Clinically, blackheads appear as black dots within an open pore. Whiteheads are small, white raised bumps. Blackheads and whiteheads usually are not inflamed. Inflamed, red bump acne occurs in response to bacteria such as Propionibacterium acnes trapped in the clogged pore.
In contrast to normal pores, acne prone pores are those with lining cells that become abnormally sticky. These sticky keratinocytes can no longer be shed one at a time, but instead become clumps that clog the hair follicle.
About your Pores
Pores are the tiny openings in your skin that are present everywhere on the body except the palms of your hands and soles of your feet. Pores, or hair follicles extend from the top layer of the skin all the way down to the fat. There are specialized oil producing glands called sebaceous glands attached to each hair follicle. If you are genetically destined to have large, very productive sebaceous glands, you have oily skin. In contrast, people with small, minimally productive sebaceous glands tend to have dry skin. In women, most of the pores on the face, chest, and back have tiny, light hairs coming out of them called vellus hairs. These vellus hairs are largely invisible to the naked eye. Therefore, while hair density in women varies by genetics, most have less of the dense and dark facial hair seen in men, whose follicles are more often filled with thick, darker hairs called terminal hairs.
Acne Prone Pores
In contrast to normal pores, acne prone pores are those with lining cells that become abnormally sticky. These sticky keratinocytes can no longer be shed one at a time, but instead become clumps that clog the hair follicle. This clogged pore is the basis of every pimple in every individual, regardless of age, race or ethnicity. The clogged follicle appears on the skin as either blackhead or whitehead. If the sticky keratinocytes remain sealed within the pore and are not exposed to oxygen, a whitehead is formed. In contrast, if these keratinocytes are exposed to oxygen, they become oxidized, and a blackhead results. A bacterium called Propionibacterium acnes is often trapped in the acne prone pore.
This bacteria thrives in the clogged pore and is fed by the oil produced by the sebaceous gland. Whether you are sixteen, thirty-five, sixty-one or ninety-six years old, the bottom line story is the same. If you have acne, your keratinocytes are misbehaving. Your acne lesion begins its annoying life as a microscopic clogged hair follicle, invisible to the naked eye, technically called a microcomedone. The microcomedones forms because the cells that line the follicle become abnormally thick and sticky, clogging the pore. Specifically, your keratinocytes become abnormally thick and sticky in response to adult hormones, leading to what we call a pimple. So, the truth is that acne is really all about hair follicles and hormones. Contrary to popular myths and misconceptions, breakouts are rarely the result of poor hygiene, a poor diet, or evil thoughts. They happen because you inherited a genetic predisposition that directs your keratinocytes to behave abnormally in response to adult hormones. While there are some times abnormal hormone levels, most acne sufferers have normal hormone levels.
Normal Pores
Specialized cells called keratinocytes line all of the pores, or hair follicles on your skin. These hair follicle lining cells live for only a finite period of time, then they die. These dead cells slough off; that is, they are shed or cast off and are replaced by new, healthy cells. The keratinocytes are microscopic, so they are invisibly shed. A few are lost to the washcloth or the stream of water in the shower, while others are lost to an astringent pad or brush of a fingertip. This replacement of lining cells is an ongoing renewal process that occurs throughout your life.