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Just What is Acne?

(The First Step to Discovering How to Get Rid of Acne Forever)
Acne is a skin condition typified by groups of spots and pimples (whiteheads and blackheads) usually accompanied by scaly red skin. In more severe cases there are bigger lumps and pus filled pustules too. Being very clear on ‘What is Acne?’ and understanding the causes of acne can play a major part in the treatments you receive and your ability to Get Rid of Acne Forever.

Figure 1 Typical Moderate Acne on Forehead

Acne is rarely threatening to overall health but it is unsightly and often causes stress and psychological trauma.

How Common is Acne
Acne is prevalent throughout the World. It seems to affect people from all races and is no respecter of color or religion. At any particular time, around 17 million Americans are thought to have Acne. Scaled up that figure equates to over 400 million people worldwide. More correctly termed Acne Vulgaris (common Acne) it will affect 75% of 11 to 30 year old at some time in their life.

Disclaimers
No one at www.fixacneforever.com has any medical training whatsoever. This article and the views shown within it are based on in-depth online research to answer the questions ‘What is Acne?’ and ‘What Causes Acne?’ Please refer to our medical disclaimer notice for more information. From our research we estimate that 90% of all acne articles on the internet are written to sell products or services. There is almost no research or understanding of the nature of Acne. Consequently, many of these products are likely to be little more than ‘snake oil’ with the sole purpose of separating you from your hard earned cash.

We are not completely innocent in this. Advertising fees we receive enable us to provide and maintain this site. Our guarantee to you is that we will never recommend products that we have not thoroughly tried or researched online first. For the avoidance of doubt you should read our ‘ About Us’ and ‘Affiliate Disclosure’ statements.

Purpose of this Article
Ok, with the above proviso out of the way, the primary purpose of this article is to help you make informed choices in the treatment of your acne and to help you start the journey in getting rid of acne forever. This is a long article. However, if you can make it to the end we are confident that you will be in a much better position to make intelligent, informed decisions on managing your condition.

Terminology
  Whiteheads – small, sub surface spots Blackheads – break the surface. Black and clearly visible (NB: A new post has been added showing a short video on the difference between whiteheads and blackheads and how they form)

Whiteheads and blackheads are called comedones. Whiteheads are closed comedones while blackheads are open.     Papules – solid, elevated bumps up to 5mm diameters that do not break the surface. Pustules – small, blister like bumps filled with pus. Usually read at the base. Nodules – elevated lesions on or in the skin. Lesions are superficial growths or patches of the skin that don’t resemble the area immediately surrounding it. They are larger than papules – over 5 mm in diameter. Cysts- clearly visible – size can vary from small (microscopic) to pretty large.

Given the incidence of Acne we have gained an impressive body of knowledge of what it is. More surprisingly relatively little is known of exactly how it is caused and why it affects so many people so badly.

The Basic Mechanics of ‘What is Acne’
We know the mechanics of Acne formation – a hair follicle pore gets blocked, there is a build-up of dead skin cells, sebum (oil) and, most importantly, a build-up of bacteria inside the pore. Where there is not an excess of bacteria we end up with a whitehead or blackhead. When accompanied by runaway bacterial multiplication we get pustules, nodules and cysts.

The Role of Hair Follicles
The average human being has around 5 million hair follicles spread over the whole body. Most of us have about 100,000 or so hairs on our heads (blonds have more (120,000), red heads less (c80, 000)). All told that is a lot of follicles. It’s not just the number of follicles that causes the problems though – hair is really complex stuff.

Figure 2 - Inside a Hair Follicle

If you take a quick look at a hair follicle you can see it is an impressive feat of evolution. The hair needs blood supply to grow so every follicle is fed by a capillary. It needs to be firmly attached. The sebaceous gland creates sebum – oil that acts as a natural conditioner and also probably helped water/weather proof our coat way back in the days when we relied on our hair to keep us warm. In normal operation the sebum is deposited on the hair and moves along it to the pore taking dead skin cell and other detritus (bacteria, fungi, etc.) with it. In addition, each and every hair follicle includes a muscle that erects hairs when we are cold or afraid (nowadays we feel this most often as goose bumps). These little miracles of evolution are also coded for how long hairs should grow – seemingly limited less on our heads and face (not eyebrows) but to some genetically prescribed length on our bodies and arms. Skin is much more complex than this though. There are around 2-3 million sweat glands over the surface of the body.

Figure 3 - 3d Skin Diagram Showing Hair Follicles and Sweat Glands

These too can get clogged and produce symptoms similar to Acne. More correctly this condition is known as Hidradenitis Suppurativa or Acne Inversa The secret to understanding how Acne occurs is tightly wound up in understanding how hair follicles work. The problem is, as with much of the human body, we only know what happens and not why.

Skin Flora and Fauna
Until recently it was thought that our skin was home to a few hundreds of types of bacteria. More recent studies show this figure to be grossly underestimated. In 2011 scientists in North Carolina took samples from the belly buttons of 200 volunteers. They discovered over 4000 different strains some of which were completely new to science. In a study published in May 2013 in the online edition of Nature scientists from the National Institutes of Health examined the fungi on the human body. They found markers representing more than 80 fungal types. Usually the bacteria and fungi on our skin exist together in close harmony. We know that some are actually beneficial in fighting off more dangerous bugs and in helping with wounds etc. In truth though, we have little real knowledge of how our skin flora and fauna work together. One particular bacterium – Propionibacterium acnes – is implicated in causing Acne. Interestingly this bacterium is only found in minute quantities on human skin. It is much more commonly found in hair follicles.

Why does Acne Happen?
Thank you if you have stuck with me this far. I think it is really important to understand what is happening before we go on to look at how Acne might be fixed. There are a lot of snake oil salesmen out there that you will be able to see through once you know the mechanics of the infection. The symptoms show when a hair follicle gets blocked. Please note – this is important – the blocking of the hair follicle starts within the follicle itself. There is no outside agent involved. Understanding this point allows us to get rid of a couple of the more popular myths about acne:  Use of too much make-up can cause acne

Not washing properly causes acne

Nevertheless, if you suffer from Acne we strongly recommend washing frequently (at least twice a day) with a mild soap. Keeping your skin clean and allowing air to the affected area are known to be beneficial for almost all wounds and infections. Acne is no different.

Adolescence Acne
During adolescence the body dramatically increases the production of androgenic hormones. These are often called the male hormones (the best known being testosterone) but are produced by females too. Amongst many other functions these hormones ‘turn-on’ hair follicles in certain parts of the body and boost the production of sebum by the sebaceous glands. It is these hormones that trigger the changes in hair patterns for boys and girls associated with puberty. For some reason (not yet known) there is a tendency for the sebaceous gland to over produce oil (sebum). This may be combined with the triggering of hair growth particularly in adolescents which, in turn, is associated with the creation and shedding of more skin cells. This is the point in which the whole process becomes somewhat murky (literally and figuratively). What is known is that the excess oil and skin cells can form a plug which blocks the pore of the hair follicle. If the plug forms below the skin surface whiteheads form. Whiteheads can be unsightly and, as they don’t break the surface of the skin, fairly difficult to treat. If the plug breaks the surface of the skin the oil will oxidise and turn black forming into blackheads. While blackheads are almost always unsightly they can be easier to treat than whiteheads. In more serious cases the balance of the natural skin flora and fauna is disturbed. With the closure of the pore a new Eco climate is created that favours the production of some bacteria over others. It is the build-up these bacteria that lead to painful and unsightly pus filled pustules and cysts. Remember this all occurs inside the skin.

Adult Acne
While we don’t fully understand the cause and triggers of Acne in Adolescents we at least have a pretty good working picture of what happens and why. Unfortunately a significant percentage of adults between the ages of 20 and 60 also suffer recurrent breakouts. A UK National Health Service study shows women account for 80% of adult acne. The mechanism for the formation of Acne in Adults is the same as already discussed – the sebaceous gland overproduces sebum, the sebum mixes with dead skin cells within the follicle and a blockage occurs. The over-production of sebum is thought to be due to an imbalance of hormones. There are many events that produce hormonal imbalances for women: pregnancy, child birth, periods and the like. The reasons are not as clear cut for men but can include the taking of steroids – particularly testosterone – to boost body and muscle mass.

What does this all mean for the treatment of Acne?
The key fact I have stressed throughout this article is that Acne is caused from within the body and specifically the skin. There is no evidence that overuse of cosmetics or perceived poor personal hygiene (teens not washing enough) have any effect whatsoever. The immediate, obvious conclusion is that vast majority of Acne miracle creams and lotions are going to have minimal if any effect. Most over the counter (OTC) treatments are based on Retinoids and/or benzoyl peroxide (BP). Topically applied there is evidence that both Retinoids and BP do have a positive effect on symptoms. Indeed many treatments prescribed by your physician will be based on one of both of these substances. Further evidence for the combinatorial approach is contained in a 2013 Article, Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne” published in ‘Pediatrics – Official Journal of the American Academy of Pediatrics’. Read this if you are deeply interested in the subject - the conclusion and the recommended treatment is interested.

Time for measuring benefits is gauged in weeks if not months. Getting rid of your acne is not going to happen quickly. The treatments will escalate over time – if there is little or no discernible improvement in the short term the type and concentration of the medication can be altered or increased. Most of us do not have the time or facilities to subject ourselves to this sort of evaluation.

Summary
This article now runs to over 2,000 words – more than twice the intended length. Most people will never read this far – congratulations if you are still reading. As we said right at the very start being clear on ‘What is Acne’ is going to have major impacts on the treatments you choose. There are a couple of very important insights:        Most OTC medication does not and cannot work. There is very little evidence to support the efficacy of most OTC preparations Most home remedies are little more than old wives tales Acne is caused by blocked hair follicles – the root cause of which is over production of sebum by the sebaceous gland Hormonal imbalances are strongly implicated in the over production of sebum Hormonal issues alone do not explain why some people get Acne while others don’t Other (potentially unknown) lifestyle or well-being issues are in play

Given the complexity of Acne and the lack of evidence based research it is hard, even now, to draw firm conclusions on how to get rid of Acne – preferably forever.

Recommendation
Our strong recommendation remains to address all of the factors that might combine to cause acne. All of our research still leads us to recommend Mike Walden’s Acne No More. It has hundreds of recommendations from reportedly happy customers. Given the lack of evidence to support almost all other treatments, the time taken for any of the above treatments to work, and the low cost of Acne No More we recommend giving it a spin. It is sold on clickbank so you have a full 60 days to try the product and see if it works for you. If you haven’t seen that start of any results in this time you absolutely should be asking for you money back and posting your findings on our Acne No More Review Page