How Does Acne Actually Form?

Acne doesn’t start with the pimple you can see.

It starts inside the hair follicle.

Normally, skin cells lining the follicle shed and make their way to the surface. In acne-prone skin, those cells don’t always shed normally. They can accumulate and mix with sebum, eventually creating a microscopic plug called a microcomedone.

This is the beginning of most acne lesions.

From Microcomedone to Breakout

• If the follicle remains plugged but closed at the surface → closed comedone (whitehead)
• If the plug is exposed at the surface → open comedone (blackhead). The dark colour is caused by oxidation when the material is exposed to air.
• If inflammation develops → papule
• If pus accumulates → pustule
• If inflammation develops deeper within the skin → nodule (often called cystic)

So What Actually Creates Acne?

There are four major processes involved.

1. Too Much or Altered Sebum Production

Sebum isn’t bad, our skin needs it. But increased or altered sebum production can contribute to the environment in which acne develops.

Hormones and genetics can both influence how active our sebaceous glands are.

Depending on the skin, treatments aimed at managing acne and oiliness may include BHA Peels and Laser Treatments.

2. Abnormal Shedding of Cells Inside the Follicle

This is called follicular hyperkeratinization.

Instead of shedding normally, skin cells accumulate inside the follicle and contribute to the initial plug. Genetics can influence someone’s tendency toward this process, which is one reason some people are simply more acne-prone than others.

This is where appropriate exfoliating ingredients, particularly (Beta Hydroxy Acids) BHA, which is oil-soluble and can penetrate into the follicle can be useful.

Chemical and herbal peels may also have a place here by helping manage excess buildup and support healthy skin renewal.

3. Cutibacterium acnes

Called Cuti (cutie) for short 😑. C. acnes isn’t a foreign infection you suddenly “catch.” It’s a normal resident of our skin.

But inside a plugged, sebum-rich follicle, conditions can favour C. acnes, and its interaction with our immune system contributes to inflammation.

This is one of the processes we can target with certain laser and LED treatments.

A Quick Note About LED

Different wavelengths of LED light do different things.

• Blue light works closer to the surface and targets porphyrins naturally produced by C. acnes. These molecules (porphyrins) readily absorb blue light. When they do, they become energized and transfer that energy to oxygen, creating reactive oxygen species (ROS) that can damage the bacteria within superficial follicles.
• Red light penetrates deeper and is used primarily for its anti-inflammatory and skin-repair benefits.
• Near-infrared (NIR) penetrates deeper still and can further support the inflammatory response and tissue recovery.

This is why we may use more than one wavelength when treating acne.

Hypochlorous acid can help kill bacteria on the skin’s surface and calm inflammation, but it won’t clear acne on its own because it can’t penetrate into the follicle where acne develops.

4. Inflammation

Inflammation isn’t just something that happens after acne appears. It’s involved surprisingly early in the acne process.

As inflammation increases, we start seeing those red papules, pustules and deeper inflammatory lesions.

Treatments such as Red/NIR LED and appropriate laser treatments can be useful here because calming inflammation is an important part of managing acne not just getting rid of visible pimples.

So Why Not Just Dry Acne Out?

Because skin still needs a healthy barrier.

Over-cleansing, over-exfoliating and stacking multiple acne products can leave the skin dry, irritated and inflamed, without necessarily stopping what’s happening inside the follicle.

The goal isn’t to attack the skin.

It’s to address the processes contributing to acne while keeping the skin barrier healthy enough to do its job.

Do I Need All of These Treatments?

Absolutely not.

Understanding the different processes involved in acne doesn’t mean we need a separate treatment for every one of them.

For one person, a few changes to home care may be enough. Someone else may benefit from a salicylic acid peel or LED. For persistent inflammatory acne, we may consider laser. And sometimes the best thing we can do is stop doing so much and give an irritated skin barrier a chance to recover.

Timeline and Budget Matter Too

LED can be a great option for helping manage acne and inflammation, but it generally requires more frequent treatments. Laser is a larger investment per treatment, but may make more sense for someone looking for a more intensive approach with fewer clinic visits.

Neither is automatically better.

The right approach depends on your skin, the type and severity of your acne, your goals, how quickly you’re hoping to see improvement, how often you can realistically come into the clinic and what you want to spend.

Bottom Line

The point isn’t to throw everything we have at acne.

It’s to understand what’s happening and choose the most sensible way to treat it.

Why Is It Happening to Your Skin in the First Place?

That’s what we’ll tackle in our next blog: Why Am I Breaking Out?