Acne is a disease that affects the skin's oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows.

Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but, it can cause scars.

Acne is the most common skin disease. Nearly 17 million people in the United States have it. People of all races and ages get acne. But it is most common in teenagers and young adults. Nearly 85 percent of people between the ages of 12 and 24 get acne. For most people, acne goes away by age 30. But some people in their forties and fifties still get acne.

Most medical literature still maintains that the exact cause of acne is unknown. Actually, from what we have learned, we already know that acne is the result of excess production of sebum by the over-stimulated sebaceous glands and clogged follicles.

The causes of acne therefore can only come from two fronts:

a) Whatever that drives sebaceous glands to work overtime, and
b) Easily clogged pores.

Let's look at the second front--easily clogged hair follicles--first, as this is the cause of acne that is rarely mentioned.

I have always wondered why my acne condition has been so stubborn and long-lasting. While most people have to bear with it for perhaps a few years, I suffered for decades. One day, it dawned upon me that perhaps I was born with an acne condition. Could it be that my pore openings are smaller than the average?

We know that over-production of sebum occurs in the teen years and, as a result, clogged pores and acne breakouts happen to many during this period. What if I were born with smaller pores? It would explain why my acne continued to embarrass me even after I'd passed my twenties. For people with smaller pores, even normal sebum production could have the pores clogged easily, from teen years on and thereafter.

In addition, my hair follicles may have an innate ability to shed skin cells quicker and more often than normal. It has been observed that during puberty, skin cells are shed more rapidly and tend to stick together. This makes plugging the follicle more likely when they mix with sebum. In cases like mine, the shedding machine may begin working overtime after puberty.

To long-term acne sufferers, it's possible that we are born with smaller pore openings, or a higher rate of shedding skin cells, or both. We may simply be equipped with easily clogged pores. Blame it on heredity.

On top of it, our pores can also be blocked readily by certain oil-based moisturizers and cosmetics that contain synthetic chemicals and vegetable oils. If you are often attacked by acne breakouts, change to a non oil-based moisturizer and similar cosmetics. Test to see if artificial make-up is the suspect to your acne condition.    

What drives the sebaceous glands to work overtime is a more complicated matter. It could be because of heredity. It could also be a matter of many other factors.

Why heredity again? We know that when the sebaceous glands are over-stimulated, they will enlarge and secrete more sebum. Western medical researches have identified a number of factors that could cause an over-stimulation of the oil glands. These include:

·     increased production of the male sex hormone androgens at puberty; ·     hormonal imbalance in women at menstruation; ·     other factors that cause hormonal changes, such as stress, not enough sleep, etc.

While these factors could lead to occasional outbreaks of acne for many people, the long-term acne sufferers may inherit these symptoms. There are people who are born with over-sensitive oil glands that keep on producing a higher level of sebum all the time, stimulated or not. These are the people with oily complexions. They are, therefore, more prone to having acne.

There are also people who are born with a hormonal imbalance, an over-production of androgens, or inadequate estrogen. My daughter is a case of the latter. They too, because of heredity, are more likely to have acne breakouts more seriously and for a longer period of time than most people.    

For most people, acne usually begins during puberty when the body starts to produce the male sex hormone called androgens. This is the main cause of acne. The sebaceous glands are very sensitive to androgens. They cause the glands to enlarge and secrete a higher level of sebum. During puberty, the skin cells are shed more rapidly and they tend to mix with the abundant sebum more easily. As a result, there is a greater likelihood that the hair follicle will become clogged and form acne.

Young women tend to have acne flare-ups that coincide with their hormonal changes associated with their menstrual cycle. Likewise, stress and insufficient sleep are situations that can cause hormonal imbalance in our body as well as acne breakouts.

Hormone is known to be the main culprit for acne.

Some things can make acne worse:

• Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts
• Leaning on or rubbing the skin
• Pressure from bike helmets, backpacks, or tight collars
• Pollution and high humidity
• Squeezing or picking at pimples
• Hard scrubbing of the skin.