Chapter One
The Simple Science Behind
Oily/Acne-Prone Skin
If you have acne-prone skin, you probably have just one burning question: How can I get rid of my acne right now-and hopefully, never have it again? I have both bad news and good news for you. The bad news is that there's no overnight fix for acne. As you'll learn, new skin cells take a full 28 days to grow and mature, so it will take a full 28 days for new, healthy skin cells to get to the surface of your skin. The good news is that acne is not simply a matter of genetics or bad luck. Although you may be more prone to breakouts than people with other skin types, there's a lot you can do to reduce and even eliminate your acne. All it takes is a little knowledge and empowerment-which is exactly what you'll get here in Part One. The even better news is that once you learn how to clear up your acne, your skin type is the least likely to show early signs of aging. Your big, beautiful sebaceous (oil) glands keep your skin glowing, supple, and alive!
In this chapter, we're going to lay the foundation for your skin care routine by explaining the simple science behind your skin's symptoms-specifically, how new skin cells form and what can disrupt this natural process to clog pores and cause pimples. I promise, I'm going to keep this as simple as possible. But it's so important for you to understand how acne forms so you understand how to clear it up!
Did You Know? There are actually six types of acne-prone skin, but I will focus on only the two most common types: oily acne-prone and dry acne-prone. Oily acne-prone skin occurs most often in teenagers or women in their 20s, while dry acne-prone skin occurs most often in women over 30.
How Does Acne Form?
First of all, just as you don't get fat after eating one piece of chocolate cake, you don't get acne overnight. It's a process. So what underlying process results in those blackheads, whiteheads, and pimples you see on your skin? There are four main factors:
- Blocked pores
- Overproduction of oil
- Bacteria colonization
- Inflammation
Any or all of these four factors may be contributing to your acne, so let's dig deeper and see what's really going on beneath the surface!
Step 1: Blocked Pores
The first step is blocked pores. You hear people say all the time, "Oh, my pores are clogged!" You intuitively know that clogged pores lead to the blackheads, whiteheads, and pimples you see. But the real question is, why do your pores get blocked? It all starts way below the surface, down at the cellular level.
Image 1.1: The Layers of Your Skin
The first thing you need to understand is how your skin cells form in the first place. Image 1.1 shows you the three main layers of your skin-the epidermis, dermis, and subcutaneous level (fat tissue). For your skin type, you only need to focus on the top layer, the epidermis.
Image 1.2: The Life Cycle of Skin Cells
Image 1.2 shows you the life cycle of your skin cells. It goes like this: Your new skin cells (technically called keratinocytes) form at the bottom of the epidermis. Those baby skin cells start out as living cells, which means they have cell nuclei (the central part of the cell that contains genetic material) and are nourished by your blood vessels.
As they develop, they gradually mature, flatten, and then die, slowly moving up toward the surface of your skin-a process that takes about 28 days, or four weeks. When your new skin cells die, they become known as corneocytes (dead skin cells), and they're what you see on your skin's surface. In fact, there are about 15 to 20 layers of dead skin cells on the top layer of the epidermis. These cells are continually in the process of sloughing off as newer skin cells move up the epidermis beneath them.
So what does this have to do with your pores? If you look back at Image 1.1, you'll see that the epidermis lies on top of the dermis and surrounds your hair follicles. What you call your pores are simply the openings of your hair follicles. Your sebaceous glands, or the glands that produce the oils that keep your skin hydrated and healthy, are also located here. (We'll talk more about oil production in the next section.)
As part of your healthy skin cell life cycle, the new skin cells are programmed to die at just the right time. Specifically, there's a tiny structure called a desmosome that binds new skin cells together, and it's the desmosome that needs to break down at the right time so the new skin cells can flatten, die, and become dead skin cells that can easily move up to the surface of the epidermis and flake off. It's a constant process of renewal and flow, and it keeps your skin clear, glowing, and radiant.
Image 1.3 shows how the desmosomes bind the new skin cells together, kind of like tape.
Image 1.3: Healthy Skin Cells Learn to Let Go
But if the desmosomes don't break down properly, what should be like Scotch tape becomes more like duct tape, and the new skin cells remain stuck together as they flatten and die. Now these dead skin cells also remain stuck together and do not slough off, which keeps the new skin cells from moving up the epidermis, and the whole process grinds to a halt. Old cells aren't being sloughed off, new cells aren't dying, and the result is a clogged pore, or a microcomedone, the invisible precursor to the blackheads, whiteheads, and pimples you can see. It all comes down to whether the "tape," or desmosome, breaks down at the right time. So pore blockage is the first step in how acne forms.
Step 2: Overproduction of Oil
The second step in acne formation is the overproduction of oil. Your sebaceous (oil) glands should naturally produce the right amount of oil to keep your skin hydrated and protected. You can easily understand how too much oil can be a problem for your skin, but again, what makes your sebaceous glands produce too much oil in the first place?
One primary cause is a high amount of androgens, or male hormones, in your bloodstream. Androgens occur in both men and women; in men androgens are produced in the testicles and in women they're produced in the ovaries. How much androgens are in your bloodstream is determined by another very important hormone called the sex hormone binding globulin (SHBG), which is produced in the liver. When your SHBG levels are too low, the bioavailability of androgens in your blood increases-and therefore also increases in all the tissue your blood nourishes, including your skin and your oil glands. And guess what? Too much androgen in the bloodstream causes your oil glands to produce too much oil!
Image 1.4: When SBHG Goes Up, Androgen Levels Must Come Down
The opposite is also true: When your SHBG blood levels are high, you don't have as many androgens available to bind to your tissues and stimulate so much oil production. Image 1.4 shows the relationship between your SHBG levels and your androgen levels. By the way, have you ever heard women say that when they went on the birth control pill, their acne cleared up?
It's actually a scientific fact, and now you understand why: The birth control pill raises the SHBG levels in your blood, which decreases the availability of androgens, which decreases oil production.
Step 3: Bacteria Colonization
The third step in the acne formation process is bacteria colonization. If the connectors between your skin cells (your desmosomes) aren't properly breaking down and your dead skin cells are sticking together and blocking your pores (step 1), and your oil glands are producing too much oil (step 2), you now have a perfect closed environment for a particular anaerobic bacteria-propionibacterium-to form.
Oxygen naturally kills propionibacterium, but when your pores can't breathe, it thrives. That bacteria is what turns the microcomedones (clogged pores) caused by pore blockage into open comedones (blackheads) and closed comedones (whiteheads)-which can eventually turn into papules and pustules (the zits you can see).
Did You Know? Papules and pustules are also characteristic of rosacea-which often gets misdiagnosed as acne. Both have flareups, but the main difference between acne and rosacea is that rosacea doesn't have open and closed comedones (blackheads and whiteheads).
The scary part is when bacteria colonization gets really aggressive and causes the hair follicle wall under the surface to break; that's when you see the nodules that are characteristic of...
