To understand the physical changes causing acne, we need to look at the microscopic processes behind it. We all know that our skin has pores, dermatologists call them follicles. Imagine the follicle as an empty tube (they may or may not contain small hairs) extending from the top layer of skin down deeper into the dermal layers.

This deeper layer of skin, the dermis, is comprised of collagen and elastin, both support the surface layer of the skin and provide a home for the blood vessels and other types of cells. Just under this dermal layer is another layer comprised of fat that cushions and

protects the skin. It also contributes to the rounded, smooth look of a youthful face. The pore originates from the dermis as a tube. The sebaceous glands branch off of these tubes like small groups of grapes. These glands are responsible for producing an oily substance called sebum.

Now that we understand this let's look at what main causes of acne. Many dermatologists still believe the primary cause of acne to be

something known as retention hyperkeratosis. This happens when dead cells on the top layers of skin, and within the follicle itself,

do not exfoliate properly. When this happens, the keratin (or dead cells) mixes with sebum making it quite viscous and sticky, this thickness causes clogging of the follicle and can lead to a comedo.

These comedos come in two types: closed (whitehead) and open (blackhead). If the lesion is able to drain to the surface it will eventually heal on its own. If it is unable to it may develop into a papule and then finally into a pustule, more commonly known as a pimple. The inflammation may progress further and cause the lesion to grow further through the dermis

resulting in a cystic or nodular acne.

This is due to bacteria getting into the comedo. When this happens the bacteria breaks down sebum resulting in a condition known as oxidative stress in the surrounding cells. Oxidative stress is caused when free radicals overwhelm the anti-oxidants which are the natural defense system of the cell. This results in changes to the redux status, which is responsible for

maintaining the balance between free radicals and antioxidants. Under oxidative stress a chemical reaction happens that causes a gene to be turned on which leads to inflammation chemicals

called cytokines to be produced at the cellular level. This process leads to stickiness within the follicle, which results in the start of the comedo.