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At SkinMed we believe that hormonal sensitivity causes the loss of essential fatty acids from the skin and it has been shown that the oil (sebum) of acne sufferers can lose up to 90% of its linoleic acid content. Such a change causes a rapid increase in the rate the skin loses water (trans epidermal water loss - TEWL). This can be damaging to skin cells; the skin responds by increasing oil production and also increasing the rate at which it produces new epidermal cells and also increases the deposition of keratin into these cells. This thickening of the skin and also the increase in oil slows down TEWL.

The problem is that the epidermis also lines the opening of the hair follicle duct where the oil comes out of and as the epidermis thickens the increased number of dead skin cells and the oil can block this hole, which leads to blackheads and white heads. If the area under the plug is colonised by the bacteria p.acnes then a spot and inflammation can result.

The bacteria migrate under the plug because they normally feed on the oil that is produced on the surface but when this supply is stopped due to the blockage of the hair follicle duct, it goes in search of food. P.acnes releases lipase enzymes to break down the oil (triglycerides) to produce glycerol which it feeds on. The other by-products of this breakdown fall off the skin along with dead skin cells during normal exfoliation. However when this happens under the plug, the by-products of this enzyme breakdown are trapped and as they build up they cause an inflammatory response leading to tissue damage and maybe scarring.

So while there are reasons to exfoliate and wash oil off the skin one needs to be aware that this will lead to an increase neater loss again and you can end up exacerbating the condition with increased oil production and skin cell production. Also benzoyl peroxide can damage your langerhan cells (special cells that help protect the skin from UV damage and also are part of the immune function protecting the skin). Retinoids also thin the skin which can also have a negative effect. Salicylic acid is another exfoliant and can dissolve the plug. Antibiotics lead to resistance. So where do you go to clear acne but without the consequences and risks?

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