Science Questions

Is there a cure for spots?

Sat, 8th May 2010

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Question

Connor asked:

Why do we have spots and some people have acne and others don't? Is there a possible cure?

Answer

If you look at skin and if you look closely, youíll see that on the surface of the skin there are lots of little tiny pits or holes.  Those are pores.  These are tiny little glands, or the openings of little glands from glandular tissue which is deeper in the skin.  That glandular tissue produces various chemicals, mainly oil based ones including sebum which oozes out from the gland and nourishes the overlying skin and also controls the chemical environment of the overlying skin.  It controls, for instance, the growth and proliferation of various microorganisms.

The thing is, these glands are very sensitive to androgens, testosterone-like chemicals in the blood stream.  When a person goes into puberty, the time when the secondary sexual characteristics form, the levels of testosterone in both girls and boys increase enormously.  This makes the gland tissue in the skin dramatically increase its productivity of these oily chemicals and as a result, the skin becomes a lot greasier which can affect the proliferation of certain micro-organisms.  Certain microbes survive better under those conditions and it also means that itís more likely that the little ducts that drain those glands can become obstructed, either by the oil itself or other things applied to the skin like creams, lotions or just dirt and grime.

If they become obstructed because theyíre producing much more material, then bacteria, which can get into them, can overgrow within the blocked gland and the overgrowth of the bacteria can then trigger inflammation.  When you have inflammation, the immune system comes in and attacks the bacteria, and in the process it produces inflammatory chemicals that open up blood vessels, they wind up nerve cells and they also attract other components of the immune system which makes the area get red, hot, swollen and tender.

As the micro-organisms are attacked by the immune system, the white blood cells that come in to do that can also die in the process.  This is what produces pus, or the yellow stuff you get inside a spot. Itís a good idea not to squeeze a spot, because although sometimes the stuff can come out in the right way, what can happen is instead of splurging out the front, the pus-y inflammatory debris inside the spot can sometimes go sideways into the adjacent skin tissue.  This spreads the infection and also increases the degree of inflammation and this in turn can damage the underlying skin tissue which can produce more swelling and if itís very bad you can get scarring.

Some people are more prone to spots than others.  Probably because some aspects of their genetic make up might mean that they have certain populatons of bacteria on their skin that are more likely to provoke spots.  It may be that theyíre more sensitive to testosterone and androgens and this makes their glands produce more of this oily material in the first place.  Both of those in combination can conspire to make some people more prone to acne and spots and they way they react to those bacteria with inflammation for example.

So the long and the short of it is that unfortunately itís a consequence of growing up.  As you get older, the amount of testosterone being produced in surges drops a bit and therefore the skin acclimatises and becomes less greasy.

But for people for whom itís a big problem, you donít have to suffer in silence because there are some good treatments.  In people who have chronic cases,  antibiotics are very effective.  Members of the tetracycline family of antibiotics are very good and taken for about 6 months, they can sometimes eliminate the bacteria that are causing the problem and prevent any more skin damage.  This means the skin then has a chance to recover.  If it does recur you can simply start the antibiotics again.

Obviously antibiotics are dramatic measure and so you should try and use simple measures first.  Soap and water to get rid of the excess oil and then things like benzoyl peroxide creams which can help to take off the excess skin and stop the ducts from getting blocked in the first place.  But it is a big problem, luckily it does tend to improve with age.

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