Acne: Nursing pathophysiology

Acne vulgaris, often just called acne, is a skin condition that can be non-inflammatory or inflammatory.

First, let’s look at the skin, which is the largest organ in the body. It provides important functions like protection, sensory perception, temperature regulation, and vitamin D production. Its two main layers, the dermis and epidermis, rest upon the hypodermis, or subcutaneous tissue.

Starting with the most superficial layer of the skin, the epidermis is composed of layers of stratified squamous epithelial cells. There are various bacteria that live on the outer layer of the epidermis as part of its natural flora. Under normal circumstances, these bacteria don’t grow into numbers large enough to become pathogenic, meaning they typically don’t cause infection.

Next is the dermis, which is made up of connective tissue that allows the skin to contract and stretch with body movements. It also contains hair follicles, oil and sweat glands, nerves, immune cells, and blood and lymphatic vessels.

Now, each hair follicle in the dermis is part of a pilosebaceous unit, composed of a short, thin, non-pigmented hair, called a vellus hair, that extends to the epidermis through a pore called the follicular canal; an arrector pili muscle, which makes the hair stand up when it contracts; and one or more sebaceous glands, which produce and secrete oily sebum into the follicular canal and onto the skin’s surface. The sebum acts as a lubricant for the skin and protects from moisture loss.

Finally, the hypodermis consists mainly of adipose, or fat, tissue that provides insulation and padding and loose connective tissue that helps anchor the skin to the underlying muscle.

So, the main cause of acne is blockage of the follicular canals by dead skin cells, bacteria, and sebum. A primary risk factor is being an adolescent or young adult. This is because sebaceous glands are stimulated by the increased amounts of circulating androgens in puberty, causing the glands to grow and increase sebum production, which allows acne to develop more easily. Another risk factor is genetic susceptibility, so an individual is more likely to develop acne if other members of their family have acne.

Now, acne is made up of comedones, which are small bumps on the skin that can be flesh-colored, white, or dark. These comedones form when a follicular canal becomes blocked.