Acne is the result of hormones stimulating the pilosebaceous unit, which is defined as the hair follicle and the sebaceous (oil) glands that are attached to and empty into it. As the hormones stimulate the whole thing, the result can be either excess facial hair for women (see hirsutism) or acne, or both.

The oil joins with dead skin cells in the mouth of the follicle (pore) to form a plug. When the oil can't get out, it fills up and stretches the follicle. This causes an environment friendly to acne-causing bacteria, and an infection results.

The contents of the follicle are now inflamed, and it is not until the pus from the inflammation works its way to the surface that the pimple can break and drain.

If you squeeze when the inflammation is still down underneath, the infected contents have nowhere to go but to break out of the follicle into neighboring tissue. This up-to-now sterile tissue sees all this as a foreign invasion and sends in its antibodies which put up a fight, and then you have a deep, sore, cyst. All this infectious activity can lead to scarring.

The tendency to acne is hereditary, but it can be aggravated (though not caused) by a greasy diet, a dirty workplace, and touching with the fingers.

To take care of acne, you need to cleanse gently with a good cleanser. If you have an effective cleanser, you will not be tempted to scrub. After all, the tissue is sore and inflamed and needs gentle treatment. If you have active acne, use a clean washcloth every time.

Then you need to treat the acne bacteria with benzoyl peroxide (BP). The acne bacteria are anaerobic; the BP gets down into the follicle and releases oxygen on them. Some claim that a dab of tea tree oil (from any health food store) does just as well.

BP needs to be used preventively, over all the affected area. Put it on for a short time at first, then work up to once a day or even twice a day, leaving it on. Your skin may get dry and irritated at first, so go slowly; the skin will adjust. It's best to start with lower-strength formulas, such as 2.5% for mild acne, 5% for moderate, and 10% only if things are really bad.

You also need to exfoliate the old dead skin cells so that they won't clog the pores and cause the situation in the first place. For this we have a glycolic or other hydroxy acid.

A regimen of washing, exfoliating, and medicating should keep the acne under control. Your local esthetician will probably offer acne facials, and that is an excellent way to see improvement fast. S/he may use high-frequency current to dry and sterilize the affected area.

A good way to start home care would be a glycolic acid cleanser and a tube of benzoyl peroxide gel: 5% for moderate acne, 10% for a bad case. The next step would be to add a daily glycolic acid or salicylic acid product for better exfoliation. Another way would be to use a benzoyl peroxide cleanser and then later add a topical glycolic or salicylic to exfoliate.

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