What is Acne?
In simple Language; ACNE = PIMPLES. Mainly it occurs due to the clogging of hair follicles with sebum, dead skin cells, dirt. There is a role of hormones (Androgen), P.acnes microbe, and diet in addition. All of the above leads to inflammation causing Acne and eventually ACNE SCARS in some. 

Acne vulgaris is a common Dermatological disorder of the pilosebaceous unit that has complex pathophysiology and can be triggered by a number of factors. It primarily affects teenagers and can also affect adults. In a recent study, acne ranked 8th most prevalent disease in the world. With regards to gender, acne is higher among women than men in all age groups. 72.3% of teenagers and 30% of adults are known to suffer from Acne. Although acne scars are more commonly seen in men as compared to women.

Where Does Acne Occur?
It is commonly seen on the face, shoulders, chest, and back - the sites of maximum oil glands. Facial acne being the commonest of them all affecting cheeks, chin, nose, and forehead that is also called a T-zone in that order. Oil glands are absent on palms and soles, hence these are the two areas where Acne does not occur.

Development of Acne
The Major factors  contributing to the development of acne vulgaris include the following

How Does Acne Occurs?
Acne occurs when the hair follicle becomes plugged with oil and dead skin cells. They form a plug, and it creates a sebum-rich, oxygen-poor environment, which is ideal for the proliferation of P.acnes. At the same time, the draining duct widens and the sebaceous gland grows larger and wider due to the accumulated material. These bacteria produce enzymes that hydrolyze the triglycerides in the sebum, and this leads to further hyperkeratinization and inflammation. 

This early stage of acne is called microcomedo. Microcomedones occur under the skin and are not visible through the naked eyes. They represent the primary precursor lesions that will evolve into either non-inflammatory or inflammatory lesions.

Types of Acne:

Acne lesions fall into two categories:
a) Non-inflammatory Acne (not red or sore):

• Whiteheads - small white dots on the skin
• Blackheads - small black or brown dots on the skin

b) Inflammatory Acne (Red or Sore):

• Papules - raised red pimples with no white or yellow center
• Pustules - raised red pimples with a white or yellow center
• Nodules - large (over 5mm wide), severe, painful, fibrous lesions not filled with puss
• Cysts - large (over 5mm wide), severe, painful, fibrous lesions filled with liquid or puss

What are white and blackheads actually?
Whiteheads appear as small white spots on the skin surface because the skin cells completely block the pores opening.

Blackheads appear as black or brown spots on the face due to partial blocking of pores by skin cells. Due to partial clogging, skin oil and dead cells can seep out of the pores to the surface up where the contents get oxidized giving a blackhead its characteristics black color.

Whiteheads and Blackheads can heal or they can continue to grow into inflammatory acne.

How do you know if your acne is hormonal?
Hormonal acne is one of the most recalcitrant Acne. Most of the women suffering from hormonal Acne might be a victim of PCOD as well.
1. Acne on your jawline and chin

2. Painful deep seated nodules and cysts

3. Acne flares up with your cycle

4. You have oily skin

5. Acne not coming under control despite various remedies

Does smoking cigarettes cause acne?
A few studies have shown that:

• Smoking tobacco negatively impacts the skin through slowing the healing process, which could in turn, impact how quickly acne lesions heal
• Smoking also increases inflammation in the body. This is partially noteworthy for acne sufferers since inflammation plays an important role in the formation of acne.

Using hand held devices or washcloth while washing your face helps clear acne?
Using hand held devices or washcloth while washing your face will cause irritation and friction leading to something called as FRICTIONAL ACNE. Hence, the best is to wash your face gently with clean fingers.

Washing the skin several times a day with skin products is the best way to fight acne?
washing your face too much can rub your skin of the natural oils it's producing, which may cause it to create more and could potentially lead to more breakouts. Hence, your face should be ideally washed only twice a day.