Before we can properly treat acne, we first need to understand some simple anatomy of the skin. A good place to start is at
the skin surface. It's composed of dead cells called keratin, which also acts as a protective layer for the underlying living cells.

These living cells are in the spiny layer (under a microscope they appear to contain a series of little bridges). As we continue moving deeper through the inner layers we come to the second layer - the basal cells.

These are constantly dividing and moving closer to the skin's outer surface. All these do is grow and divide on their way to the surface. They eventually mature and become part of the outer layer known as the stratum corneum. This maturing process is
known as keratinization.

In order to understand the physical changes that cause acne, we should look at the microscopic processes that produce it. We all know our skin has many pores, known as follicles. Imagine the follicle as a tube (they don't always contain hairs) extending from the surface layer down deeper into the deeper dermal layer.

This deeper layer of skin, the dermis, is comprised of collagen and elastin, that support the surface layers of. They also provide a home for the blood vessels, nerves and other cells. Just under the dermal layer is a layer of fat that cushions and insulates the skin and contributes to the rounded look of a youthful face. The pores originate from the dermis as a tube. The sebaceous glands branch off of them like clusters of grapes. They are responsible for producing the oily substance - sebum.

Now let's look at what causes acne. Many believe that the primary cause is something called retention hyperkeratosis. This occurs when the dead cells on the surface layers, and also within the follicle,
do not exfoliate properly. When this occurs, the keratin mixes with sebum (oil) making it viscous and sticky and eventually clogging the follicle to become what is known as a comedo.

These comedos come in two groups: closed comedo (whitehead) and open comedo (blackhead). If the lesion is able to eventually drain to the surface it should heal on its own. If it cannot it may develop into a papule and then finally into a pustule which is commonly referred to as a pimple. The inflammation may progress further and cause the lesion to grow deeper through the dermis resulting in a cyst or nodule.

This is due to bacteria infiltrating the comedo. It can cause a condition known as oxidative stress in the surrounding cells. Oxidative stress is caused when free radicals overwhelm the anti-oxidants, which are the cell's natural defense system. This results in changes to the redux status, responsible for
maintaining cell balance by controlling free radicals and antioxidants in the cells.

Under oxidative stress a chemical chain reaction takes place that causes a gene to be turned on which leads to inflammatory chemicals
called cytokines to be produced at the cellular level. This process leads to stickiness within the follicle, which results
in the beginning of the comedo.