AcneNet This Month
June 1999

Sometimes young people ask "Why me?" when they see blackheads (open comedones) and whiteheads (closed comedones) developing. Especially during the ages 12 to 20 when young people are anxious to look their best, the development of comedones and acne can seem like a social misfortune for which they are individually selected.

Actually, almost the opposite is true. Studies of thousands of young people have shown that comedones occur in 60 to 80 percent during their early to mid-teens. In a proportion of these young people more severe acne follows the development of comedones, reaching a peak three to five years after the first comedones appear.

Sometimes, what appears to be comedones in a young person is actually enlarged sebaceous follicles, especially around the chin and nose. Enlarged sebaceous follicles can be a normal phenomenon in the young person, but when the young person is concerned about the possibility of acne he or she may misinterpret the enlarged follicles as acne.

The "acne of adolescence" very frequently disappears after about age 20 to 25. However, a person should not just wait for acne to go away by itself. Whether acne of adolescence is mild or more severe, there is a lot that can be done to keep acne under control and improve the appearance of the skin (click on Acne treatments).

And, just because comedones and acne are so common during the teen-age years, there is no reason for a young person to say "I just have to put up with it". Information from resources like AcneNet can help you manage mild acne, and a dermatologist can help you manage more severe cases.

Fact of the Month

Comedones arise from sebaceous follicles on the surface of the skin. It is interesting to know that there are three kinds of follicles on facial skin, where most comedones occur. Only one kind, the sebaceous follicle, usually gives rise to comedones.

Beard follicles are follicles from which long, coarse beard hairs grow. Beard follicles are seldom involved in acne—maybe, some but not all investigators believe, because the beard hair acts like a wick helping to drain oily sebum from the follicle and thus preventing obstruction of the follicle.

Vellus follicles are follicles with small openings at the surface of the skin, each follicle containing a tiny hair and large sebaceous glands . Some investigators believe that vellus follicles are seldom involved with acne.

Sebaceous follicles are large follicles with large pore openings that may be visible on the surface of the skin. The sebaceous follicle contains a tiny hair, large sebaceous glands, and a canal that carries sebum produced by the sebaceous glands to the surface of the skin. Acne lesions arise most often from sebaceous follicles.

Why should sebaceous follicles always be the origin of acne? Some investigators believe that something—perhaps a change in the body’s production of hormones—can cause the biochemistry of sebaceous follicles to change. When this happens there is an abnormal production of cells and sebum within the follicle and it is this thick slurry of sebum and dead cells that plugs the follicle and causes a comedo to form. Investigations with biochemistry techniques and with the electron microscope have shown the sebaceous follicle to be a dynamic "factory" of complex chemicals. More research may one day find out exactly what "turns on" this factory to abnormal production.

Question of the Month

Each month we pose a question that is answered the following month. This month’s question:

What is sebum?

We’ll have the answer, and a discussion of the answer, on AcneNet next month.

Answer to Last Month’s Question of the Month

Last month’s question was:

Why does it take so long for the redness to go away after an inflamed acne lesion heals?

Answer: The macule that remains after an acne lesion heals is a localized inflammatory reaction that can last from a few days to a few months.

After an inflamed acne lesion heals, a localized area of redness often remains for up to a few months afterward. This is a macule. Macules are flat lesions and can be the end result of most inflamed acne lesions, and although they are an indication of localized healing they can contribute significantly to the unsightliness of acne.

After an inflamed acne lesion heals, a nonspecific inflammatory reaction remains around the sebaceous follicle that was involved in the acne lesion. White blood cells of the type that are involved in inflammation continue to cluster around the follicle and adjacent blood vessels. The extent of the macule is usually directly related to the initial severity of the preceding inflamed lesion. There also may be structural damage to the sebaceous follicle if the preceding lesion was severe.

The macule is an external sign of healing after localized inflammation. A dermatologist may be able to recommend measures to moderate the macule’s persistent redness.