The basic cause of acne is still unknown. It seems to be a multifactorial disease in which interaction of several factors play an important part in the pathogenesis. The primary event may be (a) obstruction of the sebaceous duct due to alteration in the pattern of keratinization within the follicle, (b) abnormal sebum production with excess quantities or altered composition or (c) increased bacterial colonization (proprionibacterium acnes and staphylococcus epidermi¬dis of pilosebaceous follicles which furnish the lipases responsible for hydrolysis of sebum triglycerides into free fatty acids. All three mechanisms may be involved. Obstruction of duct leads to forma¬tion of a comedone, the initial lesion of acne. A comedone can be located either in a closed follicle as a 'white head' consisting of lipid and keratin, or in an open follicle as 'black head' consisting of keratin and lipid with melanin deposition. The continual accumula¬tion of keratin and lipid may lead to rupture of the follicular wall and release of its contents into the surrounding dermis provoking an inflammatory tissue reaction.
Acne scars are actually much more common than once believed. Most people will have acne scars that are mild and mostly out of sight. However, some people will have scars that appear significant and downright ugly. The best approach to repair and remove acne scars is to treat the acne right away, as sometimes even mild acne can cause scarring. As a result, that is the best way to minimize the risk of permanent acne scars.
One area that does not very often get addressed when dealing with the causes of acne is the physiological level. Often these physical eruptions are the boy's way of expressing unexpressed emotions - such as anger, frustration and a general lack of self confidence.
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