Skin 101: Acne, How it Starts, How to Treat It

Acne 101In writing a post recently, I realized that I didn’t have a good post that explained the basics of pimples, how they start and how the typical over the counter ingredients work to treat it. There’s a reason you see the same active ingredients over and over in over the counter treatment products. There are many ways to target acne, but only a few key ingredients to do that.

Acne PathophysiologyFirst, a brief look at how acne forms. There are obviously many more things involved in this process (and really, no one really understands the entire process. If we did we’d have a magic treatment to prevent all acne). But, to understand how treatments work on acne, you first need to understand the basics of how those blemishes are formed.

1. First, when you have a typical hair follicle, you’ll find a small oil gland off of it. The normal cell cycle is for skin cells to slough off (aka- just basically fall off), and for new cells to be created underneath to replace them.

2. For some reason, within the hair follicle some of these cells will start to accumulate and clump together, rather than just going out as they usually do. As this happens, the oil production will increase some, the cells will clump together more, and the sides of the hair follicle will start to have inflammation. The inflammation contributes to more skin cells sloughing, clumping, more oil, etc. It basically becomes a downward spiral. The hair follicle starts to get clogged with oil and clumped skin cells.

3. As the hair follicle gets clogged with debris, you’ll notice that rather than just having the walls of the hair follicle with inflammation, some of those cells will start to move into the debris as well. These are various types of white blood cells, and when they accumulate together you probably know them better as pus. Around this time you’ll also have bacteria entering the mix. Typically this is p. acnes, which is usually just found around on your skin and such. It loves to eat oil, so this environment is perfect for it to thrive.

4. As the process spirals more and more out of control that hair shaft just fills up with everything. It will get big and swollen as it fills with sloughed skin cells, inflammation, bacteria and more sebum. You may even have the shaft rupture, allowing everything to infiltrate into the surrounding skin. That’s not so bueno. If it is severe enough you might even see scarring later on down the road.



  1. February 21, 2013 / 4:42 pm

    This is a great thorough review, Christine! I will share this with my skin-savvy readers.

  2. February 22, 2013 / 11:57 am

    This is such great advice! I was prescribed Lymecyline antibiotics for my mild acne, and combined with a good ol' face wash every morning and night, my face has never been so clear!
    Another great post!
    Jennifer xx
    Please check out my blog at

  3. February 22, 2013 / 5:15 pm

    This is excellent! I have had acne for 50 year (amazing but truly I've had it since I was 10 and am soon turning 60)and you have covered everything that they know today about acne. One the biggest lessons I learned was the need to always moisterize no matter how oily your face seemed. Like you explained so well, all those dry flakey cells are the devil when it comes to zit formation!

  4. February 24, 2013 / 6:51 am

    Wonderful post thanks – so helpful! I LOVE using lavender and tea tree oil in acne washes and moisturizers (even have a really nice non greasy recipe for acne serum thats antibacterial) and like your ideas on calming iinflammation Cheers

  5. March 8, 2013 / 6:48 pm

    Thank you for the great info on acne! I've noticed that my 13-year-old daughter is developing acne on her forehead and back. I want to help her but I don't know how to talk to her about it–she is super sensitive about many things and I'm worried she will shut me out even though I'm trying to help (I do speak lovingly & gently to her). Wish me luck ๐Ÿ™‚

  6. March 8, 2013 / 8:21 pm

    APE- that can be a hard talk! I HATED whenever it was brought up with me when I was a teen, though part of that might have been because it was my dad who brought it up (he's a pediatrician) and he was prescribing me things that I hated. (I had Gentamycin pads for my face, they made is super dry and tight, though they got rid of the pimples)

    Anyways, you might want to check out Bonding over Beauty, it will help you navigate some of those tricky things over the next few years!

  7. March 10, 2013 / 12:22 am

    Thank you for the encouragement! And I just read your post on Bonding over Beauty–my library doesn't carry it, so I'm going to buy the e-book this evening! What a fantastic resource. Thanks again, Christine!

    (April) ๐Ÿ™‚

  8. October 25, 2013 / 10:04 pm

    Very well written and informative article on acne! The being patient part is probably the hardest part for everyone!!

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