring in the first place.

Whatever the acne causes, acne is, in the end, a condition of the skin with well-defined players such as skin cells, sebaceous glands and follicles or pores, along with P. acnes bacteria that are lived at the base of our pore though acne can sometimes be a very localized process involving only our nose, our back, our forehead or the area around the mouth or a very generalized process involving many areas of our body. It is noted that acne can be persistent, scarring and at times very difficult to control.

What mentioned below are the factors that involved in causing acne:

• Androgens – a type of hormones that play a role in acne;
• P. acnes – bacteria that are specific to the follicles in our skin;
• Inflammatory cells – this will trigger response to skin infection;
• Sebaceous glands – the oil producing glands;
• Keratinocytes – our skin cells;
• Pilosebaceous unit – is actually sebaceous glands with attached hair follicle.

After knowing what the acne causes are, what is important is that if no satisfactory acne solutions/result was seen after 2 to 4 weeks, it is time to see our dermatologist to get the necessary professional advice for a more suitable acne care and acne clear alternative.

What does acne look like?

It is good to know that acne lesions may be localized to only one area or may cover several areas of our body. What does this mean is that some may have it only on their face, or the back, the chest or only the buttocks, whereas for others it occurs at several sites at one time. Besides, there can be any given type of lesion or a combination of types of lesions at any given time. Further, having one type of acne lesion does not exclude us from having other types of acne lesions at the same time. Therefore, the attention on acne clear and acne care procedures may vary among us.

You may want to read here on how does acne vulgaris start. In fact, the different types of acne lesions are named based on what they look like and whether there are active P. acnes at work causing a localized infection. Whatever it is, it is important to treat acne-prone skin regularly and completely before pimples even appear, from the acne control and acne solutions point of view, this is believed to be the best way to minimize acne scarring and to help clear lesions that do appear as quickly as possible.

However, once the acne lesions become visible, they can be white or black, or perhaps red, and they can as small as a pinpoint or over 1 inch in size and can be in the upper layers of our skin or deeper within our skin. Studies have shown that acne vulgaris can last from days to weeks to months, and can either resolve with little or no consequence, or can leave behind changes in our skin color and texture which shall require the attention of acne treatment and proper acne care. You may want to read here to view the image of human skin structure.

In general, the main types of lesions can be classified into noninflammatory and inflammatory as follows:

Noninflammatory with no active P. acnes

• Whiteheads (also called closed comedo): The plugged follicle that stays beneath the skin and continues to grow and looks like a white bump just under our skin.
• Blackheads: A comedo that reaches the surface of our skin and opens and looks black on the skin's surface. However, the black discoloration is not due to dirt.

It should be aware that both whiteheads and blackheads may stay in our skin for a long time. As such, with our natural inclination or have the temptation to pick out those white and black cores will then leads to redness and local infection because our fingers are never sterile, hence may lead to serious acne scarring. It is important to remember that picking at an acne pimple makes the inflammation worse, even if proper acne care and acne treatment steps are being taken. You will notice that if we pop an acne pimple, the redness often lingers for a very long time which means that the skin stays red and irritated looking for even longer.

Inflammatory and with active P. acnes within the follicle:

• Papules: These are inflamed (red and swollen) lesions that usually appear as pink bump though small on the skin and can be itchy or tender to the touch.
• Pustules: These are papules that are topped with pus and usually red at the base. The pus consists of dead white blood cells and bacteria that arise as a result of fighting between the white blood cells and the P. acnes in the follicle that then overflowed to the surface of our skin.
• Nodules: These are large, solid, painful, or fluctuant lesions that are lodged deep within the skin but with a small opening to the surface where the follicle exits to the skin. They often feel hard to the touch because they consist of a combination of oils and proteins that have accumulated within the nodular cavity. They may last for months and leave behind crater-like scars.
• Cysts: This acne term is generally abandoned in favor of nodulocystic or severe nodular acne. Usually consists of multiple deep, painful, pus-filled lesions that can leave us behind crater-like scarring in the skin.

The acne care and acne clear actions that we shall take will largely depend on the types of lesions we have, how often the break out, whether we have acne scarring, and how many body areas are involved. In fact, many of the acne treatment options, acne products and acne remedies are over-lap, and shall help us to address various types of acne lesions. We are sure all this will help acne sufferers to determine an ideal acne solutions and acne control treatment plan.

How does acne start?

For acne care and acne clear as well as proper acne control reason, it is good to have an understanding of "how does acne start?"

For a variety of reasons and in fact not all of which are yet fully understood, acne starts when our sebaceous gland increases its production of sebum and also our skin cells lining the follicle do not shed properly, this is considered as an important underlying acne causes. And over time, they pile up and will block the opening of the follicle, hence a basic acne lesion i.e. an enlarged and plugged hair follicle called the microcomedo is formed. What was known is that this plug is the first step in the formation of any type of acne lesion that may form later, and with different processes that too affect the contents of the follicle to eventually determine what translates to what.

True to be believed, the plug is so small that makes it invisible, which is the reason it is called a microcomedo. If the microcomedo stays beneath our skin and continues to grow, it is called a closed comedo, which looks like a white bump and thus is called a whitehead. Surprisingly no active bacteria are found in a whitehead and its contents are merely the accumulated skin cells and oils that cannot reach the skin surface because of the blockage.

However, in a matter of days, the blockage may sometimes reaches the surface of our skin and become open. In this case, the lesion is then called a blackhead because it looks black on our skin's surface. However, this black discoloration is not due to dirt but a process called oxidation, whereby the air, the oils, and the proteins in our skin will affect each other and cause the contents in the follicle to turn black, and will remain in the follicle to block the follicular opening. It is thick in comparison to the normal contents of our skin. Like the whitehead, no active bacteria exist in a blackhead. Interestingly both whiteheads and blackheads may stay stuck in our skin for a long time.

It is good to know that those follicles with their attached sebaceous glands are most highly concentrated on our face and the back but less densely on our chest, upper arms and buttocks. For a more detail understanding on our skin structure, please read here.

What shall we do about these lesions then? It is best to be treated with gentle exfoliation (i.e. the process of removing upper layers of dead skin) and retinoids (products that are generally in the vitamin A family), and surgical extraction is proved to be very effective for this purpose too.

However, our fingernails are not surgical instruments in this case and that picking at these lesions, no matter how tempting it is, can make them worse and thus increase the risk of acne scarring, it is good to adhere to proper acne control and acne treatment for a more satisfying acne clear, acne care and acne free result.

Will I get Acne and who gets acne?

Sadly to say that people of all races, ethnicity, and ages will get acne and need the attention and actions of proper acne care and acne clear to ensure our skin look good and clear, unarguably this has made acne the most common skin disorder worldwide.

Acne is most common in adolescents and young adults. According to statistics nearly 85% of people between the ages of 12 and 24 years will develop this skin disorder. Importantly to note is that while for some people, acne tends to go away or can be dramatically improve when they reach their 30s, but for some even in their 40s and 50s do continue to face acne vulgaris (i.e. the medical name for acne).

Right until now, medical researchers are still trying to understand why different people have different type of acne based on their genetics (i.e. the factors that we inherit from our parents) and other factors. It is believed that some people may have an increased production of specific hormones (i.e. chemical substance formed from organ of our body such as adrenal gland, pituitary, ovary, etc that has a specific effect) that trigger acne while others are more sensitive to hormones or issues related to the follicles or pores and sebaceous gland that make them more susceptible to acne lesions. It was noted that medications may trigger or worsen acne as well as the combination of several of these or other factors might set off acne flares too.

Will there be any social and psychology impact on acne sufferers given that acne might cause scarring, lumpy and bumpy look and red marks on the surface of our skin?

Studies have shown that people with acne often think of themselves as socially unworthy, inferior, or socially unacceptable, though the acne may seem mild to others. It was reported that the same person who used to exhibit great confidence and courage when his or her skin is clear may shy away from public situations as well as deny himself or herself from career or relationships opportunities if he or she has active acne.

Therefore getting to the bottom of this problem, i.e. acne causes and finding the right acne solutions is undeniably important from the perspective of acne care and acne clear, given its profound negative impact on us.

What is acne?

Many people are not aware that the medical name for acne is called acne vulgaris, which in Latin means "common." This perhaps can be used to describe that acne, acne care and acne clear are one of the most frequently diagnosed and much talk about skin conditions worldwide. Other names that are often used to describe acne are pimples, bumps, breakouts, zits, lesions (usually look like a mark in the skin), clogged pores, blackheads, whiteheads, red spots and rash.

It arises as the result of a very common and often chronic medical condition of the hair follicles (i.e. the unit that contains the hair and the roots of hair) that line our skin and its associated oil-producing glands (i.e. glands is considered as a group of cells). Acne occurs most commonly on our face, especially in the area known as the "T zone," which shall include our forehead, nose and chin. Acne vulgaris may appear on our chest, back, arms and buttocks too.

Will our lips ever get acne? The answer is no, because this part of our body does not have oil-producing glands. One thing about acne is that it is a skin condition that can occur in every gender, race and ethnicity, and at any age that shall include from birth to old age.

It is no surprise that people who were spared acne in their teen years may one day wake up in their 30s or 40s to find a few or many pimples, though, acne care and acne clear is a skin condition mostly of teenage years.

In fact, acne can consist of a single pimple or of many lesions. It usually looks red or white and can even be black. We usually will feel itchy, painful and not just unsightly. Though those with oily skin are more prone to acne thus the necessary action of acne care and acne clear, but people with dry skin may have acne too.

It is good to know that different people can have different types of lesions that can last from days to weeks to months, and with the possibility of leaving significant redness or scars. However, as far as acne care and acne clear is concerned, some understanding on how it happens is very important as this will help for better acne control and acne treatment, in short ideal acne solutions that vary among individual.

Regardless of what types of acne one has, the first step in acne progression is a combination of increased oil production from the sebaceous glands (i.e. oil producing glands that are located in the deeper layers of our skin) and improper shedding of our skin cells lining our hair follicles. The skin on our face, chest, back and upper arms all have an increased density of sebaceous glands and are attached to the hundreds of miniature hairs that exit to the surface of our skin through follicles, which is commonly known as pores.

Those sebaceous glands will produce oily substance called sebum, which will travel from the sebaceous gland through the follicle and end up on the surface of our skin. At the base of each follicle, there exists a bacterium called Propionibacterium acnes (also known as P. acnes), i.e. the main culprit that is responsible for inflammatory acne. It is good to know that inflammatory acne is a class of acne where the main lesions are papules and pustules but not comedones.

When and if the opening of our follicle gets blocked or if our skin cells of the lining regenerate either too quickly or too slowly, or do not move up and out of the follicle properly, the next layer of our skin cells behind them will have nowhere to go, also the oxygen supply in the follicle gets cut off and the sebum/oil that the sebaceous glands produce together with the protein that makes up our skin cells, will serve as a perfect diet on which the P. acnes grow and prosper and produce more P. acnes.

At this juncture, our body will likely recognize something is amiss and our body white blood cells (i.e. our body’s main defense against infection) will attack as needed to clear those acne infections and get rid of any unwanted foreign invaders. This process will leave our skin looking red and bumpy and often made us feel itchy or painful. However, if the P. acnes is not activated, then the contents of the follicle that build up and bulge behind the blocked opening will cause a lumpy, bumpy look on the surface of our skin that can be white if the opening remains blocked or black if the contents finally burst through to the surface and react with oxygen. These lesions are what we called whiteheads and blackheads, respectively. Whiteheads and blackheads are most commonly occur on our face and back and seem to be a fixture for most people on their noses.

What all this means is that where necessary this shall require our attention on the appropriate acne care and acne clear actions.