Acne is mostly an inflammatory response to lesions inflicted to some of the cells lining the sebum ducts caused by sebum outbreaks or sebum hardening inside the hair follicles, and comes before the proliferation of acne bacteria within blocked pores.
Acne treatment must address inflammation, blocked pores, and acne bacteria, and always aim to avert acne scarring.
Let’s just face it. Doctors, scientists, laymen and almost everybody on the planet, have been for eons trying to understand what causes teen and adult acne symptoms. They theorize and debate almost everything about it except for the fact that it exists. The fights about acne involve its cause, histopathology, pathophysiology, the role of diets in acne flare-ups, and the correct cure or treatment for acne pimples, zits, and acne cysts in areas like the back, face and shoulders.
We can also see quarrels about the various classifications schemes that self named "experts" come up with to describe all types of acne. If those definitions where correct, you would have more than half of the solution, for as you might know the best way to begin solving a difficulty is by describing it correctly, right?
Most treatments have been arranged to either kill all bacteria with harsh chemicals, dry out the skin to eliminate most of the oil produced by your own skin, unblock pores by partially exfoliating some of the outer layer of your skin with natural or chemical acids, lower sebum generation with aggressive drugs, or a mixture of all of them.
But what is the root cause of acne?
A root cause is an initiating cause of a causal chain which leads to an outcome or effect of interest. Normally, root cause is used to characterize the depth in the causal chain where an intervention could reasonably be used to change performance and prevent an undesirable result.
Most Acne Treatment Products Only Address The Symptoms:
Bacterial Infection with strong chemical substances that produce irritation, redness, extreme dryness and free radicals that damage the cells and cause premature aging of our skin, or antibiotics that have become useless as they start the development of bacteria resistant to antibiotics, also a big problem when more important health issues require to be addressed.
Blocked Pores with very strong chemical substances that eradicate tissues or liberate free radicals such as benzoyl peroxide, salicylic, glycolic, lactic or other strong acids that cause peeling and dryness, side reactions that make acne even worse.
Reduction of Sebum Production with unnatural ways or products, or with dangerous Isotretinoin or Vitamin A drugs (Accutane® , Retin-A and other brands) that have dreaded side reactions, and can not be taken by any women that are pregnant or could become pregnant for it causes severe birth defects. We also have to talk about the unwanted effects on skin: dry skin, nose bleed, irritation of eyelids and eyes, skin itching, skin fragility, chapped lips, awfal scaling and peeling, among other.
Skin Inflammation with anti-inflammatory cures such as prescribed systemic corticosteroids and steroid injections that also have immunosuppressant reactions that may be contraindicated, or have unwanted side reactions: the skin can turn very sensitive, tearing and bruising easily, making it likely to suffer from stretch marks. Or treatment products with non-steroid drugs such as ibuprofen which often produces unsatisfactory gastrointestinal side reactions including diarrhea, bloating, heartburn, upset stomach (dyspepsia) and ulcers.
Inflammation Is The Root Cause
Fact is acne is an inflammatory skin condition characterized by breakouts that show up on the surface of the skin. And those may or may not become infected with acne bacteria living within the hair follicles.
Did you know that Propionibacteria acnes lives in symbiosis with our body, feeding on damaged cells, collaborating with the sebaceous glands to make them into sebum, and metabolizing components of sebum into fatty acids with antimicrobial characteristics so that we are protected from pathogens?
Point is: when sebum runs through out the hair follicles to the outer layer of our skin it helps to lubricate our skin and defends our skin with the lactic acid and fatty acids it contains. Both avoid the development of some pathogenic bacteria and fungi, which are always prepared to thrive in our skin especially when our immune system becomes impaired.
Fact is that when the sebum doesn’t flow in a proper way and ends up getting trapped by either clog pores or pinched-off sebum glands — Ouch!— it breaks or destroys some of the cells that line the sebum tracts. And guess what? Our body readily reacts to the Ouch signals. Of course! It isn’t deaf to them, unlike us that often have a poor aptitude to recognize the signs of danger or even to those warning us out loud of imminent perils.
Yes, the body answers in very much the same way it learned to react during the millions years of our evolutionary drift. By sending to the place of injury and insult all its army forces of immune system fire-fighters (lymphocytes, macrophages, neutrophils) overcharged with chemical extinguishers - to eliminate the offenders, with no consideration even for its own cells that might be in their way and also do get eliminated. After all it can it used to be a matter of life or death!
This is what is meant by “inflammatory reaction”. And, Oh God! You can bet those fire-fighters are inflamed!
The diagram above shows a detailed model of the pathophysiology of inflammatory acne and dermal(skin) damage. In inflammatory acne lesions, NF-κB signal is activated (a transcription factor critical for up-regulation of many proinflammatory cytokine genes). As a side effect, inflammatory cytokine genes (eg. TNF-α and IL-1ß) are induced. These primary cytokines will spread the inflammatory effect by acting on endothelial cells to create adhesion molecules (eg. ICAM-1) to facilitate recruitment of inflammatory cells into the skin. TNF-α and IL-1ß will also work to stimulate the production of secondary cytokines, such as IL-8, which can aid in the movement of the inflammatory cells towards the increasing amount of these special chemicals. By using their cell outer layer receptors, TNF-α and IL-1ß not only augment the NF-κB signaling cascade, but also activate MAP kinases (mitogen-activated protein kinase) to activate AP-1 mediated gene transcription (another very important transcription factor that has to do with inflammation). As a consequence of activator protein 1 (AP-1) activation (cJun induction), AP-1-driven matrix metalloproteinases (MMPs), a type of zinc-dependent protease enzymes, are produced by resident skin cells. Together with neutrophil collagenase and neutrophil elastase enzymes brought in by (PMNs) polymorphonuclear leukocyte inflammatory cells, they synthesize extracellular matrix proteins such as collagen and elastin. After this it comes the matrix synthesis and repair. This is imperfect. Most of the imperfections have the capacity to leave clinically undetectable deficits with the arranging or forming, or both, of the skin layers.
Nevertheless, when they happen to an important extent in time, accompanied by sustained procollagen synthesis, acne scarring turns clinically visible. American Journal of Pathology. 2005. Inflammation and Extracellular Matrix Degradation Mediated by Activated Transcription Factors nuclear factor-κB and Activator Protein-1 in Inflammatory Acne Lesions in Vivo. Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, US.
Now of course there are factors that "trigger " hyperactivity of our glands, blocked pores, bacterial infection and the like. Stress is the hands-down primary cause of sebaceous glands hyperactivity that might turn out into acne inflammation. There are many other contributing factors also. These can include, picking and squeezing pimples, the pressure pressure or friction (head bands, caps, etc), way of living, birth control pills, cosmetics, climate and diet, but stress is the Big Kahuna! Now, "stress" is another story, and you might afterwards go to our FAQ and find even more in regards to the biology of stress & acne.
One more time, you can’t blame your body for producing huge quantities of sebum. The complication is how it responds to damage inflicted to the cells that border the sebum passages. When the canals become overcharged with sebum pushing to flow to the surface —where it belongs—, or when they aren’t able to reach the surface of skin because of blocked pores and pinched-off sebum glands.
Ok! You might address very oily skin and blocked pores with an acne treatment product, for a determined period of time, and till your skin is back in balance. And you might also change some of your nutritional habits to prevent sebum canals pinched-off by the pressure of excess moisture attracted by toxins expelled within your dermis by your lymphatic system, as you may learn by going to the Acne & Rosacea FAQ and the links there on detoxifying your skin and avoiding dairy products and changing your diet to prevent acne breakouts.
Now, what about the inflammatory reaction which happens each time there is an outflow of sebum triggered by your adrenals as it is guaranteed because of natural hormonal imbalances now and then? Well that is unless you are living in a totally stress free world. It may not be a very attractive realm though, don't you agree?
Got the point? Modulating the inflammatory response is the recipe for success! Calm down you guys (immune cells), past are the moments when bacteria and other micro-organism ruled.
Is this nothing but wishful thinking? Isn’t it true that we carry on and inside our body three times more bacteria than the the exact number of cells our organism is composed of?
The thing is that our body is ingrained with the memories of past battles, fought to protect our body whenever broken or injured and doesn’t listen to just any argument made up by the pharmaceutical or cosmetic marketers that sell anti acne products aiming to control bacteria.
During our evolution, injuries and wounds were a problematic threat to our organism, not just due to blood loss, but also due to tissue injuries or infection from dirt, splinters and bacteria.
The adult wound recovery method that evolved to answer to all these threats has two main characteristics: First, there is a fast and large inflammatory response, with recruitment of active macrophages, neutrophils and lymphocytes to the injury site; and second, there is a fibrotic "walling-off" response to separate the foreign body, with liquefaction of surrounding tissue that might lead to abscess formation and also loss of tissues and thus scarring.
Actually, acne lesions are in this matter similar to any skin wound. Our body answers with the same powerful inflammatory knee-jerk to the sebum that is meant to flow to the skin surface but stays trapped within the hair follicles as if it where a foreign body; or when sebum production is exacerbated and the first flow of sebum through the previously empty duct creates shear forces of sufficient magnitude that hurt the lining of the sebum canals or the pilosebaseous glands.
Inflammation increases when acne bacteria (Propionibacterium acnes) and other bacteria always present on the outer layer of the skin (Staphylococcus aureus, Staph. epidermidis, diphtheroids, streptococci, Candida, etc) begin to multiply without control in punctured or broken skin. The problem is magnified if right there the deliciously rich feeding fatty sebum is abundant.
"An abscess and its subsequent scar is not an evolutionarily optimized end point for today's injuries, Dr. Mark Ferguson, D.D.S., Ph.D., professor in the faculty of life sciences at the University of Manchester, England, says. The abscess and scarring response, with its massive inflammatory overdrive, is optimized for a very different type of skin lesion than those occurring nowadays where hygiene and clean faces and bodies rule. The abscess and scar is induced by this inappropriate inflammatory response..."
Wounds that affect the cells lining the sebum canals, arising due to a sudden overflow of sebum or pinched-off sebum glands, take place in otherwise clean skin without dirt or contamination by foreign bodies. These lesions should therefore be great candidates for repairing without complications using a regenerative injury healing method rather than a scarring method. The result should be marked by scar less recovery.
The healing time within the hair follicles should be very much like what our body accomplishes for fetal injuries which heal quickly by regenerating cells and leaving absolutely no trace behind.
There’s something missin in all the other treatment products out there. Something that would signal our body that it is being taken care of properly and doesn’t need to overly react with its inflammatory battalion. Not just the innate or chemical ingredients that fight the symptoms, when it is too late: acne bacteria gone wild, occlusion of the ducts (microcomedones) and then enlarged comedones that transform into inflammatory lesions.
This is a vicious cycle that causes continued and/or increased obstruction of the outgoing flow of the sebum, which in turn can lead to to more pressure, inflammation and continue or progressive infection.
Such continued obstruction, with or without infection, leads to the production of cysts. Infection of a cyst results in the formation of an abscess which can lead to local tissue destruction. If this destruction of tissue has included the connective tissue factors of the skin or subcutaneous tissues to a sufficient degree, the healing process is often accompanied and/or is followed by the formation of a scar.
Acne scars can range from small to extensive and severely disfiguring problems which are permanent effects of acne. While the mechanism by which acne begins and maintains itself for an indefinite time may and often does come to a halt as a result treatment or spontaneously but the scars remain for life unless they are eliminated.