Athina Matekovits Dalamaga - Dermatologist - Venereologist

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Acne is probably the most common skin condition worldwide. It can occur at any age, but most people who have acne are teenagers and young adults.

While so common, reliable information about acne seems scarce. Misinformation leads to wrong treatment modalities that are often ineffective or even deleterious for your skin.

Four key players seem to be responsible for the development of acne:

  1. Excess sebum production. Sebum is the oil produced by special glands in the skin. It seals in the moisture preventing the skin from drying out and protects it from contact with irritant environmental agents ( see Information – the skin). Sebum increases dramatically during adolescence when hormone known as androgens boost sebum production. In this way the skin becomes oily.
  2. Clogged pores. Skin pores correspond to the openings of hair ducts on the surface of the skin. Sebum produced by sebaceous glands is normally released to the surface through the openings of the pilo-sebaceous units. Dysregulated maturation of epidermal cells (keratinocytes) cause obstruction of these openings, blocking the normal flow-out of sebum to the surface of the skin. Obstructed pores form “whiteheads” and “blackheads” on the skin, which are called comedos.
  3. Bacterial overgrowth. Propionobacterium acnes (P. Acnes) is a micro-organism found normally on everyone’s skin. In an environment with excess lipids, such as olily skin, it flourishes and causes inflammation.
  4. Inflammation. P. acnes overgrowth and rupture of clogged pores into the skin cause inflammation. Depending on the intensity and the depth of the inflammatory reaction acne may manifest as tender papules with or without pus – “pimples”, nodules or cysts.

Mechanism of acne formation:


The presence or not of inflammation and the intensity of the inflammatory reaction are responsible for the clinical manifestations of the different types of acne. In order of severity, acne is classified as follows:

Comedonal acne (mild acne)

Papular/papulo-pustular acne (moderate acne)

Nodulo-cystic acne (severe acne)

The deeper and more severe the inflammatory reaction, the greater the possibility of permanent scarring after the healing of active acne lesions.

In spite of the fact that acne is self-limited as a disease, it is not recommended to wait and watch without proper treatment. Apart from the disfigurement and the scarring it may produce, acne is also responsible for low self-confidence and may lead to depression. Therefore, acne should be treated properly and in time!

For detailed information about acne treatment modalities click here.