Acne vulgaris pathophysiology

Inside the pore are sebaceous glands which produce sticky sebum. When the outer layers of skin shed (as it does continuously), the dead skin cells left behind may become ‘glued’ together by the sticky sebum. This causes a blockage in the pore, especially when the skin becomes thicker at puberty.^[1] The sebaceous glands produce more sebum which builds up behind the blockage, and this sebum harbors various bacteria including the species Propionibacterium acnes. Since the body’s natural defense against bacteria is primarily phagocytes (white blood cells), these rush to the site behind the blockage (where the bacteria are). This is what gives some pimples the ‘whiteheads’ (unless the phagocytes are deeper in the skin, which means you can’t see the ‘white’ caused by them). The white blood cells then destroy (by phagocytosis) the bacteria to prevent infection. The pain one may feel when a pimple is present is caused by the widening of skin around the white blood cells.

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