We can all recognize acne: white heads, black heads and cysts. But do you know what causes acne? Or what treats acne? Or why acne treatments work? Dr. Schultz answers all of these questions in Acne 101.
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Different Causes of Acne Hello. I’m Dr. Neal Schultz and welcome to DermTV. We recognize acne breakouts as puss 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. And 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 which is the fat or the subcutaneous tissue. But what we’re really focussed on here is this long, club like organ in the dermis in the middle layer. And this is the hair follicle. 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 to 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 puss 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 there at sometimes and not there other times, we really don’t understand. But we do know that with the hormonal changes that occur in adolescents, those hormones cause you to make much more oil. And once the oil is working, you’ll 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 the most called the free fatty acid. Free fatty acids are very irritating to the skin, to the inside of the skin, almost like a splinter is rotating to the inside of the skin. Just the way a splinter will often cause a puss bump or puss pimple, free fatty acids are so irritating that cause an accumulation of puss. And that accumulation of puss down here is where your red tender pimple, your puss 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’re conducted out with the oil as the oil flows up and it get carried out. But 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’s 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 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 killed bacteria that’s acting on the oil, you will not get puss pimples or cysts. If you use exfoliants which take dead cells away or dissolve dead cells and 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. Please join me again at dermtv.com. If you have a question, please send it to me by visiting dermt

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