Acne Anatomy: How Pimples Form

Article by Cristal G. Orpilla, R.N.

Acne is a common problem many people face.  But don’t let pimples get the best of you.  Technologies have made it possible to keep acne at bay.



Acne. Pimples. Zits. Blemishes.

No matter what they’re called, acne has affected many people- adults and teenagers alike. Acne typically affects anyone, of any race, and at any age, be it 10 or 40. Although acne is a very common problem many people face (pun intended), its highly visible nature is what makes it such a universal complaint. So much so, that for some people, acne can have a deep psychological impact regarding a person’s appearance and self-esteem. Science and technology has made it possible to keep acne at bay, but without an understanding of how acne forms, many people just end up relenting to trial and error when it comes to treating acne.


How Does Acne Form?

While reading labels on various lotions and makeup, the word comedogenic (or non-comedogenic) probably pops up. Comedogenesis is simply the clogging of a hair follicle or pore . This usually precedes acnegenesis, or acne formation. Pore clogging typically happens when sebaceous (oil) glands in the skin produce too much oil, and surface skin cells (known as keratinocytes) start to stick together. The amount of oil produced can be due to hormones, such as the case in adolescent acne or acne that is related to the pre-menstrual cycle. The bottom line is that when the pore clogs up, this becomes a rich nutritional source for Propionibacterium acnes (P. acnes), which is the bacterium responsible for acne formation. Because of this source, P. acnes will start to collect in a specific area. When enough P. acnes gather together in one spot, say the nose for example, the body kickstarts an immune response to try to purge the bacteria. This results in redness, pus, inflammation, and the resulting mound that many people love to pick at. But don’t be a picker!! The nails harbor lots of bacteria, and introduction of such to an area that’s already inflamed will only cause more inflammation. Sharp nails also risk irreversible pick scars that will look deep and depressed.


How acne forms: P. acnes bacteria grows as it munches on oil from clogged pores


How Can I Treat Acne?

So what can be done to prevent P. acnes from wreaking havoc in the skin? There are various ways of killing P. acnes.

Benzoyl Peroxide
Benzoyl Peroxide (BPO) kills P. acnes due tp oxygenation of the affected pore/follicle. Treatments such as cleansers and lotions that contain a concentration of BPO are effective in reducing P. acnes, but it is important to note that because oxidation causes free radicals, prolonged use of higher concentrations of benzoyl peroxide may eventually lead to accelerated aging of the skin.


Who knew the smelly pink stuff that looks like Calamine would work to dry up acne? Sulfur has a dual action because not only does it have antibacterial properties that kills P. acnes, it’s also a good keratolytic that causes the top layers of the skin to loosen and slough off. However, it’s important to make sure to do a patch test first to ensure you are not allergic to sulfur, because it’s known to cause reactions in some people. Also, using sulfur too often will cause overdrying.


Antibiotics such as topical erythromycin and clindamycin also target and kill P. acnes. But caution should be used because there may be a likelihood that the bacteria may form a resistance to the antibiotic over time.


Photodynamic Therapy (PDT)

In a previous article, I wrote that various light systems today are used to improve skin conditions such as acne. Specifically, blue light with a wavelength of about 420 nanometers is absorbed by P.acnes, which leads to the excitation of particles called porphyrins that live in P. acnes. As porphyrins are excited, they break down the bacterial walls of P. acnes and destroys them.

Although blue light alone was clinically shown to improve mild to moderate acne, severe cystic acne needs more power punch. A more powerful form of PDT combines LED light with 5-aminolevulinic acid (Levulan). A Levulan swabstick is first applied on the skin, and left on to “incubate” for about 1-2 hours. A patient is then exposed to LED light (with safety eyeshields on) for a few minutes to activate the Levulan. In addition to killing P. acnes through the use of wavelength-specific lights (the photodynamic part), Levulan acts to shut down sebaceous glands that produce excess sebum (oil).

It is extremely important to note that although Levulan has a high efficacy rate in severe acne lesions, it is not for everyone. Darker-skinned individuals,  with  Fitzpatrick skin types 5-6 are not ideal candidates because they have  a greater chance of hyperpigmenation (skin darkening) from the treatment. It should also be noted that some may feel a burning sensation after photoactivation, which also has subsequent redness, followed by severe peeling of the skin. This lasts a few days, up to about a week of downtime.


Whatever the degree of acne, these different treatment modalities help to control its effects. So even though acne is not curable, it is manageable. Consulting with a skincare professional will help ensure you look and feel your best so you can put your best face forward. How have you treated your acne woes?

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Online Editor, Beauty Writer at Beauty-Goodies
As a New York City-based registered nurse with backgrounds in pharmacology, medical research, medical spa aesthetics, and cosmetic dermatology, Cristal became interested in the ways people go about achieving beauty. When she's not working full-time at Cornell Medical Center or performing aesthetic treatments at a midtown NYC medical spa, she daylights as a beauty writer, and has a penchant for scoring sample sale treasures, bellydancing, playing dress-up, and of course, chatting about beauty goodies.

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