About Face

Procedures Menu

About Face

C H A P T E R F O U R

Acne Scarring

Chapter Four Acne Scarring Types of Scars Scar Treatments Dermabrasion Injections Dermal Punch Grafting Excision Face-lift

TEENAGERS ARE SURELY AMONG the bravest souls on earth, heading into the responsibilities of adulthood even while their bodies work to betray them. Puberty brings with it an increase in male hormones in both girls and boys, which causes all manner of disruption - especially at high school dances - but the worst of it, any teenager will tell you, is acne.

Acne vulgaris is the medical term for the kind of acne that plagues most teenagers. The word valgaris, by the way, is the Latin word for “common”: it is the most common kind of acne. There are other kinds of acne, like acne rosacea, I but acne vulgaris is the kind that, at its worst, causes scarring in about five percent of the kids who are afflicted with it.

Acne vulgaris is a chronic inflammatory disease of the “pilosebaceous follicles” of the skin. As mentioned in the chapter on aging skin (Chapter Two), skin is composed of two layers: the thin upper layer called the epidermis, and a thicker layer below called the dermis. Below the skin is the subcutaneous layer of mostly fatty tissue surrounding essential blood vessels. The “follicles” are small sacs in the dermis layer, each with a canal leading to the surface of the skin. “Pilosebaceous” refers to a unit consisting of a hair follicle, a fine shaft of hair and a sebaceous gland.

Male hormones stimulate the sebaceous glands to increase production of the oily substance known as sebum. Ordinarily, and in the right amounts, sebum is a friendly substance that acts to keep the hair and skin lubricated and supple, with a moisturized appearance. But some teenagers produce too much sebum during the years of hormonal imbalance, and this is where the trouble starts.

As it always does, the basal or bottom layer of the epidermis goes about the business of manufacturing new skin cells. Usually, these cells migrate with sebum to the surface of the skin through the follicular canals mentioned above. This regenerative process slows down with age, but teenagers actually produce a brand new “stratum corneum”, or outer layer of skin, every fourteen days.

(The stratum corneum, also known as keratin, is the top of five thin layers that make up the epidermis. In descending order, the remaining four layers are the stratum lucidum, stratum granulosum, stratum spinosum and stratum basale.)

As the sebum and new cells work their way up to the surface, they can become blocked, especially in the skin of teenagers. This is because the follicular canals are stopped up with an excessive amount of sebum, which is very sticky. The problem gets worse when skin cells unable to reach the surface die and begin to accumulate in the passageway. This build-up of dead skin cells results in a plug called a comedo.

The traffic jam in the follicular canals I’ve just described leads to mere pimples in most teenagers. But in some, an extra factor is at work: a bacteria called P. Acnes. In the unfortunate five percent who go on to develop acne vulgaris, the Propionibacterim Acnes (P. Acnes, for short) bacteria in their system causes inflammation.

The sequence of events is: male hormones stimulate extra production of sebum, which plugs the follicular canals; the problem is made worse by a build-up of keratin and a comedo is created; the comedo finally grows so big that it ruptures through the follicular canals and the sticky keratin seeps out into the dermis; and there, the P. Acnes bacteria causes infection, and the infection causes inflammation. The body’s answer to inflammation below the skin is a scar.

[previous page] [next page]