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Acne is a disease of the pilosebaceous units (hair follicles and their associated sebaceous glands). Sebaceous glands secrete a thick, fatty material called sebum and patients with high sebum production have a greater risk of developing acne.
P. acnes is a normal human skin bacterium and is the dominant microbe in sebum. If this bacteria overgrows in sebum, it changes the consistency of the material leading to plugging of the duct. This results in a comedone. If the duct opening is closed, the comedone appears white and is referred to as a “whitehead.” If the duct is open, exposing the sebum to the air, the material turns black and the comedone is called a “blackhead.”
Frequently, P. acnes also irritates or inflames the lining of the hair follicle. The follicle may become a red and tender bump called a papule. Papules may progress to pustules with red bases and puss in the center. If the follicle wall ruptures, it can form a large, painful, solid nodule or puss-filled cyst and often lead to scarring.
Acne can be divided into two general types: inflammatory and non-inflammatory. Non-inflammatory acne is limited to “whiteheads” and “blackheads.” Inflammatory acne is classified as mild, moderate or severe based on the number of lesions present. Severe inflammatory acne includes cystic acne and some patients can have both types of acne at the same time.