The basic cause of acne is still unknown. It seems to be a multifactorial disease in which interaction of several factors play an important part in the pathogenesis. The primary event may be (a) obstruction of the sebaceous duct due to alteration in the pattern of keratinization within the follicle, (b) abnormal sebum production with excess quantities or altered composition or (c) increased bacterial colonization (proprionibacterium acnes and staphylococcus epidermi¬dis of pilosebaceous follicles which furnish the lipases responsible for hydrolysis of sebum triglycerides into free fatty acids. All three mechanisms may be involved. Obstruction of duct leads to forma¬tion of a comedone, the initial lesion of acne. A comedone can be located either in a closed follicle as a 'white head' consisting of lipid and keratin, or in an open follicle as 'black head' consisting of keratin and lipid with melanin deposition. The continual accumula¬tion of keratin and lipid may lead to rupture of the follicular wall and release of its contents into the surrounding dermis provoking an inflammatory tissue reaction.
Usually acne in later life can be the effect of taking certain medications rather than anything to do with one's hormones. The only exception is a woman's menstrual cycle when her hormones are usually all over the place.
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