Acne is caused by propionibacterium acnes (commonly called p.acnes bacteria) trapped in the follicle with sticky sebum and build up of dead skin cells. Some of the key triggers include the following:
- Hormones (androgens) produced at puberty
Androgens stimulate the sebaceous glands to enlarge and to produce sebum.
Monthly breakouts occur when sebaceous glands are sensitive to androgen stimulation. In adults, hormonal acne is generally located on the lower portion of the face including around the mouth and along the jaw-line. - Increased sebum production
The greater the sebum production, the greater the likelihood for acne because the oily sebum must travel up the hair shaft where it mixes with bacteria and dead skin cells that have been shed from the lining of the follicle. - Increased shedding of dead skin cells (hyper keratinization)
During puberty, skin cells inside the follicle shed more rapidly and tend to stick together. Sticky skin cells mix with sebum to form a plug in the follicle. This plug is called a microcomedone (the beginning of all acne lesions). - Bacteria (propionibacterium acnes)
“Plugged” follicles are a breeding ground for bacteria. Some p. acnes bacteria are normal but too much will produce chemicals that can cause inflammation in the follicle and surrounding skin. One of the keys to the problem is that blackheads start as microcomedones 2-3 months before they are visible.
