Hormonal fluctuations trigger more oil production inside the pore. Normally, this isn’t a problem because the dead skin cells don’t get trapped. But with acne prone-skin, when the dead skin cells shed more quickly and form a blockage, the perfect environment for the P. Acnes bacteria is created. The oil is a nutrient for the bacteria, so the bacteria proliferates. So you see, bacteria is not the “cause” of acne, it is the effect of too many dead skin cells. This is an important distinction to remember.
But, some people don’t get inflamed lesions — inflammation is also an inherited tendency. If the dead skin cells and the oil that form the plug don’t become inflamed, the plug becomes a whitehead; that is, a non-inflamed lesion under the skin, also called a “closed comedone”.
Or the plug can become a blackhead, which is a non-inflamed acne lesion where the pore remains open, also known as an “open comedone”. In the case of a blackhead, the tip of the plug darkens as it is exposed to oxygen in the environment. As the oil in the pore builds up, inflammation can develop in the cells surrounding the pore. Blackheads can be infected or not depending on whether the P. acnes bacteria have affected the cells around the pore.
Part 3 of "What is Acne?"
Content courtesy of Face Reality Acne Clinic
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