Both adults and teenagers can suffer from acne. Even though acne is typically considered a women’s skin problem, men can certainly have acne. Acne breakouts can occur at different stages of life but are more common during puberty or when sebaceous glands (oil glands) are more active. The oil glands are stimulated by androgen in both men & women. Acne is a skin condition that is chronic and inflammatory in nature. Whiteheads, pimples, cysts, papules, pustules & nodules are all types of acne. For some, it may decrease their quality of life and can also be very painful in other cases. The pathogenesis of acne starts below the skin. Conventional topical products only provide a temporary solution as they are unable to effectively penetrate the target site. Even though some topical products may show a visible reduction in acne, they fail to prevent future acne breakouts as they do not target the root cause of acne breakouts.

Knowing acne and its pathogenesis.

Acne vulgaris commonly known as ‘acne’ is a disease of the pilosebaceous unit (comprises hair follicle, hair shaft and sebaceous gland in the skin) that causes non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and various degree of scars.

The first factor in acne pathogenesis is the androgen hormone-induced enlargement of sebaceous glands with the overproduction of sebum. Excess sebum production causes blockage in the pilosebaceous unit and increases cell turnover in the follicular canal thus leading to acne.

The second factor in the pathogenesis of acne is a disturbance in the normal architecture of pilosebaceous follicles mediated by inflammatory cytokines which induce keratinocyte hyperproliferation which initiates follicular plugging and leads to the formation of a thin-walled cystic lesion- comedo. As the keratinocytes and sebum continue to accumulate, the micro comedo wall eventually ruptures and leads to inflammation.

The acne lesions are filled with sebum – a lipid-rich substrate that is a rich source for Propionibacterium acnesis (an anaerobic bacteria that is present on the skin without being harmful) to thrive and proliferate becoming an opportunistic pathogen.

P.acne is involved in the development of inflammatory response and stimulates a cascade of the inflammatory response which in turn activates hyperkeratinization and inflammation. Altered lipogenesis, sebum production, hyperkeratinization, proliferation/differentiation of sebocytes, and cytokine expression can be a reason for the formation of acne lesions. Acne management can be done efficiently only when the exact mechanism involved in the pathogenesis gets attention. These mechanisms play direct & indirect roles in acne pathogenesis.

Acne Grading

There is no universal standard grade for acne grading but acne severity is classified in a more or less similar manner. Acne lesions occur primarily on the face, neck, upper back, and chest. When assessing the severity of the acne, one needs to consider:

• The distribution of acne (back, check, and upper arms)

• Type and number of lesions (comedones, papules, pustules, nodules)

• The presence or absence of scarring.