According to the American Academy of Dermatology, acne is the most common skin condition in the US, affecting up to 50 million Americans every year. Approximately 85% of people aged 12-24 experience at least minor acne.
Over-the-counter commercial acne treatments does not always work and can cause further skin irritation. Prescription acne treatments often contain antibiotics and can lead to antibiotic resistance.
A study of 468 acne patients who were treated with antibiotics found that 178 participants carried resistant strains of one or more bacteria found on the skin.
How Acne Develops
Acne is a disorder of the pilosebaceous unit, a structure in the skin consisting of the hair shaft, hair follicle, erector pili muscle (which causes goosebumps) and sebaceous gland. These units are densest on the face and chest.
The sebaceous gland produces a mixture of fats called sebum, which moisturizes the hair and skin. Hormonal activity can lead to increased sebum production (which is why acne is common during puberty and is one of the symptoms of PMS and pregnancy).
Propionibacterium acnes bacteria grow inside the pilosebaceous unit and feed on sebum. When sebum production is elevated by hormones, the fats combine with keratin (protein) in the skin to form plugs called comedones which block the opening of the hair follicle. Uninflamed comedones appear on the skin surface as blackheads or whiteheads.
The low oxygen levels and excess sebum within the blocked follicles create an environment where Propionibacterium acnes can thrive and multiply. Most of the skin damage associated with acne is not caused by the bacteria itself, but by the body’s immune response to it.
Inflammation is created when white blood cells arrive to fight the bacterial infection. The comedo turns red and swells into a papule, better known as a pimple. A pustule is created when fluid within the inflamed comedo accumulates dead white blood cells.