Acne in plain English - What is Acne?

A normal follicle

A normal follicle looks like this:

For reasons no one completely understands, follicles, often called pores, sometimes get blocked. Sebum (oil) which normally drains to the surface gets blocked and bacteria begins to grow. Both whiteheads and blackheads start out as a microcomedone. The picture below is a microcomedone:

There are two types of acne:

Non-inflammatory acne

Microcomedones become non-inflamed skin blemishes called comedones--either a whitehead or a blackhead:

Whitehead

When the trapped sebum and bacteria stay below the skin surface, a whitehead is formed. Whiteheads may show up as tiny white spots, or they may be so small that they are invisible to the naked eye.

Blackhead

A blackhead occurs when the pore opens to the surface, and the sebum, which contains the skin pigment melanin, oxidizes and turns a brown/black color. It is not dirt and can not be washed away. Blackheads can last for a long time because the contents very slowly drain to the surface.

A blackhead or whitehead can release its contents to the surface and heal. Or, the follicle wall can rupture and inflammatory acne can ensue (see below). This rupture can be caused by random occurrence or by picking or touching the skin. This is why it is important to leave acne prone skin relatively untouched.

Inflammatory acne

Papule

A papule occurs when there is a break in the follicular wall. White blood cells rush in and the pore becomes inflamed.

Pustule

A pustule forms several days later when white blood cells make their way to the surface of the skin. This is what people usually refer to as a "zit" or a "pimple".

An inflamed lesion can sometimes completely collapse or explode, severely inflaming the surrounding skin, and sometimes engulfing neighboring follicles. These lesions are called nodules or cysts:

Nodule

When a follicle breaks along the bottom, total collapse can occur, causing a large, inflamed bump that can be sore to the touch.

Cyst

Sometimes a severe inflammatory reaction can result in very large pus filled lesions.

Milia

Milia are tiny white bumps that occur when normally sloughed skin cells get trapped in small pockets on the surface of the skin. They are common in newborns across the nose and upper cheeks and can also be seen on adult skin. The bumps disappear as the surface is worn away and the dead skin is sloughed. In newborns, the bumps usually disappear within the first few weeks of life. However, for adults milia may persist indefinitely.

Treatment is usually not indicated in children. Adults can have them removed by a physician for cosmetic improvement.
for complete information on milia.

Ethnic Skin and Acne

Acne and Black Skin

Acne and black skin

Overview: Acne is the most common skin disorder in black adolescents and black adults and is often the primary reason for a visit to a doctor or dermatologist. According to the Journal of the European Academy of Dermatology and Venereology, "Acne vulgaris is an extremely common dermatological problem in Africans and people of African descent worldwide." Despite this prevalence, relatively few studies have been conducted on people with black skin. Not surprisingly, people with dark skin often experience the same intense distress from acne.

What is different about black skin: People with black skin tend to have inflammatory acne, which is the most common type of acne. This is actually good news because inflammatory acne is easier to treat than non-inflammatory acne. Black people also tend to have less nodules and cysts, the more severe types of acne lesions. Despite the fact that black people tend to have less severe lesions, there is a higher chance of keloid scarring, especially on the chest and back, making effective acne prevention paramount. Next, people with dark skin tend to have more incidence of post-inflammatory , a big word that means marks left after acne goes away. This is such a big issue that dermatologists often remark on how their black patients consider these marks worse than the acne itself. Click on the Dark Spots tab above to learn more about how to contend with these dark spots that acne leaves behind.

Pomade acne - a special case: Sometimes the greasy emollients which make up black hair care products can come into contact with the skin and aggravate acne. If you use these products and tend to break out along your hair line or in places where your particular hair style comes into contact with your skin, this may be the culprit.

How to treat acne in black skin: Luckily, inflammatory acne develops and is treated the same way in people regardless of skin color, and with the right regimen is easy to clear. There are several options including topical treatment as well as . According to the International Journal of Dermatology, "benzoyl peroxide is particularly effective for the inflammatory component." Benzoyl peroxide is a mild drying and peeling agent, but people with black skin tend to have less flakiness and scaling of the skin and tolerate it well. I outline a highly effective here on Acne.org.

The bottom line: The first and foremost concern should be prevention. Preventing acne will prevent the dark spots that are often left behind and will also prevent scarring. Concentrate your efforts on clearing up your acne and getting it under complete control. Then, if you choose, you can embark on one of the many methods of hastening healing of the dark spots that are left behind.

Note: People of African descent should not take the antibiotic minocycline to treat acne symptoms. "Fatal cases of hypersensitivity" have been reported with this drug in people of African descent.