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A major mechanism of acne-related skin inflammation is mediated by C. acnes's ability to bind and activate a class of immune system receptors known as toll-like receptors (TLRs), especially TLR2 and TLR4. Activation of TLR2 and TLR4 by C. acnes leads to increased secretion of IL-1α, IL-8, and TNF-α. Release of these inflammatory signals attracts various immune cells to the hair follicle including neutrophils, macrophages, and Th1 cells. IL-1α stimulates increased skin cell activity and reproduction, which in turn fuels comedo development. Furthermore, sebaceous gland cells produce more antimicrobial peptides, such as HBD1 and HBD2, in response to binding of TLR2 and TLR4.
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What's Going On: You might be all too familiar with these, which tend to make their debut when you’re in high school. "Blackheads, like whiteheads, are blocked pores," says Zeichner. What gives them their namesake color, though, is the oil. It's already dark, but blackheads also have a larger opening at the surface than whiteheads do, meaning air can enter and oxidize that oil sitting inside the pore, turning it even darker.
If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.
Similar to the above natural acne remedies, these acne treatments can be inexpensive and worth giving a try. Best of all, these use products you probably already have in your household, like apple cider vinegar and toothpaste. Use home remedies for acne with caution if you have cystic acne, open sores or inflammatory acne, which are best treated with medical supervision.
That’s good news because the British Medical Journal reports that acne affects more than 80 percent of teenagers and continues in adult life in 3 percent of men and 12 percent of women. In fact, it seems to be increasing, which could be due to autoimmune disease, leaky gut syndrome or allergies, for example. Hormonal factors may play a role in breakouts as well. (1)
How to Handle It: Speaking of touching, don't! Picking it, squeezing it, or poking at it will only worsen the situation. These may disappear on their own after a few days. Otherwise, Zeichner suggests visiting your dermatologist for a shot of cortisone, which will reduce inflammation and shrink it in just 24 to 48 hours. But if a last-minute appointment isn't in the cards, play mad scientist. First, ice the area, and then apply salicylic acid gel, benzoyl peroxide gel, and 1 percent hydrocortisone cream. The combo will calm skin, kill bacteria, and draw out excess oil from the pimple — all things necessary to take this down, says Zeichner.
Doctors aren’t certain what causes it, but the leading theory is that, just like with teen acne, hormones are to blame. “Babies get a surge of Androgen hormones when they’re around a month old, and those hormones can cause enlarged oil glands and, ultimately, acne,” says Dr. Kahn. Oxytocin and Prolactin, which are the hormones that your baby gets from breastfeeding, don’t tend to cause pimples, she adds.
The severity of acne vulgaris (Gr. ἀκµή, "point" + L. vulgaris, "common") can be classified as mild, moderate, or severe as this helps to determine an appropriate treatment regimen. There is no universally accepted scale for grading acne severity. Mild acne is classically defined by the presence of clogged skin follicles (known as comedones) limited to the face with occasional inflammatory lesions. Moderate severity acne is said to occur when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body. Severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.
Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.