Acne is a chronic inflammatory condition of the skin related to sebaceous glands. It is characterized by formation of small cysts which can have inflammation around (papules), tiny pus inside (pustules), can rise above the skin whiteheads (closed comedones) or can be open to the surface of the skin (open comedones or blackheads). The abnormal increased sebum is produced by the sebaceous glands (seborrhoea) which can be colonized by specific bacteria causing chronic condition, which is not infectious and usually starts in adolescence and is resolved by the mid- twenties.
Acne predominantly occurs on the face, but can also be on the back and chest. In very advanced stages of acne we can see big cysts, disfigurating nodules full of pus and connections (sinuses) between them, which can lead to many types of scarring, keloid formation and post inflammatory pigmentation. Acne develops earlier in girls than in boys, which probably reflects the earlier onset of puberty, however some patients still have problems worthy of therapy up to the age of 35 or more. To a certain degree, we can blame acne for genetic predisposition and abnormal high level of hormonal (androgen) production. Excessive sensitivity to testosterone or lack of SHBG (sex hormone binding globulin) can lead to increased free testosterone level in the body.
However, the androgenic hormonal balance is far more complex because the sebaceous glands are independent of sensitivity to blood hormone levels and other hormones can contribute to the final result.
Other predisposing factors for acne are: Tendency to blackheads and whiteheads, specific skin bacteria like: many types of propionibacterium, malassezia furfur, skin pH, local skin enzymes (lipases, proteases, phosphatases, etc.), excessive immunological reaction, diet, sweating, premenstrual flare and polycystic ovarian syndrome. In an older group of patients, acne can be misdiagnosed for rosacea, eczema, milia, ringworm infection, drug eruptions, zinc deficiency, etc.