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Introduction to Acne
Course Author—Alexa Kimball, M.D., M.P.H.
• Nu Skin Professional Advisory Board Member.
• Director, Clinical Unit for Research Trials in
Skin (CURTIS); Mass General and Brigham
and Women's Hospitals; Harvard Medical
School.
• Has contributed significantly to medical
literature with articles and abstracts published
in journals such as Archives of Dermatology
and Journal of the American Academy of
Dermatology.
• Graduated Phi Beta Kappa from Princeton
University and received her medical degree
from Yale University School of Medicine.
Objectives
After viewing this course, you should
understand the following:
• Types of acne breakouts
• Acne life cycle
• Effects of acne
• How to treat acne
Did You Know?
When you’re under stress, your body produces
stress hormones, such as cortisol. These stress
hormones may stimulate an overproduction of oil in
the skin, a main cause of acne breakouts.
What Is Acne?
Definition of Acne
Acne is an inflammatory skin condition that
occurs when sebum (oil) and dead skin cells
block the pore opening, causing sebum to
build up inside the pore.
Although acne is a common skin condition,
if left untreated it can lead to severe
inflammation and permanent scarring.
Who Is Affected by Acne?
• Acne affects people regardless of age, gender, or
race.
• More than 80 percent of people suffer from acne at
some point in their lives, many into adulthood.
• 20 percent of all adults suffer with active acne.
• Of the 85 percent of young adults (between ages 12
and 24) that suffer from acne, 25 percent will have
permanent scars ranging from mild to severe.
Acne Life Cycle
Acne Life Cycle
Stage One: Clogged Pores
Each pore in your skin is essentially a hair follicle
lined by cells from the epidermis (the upper most
layer of the skin). The hair follicle is connected to
multi-lobed sebaceous glands (oil producing
glands).
Sebaceous glands produce sebum, a natural
substance that lubricates the hair and provides
essential fatty acids and lipids that are necessary
to maintain the skin’s protective moisture barrier.
Acne Life Cycle
Stage One (continued): Clogged Pores
As part of the skin’s healthy processes, cells that
line the pore are continuously shed. They mix
with sebum and flow out of the pore onto the
surface of the skin. If the sebaceous glands
produce too much oil, generally in response to
hormones, the mixture of dead skin cells and
sebum form a plug, blocking the pore opening.
Acne Life Cycle
Stage Two: Bacteria
Dead skin cells lining the pore continue to be
shed and oil is still produced by the sebaceous
glands, both of which build up behind the plug.
The accumulated mixture of sebum and dead
cells attracts the bacteria found naturally in the
skin (known as P. acnes or propionibacterium
acnes), which feeds on oil and multiplies rapidly
inside the pore.
Acne Life Cycle
Stage Three: Inflammation
The bacterial overgrowth triggers the body’s natural inflammatory
immune response: blood vessels become leaky, allowing white
blood cells to flood the area. This causes swelling and redness in
the region, which can ultimately lead to the discoloration and
scarring associated with acne.
Types of Acne Breakouts
Types of Acne Breakouts
There are many types of acne breakouts, all of which result when oil
and dead skin build up and clog the pore opening. Blackheads,
whiteheads, pustules (or nodules), and cysts are the four most
common types of acne breakouts.
Healthy Pore
Blackhead
Whitehead
Pustule
or Nodule
Cyst
Types of Acne Breakouts
Blackheads (or open comedones) are clogged
pores that are only partially plugged, allowing
some of the trapped sebum and oil to escape the
pore. The sebum within the hair follicle solidifies.
The dark color associated with blackheads is
due to the oxidization of sebum and melanin in
the dead skin cells when they come into contact
with the air.
Blackheads are generally not inflamed or
infected with bacteria, and do not cause
scarring.
Types of Acne Breakouts
Whiteheads (or closed comedones) are the
result of completely clogged pores. Below
the skin, excess oil and dead skin cells fill
the pore and begin to create a small, whitish
bump.
Limited bacterial growth and a low-grade
immune response create the white pus
associated with whiteheads. They are not
highly inflamed and do not generally cause
scarring.
Types of Acne Breakouts
Pustules (or nodules) are red, inflamed acne
breakouts that occur when clogged pores
become infected with bacteria (P. acnes).
A pustule is similar to a whitehead, but is highly
inflamed, and appears as a red bump with a
white or yellow center.
Because of the inflammation and swelling,
pustules cause the distinctive discoloration
associated with acne and may also cause
scarring.
Pustule
or Nodule
Types of Acne Breakouts
Cysts are severely inflamed and pus-filled
acne lesions that occur when the contents of a
clogged pore seep into the dermis (lower layer
of the skin). The deep inflammation and
infection cause a severe immune response:
white blood cells flood the area, which then
becomes swollen and sore. This results in the
formation of a cyst.
Acne cysts are painful and often cause
scarring. The white blood cells can overreact
and damage the pore and surrounding area.
After the cyst heals, a permanent scar may
remain.
Effects of Acne
Past
Present
Textural damage
Hyperpigmentation
Acne Scars
Breakouts
Redness
Irritation
Oiliness
Future
More acne
Potential for more scarring,
hyperpigmentation, and
textural damage
Treating Acne
Treating Acne
Because acne can begin 2–3 weeks before blemishes are visible on your
skin, the secret to controlling acne is prevention. Prevention includes eating
a balanced diet, exercising, and reducing stress, as well as cleansing with
a proper treatment system. Acne can take 8–12 weeks to treat.
Treating Acne
When treating acne topically, dermatologists
recommend a three-pronged approach:
• Unclog pores and keep them clear.
• Control oil, which helps to limit bacterial
growth.
• Reduce inflammation.
Treating Acne
The skin takes time to adjust to a new system. During
this time, breakouts may appear worse before they get
better; this is not uncommon as pre-existing blemishes
are beginning to surface. Improvements should be
visible within a few weeks and continue throughout the
next eight to twelve weeks.
Acne Myths
Myth #1: Scrub face clean to treat acne.
Vigorous washing and scrubbing can actually irritate the skin and
make acne worse. The best approach to good hygiene and
treating acne is to gently wash your face twice a day with a mild
soap, pat dry, and use an appropriate acne treatment.
Myth #2: You have to let acne run its course.
The truth is acne can be cleared up. Using a high quality,
efficacious acne treatment system can address the stages of acne:
clogged pores, bacteria, and inflammation.
Acne Myths
Myth #3: Acne is just a cosmetic condition.
While acne poses no serious threat to one’s health, it does affect the way people look
and can affect the way people feel about themselves. Acne should be taken seriously
and treated to prevent permanent physical scarring.
Myth #4: Acne is not related to diet.
While thus far science has not found a solid connection between diet and acne,
research is being revisited in this area. Some studies indicate a relationship between
acne and high-glycemic foods such as sodas, pastries, and breads. Other studies
have looked at the impact of dairy-rich diets on skin health. Many people insist
certain foods affect their acne. When controlling acne, eating a balanced diet is
always a good idea.
Acne Myths
Myth #5: There is no correlation between stress and
acne.
Acne not only causes significant stress, but is also made
worse by stress. In a recent study, Stanford University
students with acne were analyzed before and after exams.
The study showed that students’ acne worsened when under
pre-exam stress.
When you’re under stress, your body produces stress
hormones such as cortisol, which stimulate an
overproduction of oil in the skin. When this excess oil mixes
with dead skin cells, it promotes bacterial growth and can
cause acne to develop or become worse. This can, in turn,
lead to more stress, plunging you into a stress-acne cycle.
Review
Definition of acne: Acne is an inflammatory skin
condition that occurs when oil and dead skin cells
block pores.
Types of acne breakouts: Blackheads, whiteheads,
pustules (or nodules), and cysts.
Acne life cycle: Clogged pores, bacteria,
inflammation.
Effects of acne: Past, present, future.
How to treat acne: Unclog pores, control oil (which
helps to limit bacteria), reduce inflammation.
Test Your Knowledge
Congratulations!
You have finished the Acne training course.