Acne is the bane of teenagers everywhere, and while we like to think it magically disappears after puberty, that’s not necessarily always the case. Some have acne that stops when their breasts finally stop growing, or when their voice stops cracking, while others never experience acne as a teen, but end up with adult onset acne. Others just have it always and forever without proper maintenance.
Acne is caused by excess oil production, an inflammatory response, and ultimately, hormonal imbalances causing these first two problems.
The skin has multiple sebaceous glands underneath, which connect to the outer pore via a follicle. The sebaceous glands produce sebum to moisturize and lubricate the skin, sending it up through the follicle to the surface of the skin. Your skin is also continuously renewing itself, and shedding old, dead skin. When this dead skin mixes with the oily sebum, sometimes a clog is formed in the pore and follicle. Bacteria feeds on the sebum and dead skin, causing inflammation until you see that giant zit on your chin the next day.There are three main acne types, with varying levels of inflammation.
Whiteheads and blackheads
These are called comedones and may be open or closed. A blackhead is a pore blocked with sebum and dead skin, but exposed to air, causing the surface to darken into a “blackhead.” A whitehead is a closed comedone, where the plug is under the skin, appearing as a small, hard bump on the skin.
Papules and Pustules
These occur not only when the pore is clogged, but the walls around the pore start to break down from the inflammation. A papule is usually pink and tender, while a pustule is filled with pus, and usually, comes to a head. This type of acne is usually treated with a topical medication such as benzoyl peroxide, salicylic acid, or clindamycin.
Nodules and cysts
These are large, deep pimples underneath the skin. Both form large, painful bumps underneath the skin, filled with pus and sebum. This type of acne is the most likely to form scars and is best treated by a dermatologist. A topical retinoid may be prescribed, or isotretinoin may be recommended. For large, infected cysts, the dermatologist may have to surgically drain and remove them.
Bump and inflammation
These may also be signs of other skin concerns other than acne. These can include
- folliculitis, an infection of the follicles
- milia, hard calcium deposits under the skin, usually around the eyes
- rosacea, redness and swelling on the nose, cheeks, and forehead
- sebaceous filiments, a small hair-like string of sebum at the surface of the skin to help regular the flow of sebum from the sebaceous gland to the surface of the skin, and usually mistaken for a blackhead
It’s best to see a doctor or dermatologist to get a correct diagnosis for specific acne types and for the correct treatment to go with it.
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