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How Acne Forms

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Updated April 28, 2014

3 of 7

Whitehead - Closed Comedone
How Acne Forms
As the sebum from the sebaceous gland and sloughed skin cells, also known as corneocytes, build up, they become compacted and thick. If the opening of the pore is narrow or closed, this becomes a closed comedone, also known as a whitehead.

As sebaceous material builds up, inflammation develops in the cells surrounding the pore. Whiteheads can be infected or not infected depending on whether the P. acnes bacteria have been able to infect the cells around the pore.

Medications that help at this stage include:

  • Over-the-counter benzoyl peroxide kills bacteria and helps prevent P. acnes from overgrowing.
  • Prescription tretinoin products like Retin-A, Retin-A Micro, and Avita reverse the "stickiness" of the skin cells allowing them to slough normally.
  • Over-the-counter salicylic acid 2% lotion is a beta hydroxy acid that also reverses the "stickiness" of the skin cells.
  • Prescription topical antibiotics kill the P. acnes bacteria and might be used if some of the whiteheads are infected.
  • Prescription oral antibiotics also kill the P. acnes bacteria and might be used if many whiteheads are infected or if there are infected papules or pustules.
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