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1BChapter 2—The Truth About Acne 27 Acne and The Immediate Causes Acne is usually described as an inflammatory skin disease. The inflammatory response is influenced by many “on-the-surface” factors such as the over- production of sebum (oil) and keratin by the sebaceous glands. This over- production of oil clogs the hair follicle and leads to bacterial growth. The bacteria multiplies and causes inflammation, and the result can appear in the form of what is known as a blackhead (an open comedo) or a whitehead (if it's below the surface). The Immediate Causes of Acne Basically, the process of acne formation can be divided into 4 major external causes: 1)Blockage of the pore This occurs when the epithelial cells lining the pore mature and die. The epithelial cells turn from keratinocytes to corneocytes and become flatter and tougher. These scaly, rough corneocytes block the pore. 2)Too much skin oil (sebum) This is caused when there is a large presence of male hormones that circulate in the blood stream. These hormones trigger the oil glands to produce excessive amounts of sebum. 3)Bacterial colonization Clogged pores, extra amounts of sebum and certain blood toxins create the perfect environment for acne bacteria to multiply and thrive inside the microcomedo. 4)Infection and inflammation of the comedo and surrounding tissue. Certain substances found within the cell walls, where the bacteria multiply, stimulate the immune system to produce localized pro-inflammatory hormones 2003 - 201 2 A c ne N o M or e- M ik e W a l d en - Page 27