What is Acne & Acne Scars


Acne is a common skin condition that can affect both teenagers and adults. In men and women alike it is typically triggered by excess sebum. Testosterone enters the sebaceous glands and stimulates sebum production. In men testosterone originates in the male sexual organs, while in women it is produced in the ovaries and adrenal glands.

There are four main factors that contribute to acne:

  1. Overactive sebaceous glands
  2. Cell accumulation
  3. Bacteria
  4. Inflammation
  5. 1) Overactive Sebaceous Glands
  • Sebum production, or excess oil, is the catalyst for acne or skin breakouts. This is often associated with enlarged pores, a tendency toward follicle congestion, and an oily T-zone.
  • When testosterone is secreted into the body and enters into the sebaceous gland, the enzyme 5-alpha reductase converts the testosterone into di-hydrotestosterone. This stimulates sebum formation in the sebaceous glands.
  • 5-alpha reductase is sensitive to hormone levels – an excess production of sebum when testosterone levels escalate, which is seen during puberty.
  • Recent studies have shown that this enzyme may increase its sensitivity to testosterone, triggering excess sebum production even when lower levels of the hormone are present.
  • Scientists have discovered several new ingredients to regulate sebaceous gland secretions by inhibiting 5-alpha reductase enzyme activity and by decreasing overall lipid formation.

2) Cell Accumulation and 3) Bacteria

When acne is present,

  • a proliferation of cells occurs at the neck of the follicle,
  • accompanied by excess sebum that causes the cells to stick together along with bacteria (Propionibacterium acnes=Corynebacterium acnes),
  • the conglomeration of the sebum and cells leads to formation of an impaction plug that provides a nice anaerobic environment for the bacteria to thrive in,
  • this process (abnormal desquamation of sebaceous-follicle epithelium results in altered keratinization) is called retention hyperkeratosis; this first stage impacted follicle is often referred to as a micro comedone.

There are fewer lamellar granules in the Stratum Granulosum of acneic skin which contain the desquamation enzymes and lipids that comprise the barrier layer in the intercellular spaces, this could account for the accumulation of cells in the follicle canal.

Acneic skin is more permeable around the sebaceous gland and follicle, which may lead to leakage and inflammation into surrounding tissue. Studies have shown that linoleic acid, an essential fatty acid that is a component of the barrier lipid layer, is indeed deficient in acneic clients.

The bacteria in the follicle excrete a lipase enzyme to break down the sebum triglycerides into fatty acids and glycerol. The sebum is used as a food source and the free fatty acids are merely waste products that irritate the lining of the follicle. At this point, the disease may result in non-inflammatory lesions and simply produce closed commedones (whiteheads) which may turn into open commedones (blackheads) and expel their contents.

4) Inflammation

Inflamed lesions may also result, whereby the follicle wall ruptures forming a papule:

  • if the break in the follicle is close to the surface, a pustule results,
  • if it is deeper, a nodule forms,
  • in some cases, a membrane entraps the infection and a cyst develops

Regardless, matrix metalloproteinase (MMPs) enzymes are stimulated to help repair the damaged tissue and white blood cells invade the area: this is when inflammation sets in.

Scientists have discovered that specific ingredients can inhibit the lipase enzyme in the bacteria that is responsible for breaking down sebum triglycerides into free fatty acids that are known to cause irritation in the skin. Controlling the breakdown of triglycerides helps minimize inflammation due to the free fatty acids; and since the fatty acids are often attacked by free radicals leading to additional irritation, if we can inhibit the formation of the free fatty acids then we can effectively prevent inflammation before it occurs.

What can be done to treat the affected follicles?

  • Overactive sebaceous glands (i.e. excess sebum production including hormonal fluctuations like those that occur at puberty, peri-menopause, and menopause) can be controlled with ingredients such as Niacinamide to eliminate the bacteria and oily shine.
  • Cell accumulation which impacts follicles and triggers early commedone formations (whiteheads and blackheads) can be controlled with professional and home use exfoliation using ingredients like Salicylic Acid and Lactic Acid.
  • Bacteria formation in the follicles and on the skin’s, surface usually causes irritation due to the fatty acids which are the waste products of the breakdown of sebum (lipase activity) as a food source.  Anti-bacterial agents including Benzoyl Peroxide or Tea Tree Oil can help.
  • The fourth factor which should be controlled is inflammation.  The topical application of anti-inflammatory repair ingredients, botanicals and moisturizers help heal and soothe inflamed skin (some examples are Green Tea and Panthenol).

2.) Cell Accumulation and Bacteria

  • When acne is present a proliferation of cells occurs at the neck of the follicle. This is accompanied by excess sebum, which causes the cells to stick together along with bacteria (Propionibacterium acnes=Corynebacterium acnes)
  • The conglomeration of sebum and cells leads to the formation of an impaction plug. This creates a favorable anaerobic environment where bacteria can thrive.
  • This process (abnormal desquamation of sebaceous-follicle epithelium, which results in altered keratinization) is called retention hyperkeratosis. This is the first stage of an impacted follicle and is often referred to as a micro comedone.
  • There are fewer lamellar granules in the Stratum Granulosum of acneic skin, which contain desquamation enzymes and lipids that comprise the barrier layer in the intercellular spaces of the epidermis. This could account for the accumulation of cells in the follicle canal.
  • Acneic skin is more permeable around the sebaceous gland and follicle, which may lead to leakage and inflammation effecting the surrounding tissue. Studies have shown that linoleic acid, an essential fatty acid that is a component of the barrier lipid layer, is indeed deficient in acneic clients.
  • The bacteria in the follicle excretes a lipase enzyme to break down the sebum triglycerides into fatty acids and glycerol. The sebum is used as a food source and the free fatty acids are merely waste products that irritate the lining of the follicle. At this point, the disease may result in non-inflammatory lesions and simply produce closed commedones (whiteheads) which may turn into open commedones (blackheads) that expel their contents.

3.) Inflammation

  • Inflamed lesions may also result, whereby the follicle wall ruptures forming a papule.
  • If the break in the follicle is close to the surface, a pustule results, if it is deeper, a nodule forms. In some cases, a membrane entraps the infection and a cyst develops. Regardless, matrix metalloproteinase (MMPs) enzymes are stimulated to help repair the damaged tissue and white blood cells invade the area: this is when inflammation sets in.
  • Scientists have discovered that specific ingredients can inhibit the lipase enzyme in the bacteria that is responsible for breaking down sebum triglycerides into free fatty acids, which are known to cause irritation in the skin. Controlling the breakdown of triglycerides helps minimize inflammation due to the free fatty acids. Since the fatty acids are often attacked by free radicals leading to additional irritation, inhibiting the formation of the free fatty acids can effectively prevent inflammation before it occurs.

What can be done to treat the affected follicles?

  • Overactive sebaceous glands (i.e. excess sebum production including hormonal fluctuations, which commonly occur during puberty, peri-menopause, and menopause) can be controlled with ingredients such as Niacinamide. This helps to eliminate the bacteria and oily shine.
  • Cell accumulation, which impacts follicles and triggers early commedone formations (whiteheads and blackheads), can be controlled with professional and home exfoliation, using ingredients like Salicylic Acid and Lactic Acid.
  • Bacteria formation in the follicles and on the skin’s surface usually causes irritation due to fatty acids, the waste products released during the breakdown of sebum (lipase activity). Anti-bacterial agents including Benzoyl Peroxide or Tea Tree Oil can help.
  • The fourth factor that should be controlled is inflammation.  The topical application of anti-inflammatory repair ingredients, botanicals and moisturizers help heal and soothe inflamed skin (some examples are Green Tea and Panthenol).

Acne is a common problem. It can cause severe embarrassment, but treatment is available, and it is effective in many cases.

Call Nell Laser Clinic at 416-228-0011 to book a complementary consultation session for acne and acne scars treatments.

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