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Two Types of Acne
Young woman before and after acne treatm

Acne 101

What Is Acne Exactly?

Acne is definitely a four-letter word for people who suffer with it. It is an inherited disorder of the pores – pores that want to sludge up with dead skin cells much like a clogged drain in your sink. Normal pores shed about one layer of dead skin cells per day inside the pore. The acne-prone pore sheds up to five layers of dead skin cells per day and the body just can’t keep up. Technically, this is called “retention hyperkeratosis” — a condition where dead skin cells shedd more quickly than the pore can expel them. This forms congestion under the skin which are non-inflamed acne lesions (blackheads and/or whiteheads), and if bacteria is present (which just loves to feed on the dead skin cells and oil), you will get inflamed pimples, pustules and/or cysts.

Two Main Types of Acne

Most people have a combination of the two.

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Non-Inflamed Acne


Dead skin cells and oil (plus other debris) form a plug inside the pore. If this plug does not become inflamed, it can become a whitehead — a non-inflamed lesion under the skin, also called a “closed comedone.” This is also called “maturation arrest” acne, as it has not “matured” into a blackhead yet. There is another non-inflamed acne lesion called a blackhead, where the pore remains open, also known as an “open comedone.”  In the case of a blackhead, the tip of the plug darkens as it is exposed to oxygen in the environment.

Understanding Non-Inflamed Acne


Understanding Inflamed Acne

As the oil and the dead skin cells build up, they put pressure on the cells surrounding the pore. With enough pressure, the sides of the pore rupture and the contents of the pore leak into the surrounding skin. Because this material contains a lot of P. acnes bacteria, the surrounding skin now becomes infected, creating a red bump that we know as a pimple. The medical term for this red bump is an inflammatory papule. This is a pustule which is different from a pimple only in that it contains white blood cells. When the immune system fights off the P. acnes infection the white blood cells, which are soldiers of the immune system — pile up, creating pus in the pore. In addition to papules, nodules can also form. A nodule is a solid dome-shaped lesion that extends below the surface, deep into the layers of the skin. Scarring is common with nodules and can sometimes leave an impaction behind, which can flare again and again. When a group of pustules cluster together under the skin, they form a cyst. An acne cyst can appear similar to a nodule, but is pus-filled, and can have a diameter of 5mm or more across. They are usually very painful and scarring is also common with cysts.

Inflamed Acne

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We Take the Mystery Out of Acne


Acne is a mysterious disorder, but one thing IS for sure – it can be controlled with the right combination of products used in the correct way. Just as in a clogged drain, the pore must be treated with products that unclog it, keep it unclogged and kill the acne bacteria.


Real Solutions

E SKIN Forté has a clear-skin system that will have your acne under control in about three-to- four months depending on your type of acne. We combine the power of clinical-grade home-care products that are customized for your type of acne and skin with a series of bi-monthly treatments that facilitate the clearing of your skin.

Factors that Influence Acne

Women have about one-tenth the androgens (“male” hormones including testosterone and DHEA-S) men have, but these androgens contribute to the acne problem. When estrogen levels drop approximately two weeks after menstruation, testosterone, an androgen, stimulates the oil glands. Oil production increases, making an acne flare-up much more likely. So likely, in fact, that over 60% of acne-prone women get premenstrual acne, hormonal acne flares which occur about 7-10 days before their periods.

Birth Control &


Pregnancy &


Premenstrual Syndrome


Perimenopause &



Research shows that acne severity correlates highly with increased stress. Primarily, stress stimulates the adrenal gland and in the acne-prone individual, and the adrenal gland promotes oil production which leads to clogged pores. Continual stress is one of the top triggers related to the factors that contribute to acne development. Research has shown that acne is significantly associated with internal stress levels, and that chronic stress can make existing breakouts worse because chronic stress increases levels of stress-related hormones such as cortisol (from the adrenal glands) send skin’s sebaceous (oil) glands into overdrive, which mixes with dead skin cells and breakout-causing bacteria.


Food contains high iodides. Iodized salt, seafood, fish, seaweed, fast foods and dairy products. Milk and cheese is another BIG culprit – not only does it have iodides, it also has hormones in it that contribute to acne. Many teenage boys love to drink gallons of milk which is contributing to their cystic acne.) Contrary to popular notion, chocolate and greasy foods (unless they contain salt, which most do) do not aggravate acne. Stay away from “High androgen" foods. These are found in peanuts, peanut oil, peanut butter, corn oil, wheat germ, shellfish, organ meats (i.e. liver, sweetbreads and heart). These contain hormones that exacerbate acne.


 Smoking can be a culprit when it comes to acne. According to German researchers from Technical University of Munich, report the results of a study which found that smoking is a clinically important contributory factor to acne prevalence and severity.



Vitamin supplements and sports drinks/bars that again high in Iodides and especially kelp tablets (some people take these for thyroid support) are a part of this list. Vitamins almost always contain some form of iodide – it could be in the form of iodine, iodide, potassium iodide or kelp. Also, vitamins contain biotin and B-12 both of which make acne worse. Be careful with protein bars – they often have potassium iodides in them. Whey and soy protein powders for smoothies can be bad for problematic skin.

Birth Control

Birth control pills, IUDs, implants and shots are widely used today and prescribed often as a means to control acne. Most forms of birth control can have the potential to cause acne and weight gain in those susceptible. Typically, birth control is divided up as estrogen or progestin dominant and has varying degrees of androgenic (testosterone like) effects. As a general rule of thumb, those with the potential for higher androgenic symptoms should avoid birth control because in people prone to acne it can promote or worsen acne.

Certain Skincare Ingredients

 Do not ever put anything on your skin or your hair without checking the ingredients first, even if it says “Won’t Clog Pores” or “Non-Comedogenic” on the bottle. No government agency oversees this, so skincare companies can claim their products promote clear skin but still have pore clogging ingredients in their formulas. Click here for list of ingredients to avoid in all of your products; skin care, acne care, makeup, clothing and hair. Take a look at your current set of products from your shampoo to your laundry detergent and see if they contain any pore clogging ingredients. If they do, it’s time to look for something acne safe. 

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