You recognize acne breakouts as pus pimples, cysts, red bumps, whiteheads, blackheads, but what are they? What’s going on here? What’s broken? In order for me to explain this to you, I need to use a diagram of your skin. Your skin has three parts—it has an upper layer, which is the epidermis, which isn’t much of a problem here, it has a middle layer, which is the dermis, where all of the equipment, where all of the machinery in your skin is, and that’s exactly where the problem is, and then it has the bottom layer, or the fat or the subcutaneous tissue. But what we’re really focused on here is this long, club-like organ in the dermis, in the middle layer, and this is the hair follicle, and the hair follicle has the hair bulb and the hair shaft that comes up through this canal and comes out through the skin. The troublemaker is this little bulge on the side of the bottom of the hair follicle. That’s the oil gland which is also called a sebaceous gland, and that’s where you make your oil. When the oil gland makes its oil, through a little duct, it conducts the oil into the shaft of the hair follicle, comes up the shaft and onto the skin. So what’s going on here? The real problem in acne is oil, because if you don’t have any oil, and if the oil gland isn’t working, you can never have acne, that’s why Accutane cures acne, Accutane stops oil. But when you do have oil, oil combined with bacteria will cause inflammatory acne down here and inflammatory acne is pus pimples and red tender pimples and cysts, and oil up here with dead cells from the lining of the hair follicle, will cause non-inflammatory acne which is whiteheads and blackheads.
So let’s come back here to the bottom where the bacteria are. Why are there bacteria down here at some times and not at other times? We really don’t understand, but we do know that, with the hormonal changes that occur in adolescence, those hormones cause you to make much more oil and once the oil is working, you are set up for acne. The bacteria, which tend to live down here, take the normal oil, which is called triglycerides, and it splits triglycerides into a couple of things but one of them is called a free fatty acid. Free fatty acids are very irritating to the skin, to the inside of the skin, almost like a splinter is irritating to the inside of the skin and, just the way a splinter will often cause a pus bump or a pus pimple, free fatty acids are so irritating, they cause an accumulation of pus and that accumulation of pus down here is where your red tender pimple, your pus pimple, and your cysts come from. On the other hand, having nothing to do with bacteria, the lining of the hair follicle and the hair shaft has dead cells just like on the surface of your skin and they fall off, and as they fall off, they are conducted out with the oil, as the oil flows up, and they get carried out. Well, what happens if those dead cells and the oil forms a mix like cement and gives you a clog? That clog over here doesn’t know that there is more oil being made, and the body doesn’t know that there is a clog, so you make more oil behind the clog and that’s how you get a blackhead or a whitehead.
So now that we understand what’s going on with whether it’s inflammatory acne or non-inflammatory acne, we can understand why treatment works. Antibiotics kill bacteria. If antibiotics kill bacteria that ‘s acting on the oil, you won’t get pus pimples or cysts. If you use exfoliants which take dead cells away or dissolve dead cells in clogs, those exfoliants can get into the channel here and dissolve the clog and allow the oil to flow. That’s why the exfoliants help treat non-inflammatory acne like whiteheads and blackheads. So the next time you see a pimple, at least you’ll understand what it is but, more importantly, why your treatment works.