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The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle. In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle. However, increased production of oily sebum in those with acne causes the dead skin cells to stick together. The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone. This is further exacerbated by the biofilm created by C. acnes within the hair follicle. If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo). In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).
Acne is at least in part due to hereditary factors. Those whose parents have a history of acne are likely to struggle with the same condition. Your genetic makeup can determine how to get rid of pimples, how sensitive your skin is, how reactive you are to hormonal fluctuations, how quickly you shed skin cells, how you respond to inflammation, how strong your immune system is to fight off bacteria, how much oil your sebaceous glands produce, and the list goes on and on. All of these determinants can cause acne to develop more easily and determine what’s good for pimples in your complexion.
Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment. Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it. During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.
Spironolactone is an androgen blocker. It can be used to treat hormonal acne in women (only) by reducing the production of androgens (male hormones) in a woman's body, which can then reduce oil production in the skin. If you're wondering how to get rid of acne overnight, keep in mind that aldactone can take up to three months to start taking effect.
Acne that’s more inflammatory is denoted as moderate acne. This happens when there are occasional nodules and possibly mild scarring. Severe acne occurs when there are a lot of inflammatory lesions, nodules and possibly scarring. It’s also considered severe if the acne is still present after six months of treatment or if it causes serious psychological issues.
Castor oil has anti-inflammatory and antibacterial properties that can speed up healing, making it ideal for breakout-prone skin. Though I recommend using it in very small amounts with jojoba oil, hemp seed oil or coconut oil, along with one of the essential oils above, it’s high in unsaturated fatty acids, vitamin E, proteins and minerals, which can help reduce acne-causing bacteria and inflammation associated with breakouts. It can even help heal scars caused by acne.
Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discoloration and minor skin irritation.