Chapter 3 Tracing the Evolution of a Pimple

In This Chapter

Following the formation of a pimple

Classifying your acne
Ah, the pimple. It’s the bane of many a school picture and wed-
ding day. Pimples help keep photo retouchers in business.
But for many people, pimples aren’t simple nuisances that pop up
at inopportune times. Instead, they’re a daily reminder that seem-
ingly uncontrollable forces are at work in the skin.
In this chapter, I outline the events that are required to make acne
lesions. (A lesion is dermatologist lingo for any abnormality or
mark of the skin. A pimple is a lesion. A blackhead is a lesion. Your
nose isn’t a lesion, unless you have two of them.) I take you
through many of the conditions necessary for a lesion to form and
evolve: blocked hair follicles, overworked oil glands, and bacteria.
Then I help you categorize your acne in order to understand when
and why different treatments are used on the various types.
Paying the High Price for Oil
Acne lesions originate and mature in the hair follicle, the epicenter
of our acne story. (To get a visual of what a normal, healthy follicle
doing its job looks like, take a peek at Figure 3-1.) Ultimately, in
order for acne to develop, a follicle must be blocked. A blocked fol-
licle isn’t the only condition necessary for acne to form (I detail
the others in the sections that follow), but it’s a big one. So, to talk
about the roots of acne, you need to go directly to the hair follicle.
Technically, the hair follicle and sebaceous gland are called the
pilosebaceous unit (PSU). For simplicity sake, I just refer to the
whole thing as the “follicle” or “hair follicle” in this book.
The hair follicle (actually the PSU) is made up of three components:
 Sebaceous gland: This gland resembles a cluster of grapes
and produces and pumps out a beneficial oily substance
called sebum (pronounced see-bum) that coats and conditions
the hair and skin. The oily sebum is composed of a rich blend
of different lipids (fatty chemicals). Sebum rises to the surface
of your epidermis to keep your skin lubricated and protected.
It also helps makes your skin waterproof. Plus, sebum helps
carry dead skin cells out of the hair follicle and to the exterior
skin so that the body can get rid of them.
In people with acne, there is an excessive production of
sebum. Along with its producer, the sebaceous gland, its
fellow cast member, the hair follicle, and its director testos-
terone (an important hormone), sebum plays much more than
a bit part in the acne story.
 Sebaceous duct: This tiny tube steers the sebum (and the dead
skin cells it carries) from the sebaceous gland into the hair
canal, the part of the follicle through which sebum travels onto
the hairs before it is carried out to the exterior of your skin.
 Hair: I’m talking about the actual hair that sprouts out of your
pores (follicular orifices, or the holes in your skin that your
hair grows out of). Hairs are sometimes called strands or hair
shafts. Hairs are found all over our bodies; well, almost all
over. There’s no hair on your palms, I hope. Hairs help carry
sebum to our skin.