A pimple is a small pustule. Pimples are small skin
lesions or inflammations of the skin - they develop when sebaceous glands (oil
glands) become clogged and infected, leading to swollen, red lesions filled
with pus. Pimples are also known as spots or zits. The
development of pimples is primarily connected to oil production, dead skin
cells, clogged pores and bacteria (although yeast infection can also cause
pimples to develop). Sebaceous glands, which are located at the base of hair
follicles, can become overactive due to hormone disregulation, which is
why acne is most commonly associated with puberty, and why
breakouts occur around the time of menses. The most likely parts of the body to
be affected by pimples are the face, back, chest and shoulders due to the
proliferation of sebaceous glands in these areas of skin. Pimples are a sign of
acne, especially when a breakout occurs. Dermatologists and other experts are
increasingly concerned about the long-term use of antibiotics for acne
treatment, and its contribution to bacterial resistance. Experts from the
Center of Evidence-Based Dermatology at the University of Nottingham, England,
wrote in The Lancet that although pharmacies are well stocked
with a wide range of acne medications, few studies have been carried out
regarding their efficacy.
Sebaceous glands
A diagram of the sebaceous glands (image by Open Stax
College)
The sebaceous glands are tiny skin glands which secrete
sebum - a waxy/oily substance - to lubricate the skin and hair of mammals,
including humans.
Sebaceous glands are found all over human skin with the
exceptions of the palms and soles. There is a greater concentration of
sebaceous glands on the face and scalp. At the rim of the eyelids, Meibomian or
tarsal glands are a special kind of sebaceous gland that secrete meibum, a
special type of sebum that helps maintain the eye's tear-film by preventing
evaporation.
Several medical conditions are linked to an abnormality in
sebaceous gland function, including:
- Acne (pimples).
- Sebaceous
cysts - closed sacs or cysts below the surface of the
skin.
- Hyperplasia -
the sebaceous glands become enlarged, producing yellow, shiny bumps on the
face.
- Sebaceous
adenoma - a slow-growing tumor (benign, non-cancerous)
usually presenting as a pink, flesh-colored, or yellow papule or nodule.
- Sebaceous
gland carcinoma - an aggressive (cancerous) and uncommon skin
tumor.
If a breakout occurs, doctors recommend that pimples be
treated promptly to prevent the risk developing severe acne. There is also the
danger that untreated severe acne may result in visible scars on the skin.
Causes of pimples / zits
The sebaceous glands, which produce sebum, exist inside the
pores of our skin. The outer layers of our skin are being shed continuously.
Sometimes, dead skin cells are left behind and get stuck together by the sticky
sebum, causing a blockage in the pore. Pore blockage is more likely to occur
during puberty (the process of physical changes by which a child becomes an
adult capable of reproduction) as the sebaceous glands produce more sebum at
this time. Where sebum and dead skin cells accumulate and block a pore, this
encourages the growth of undesirable bacteria, including Propionibacterium
acnes - the slow-growing bacterium linked to acne. Propionibacterium
acnes generally exists harmlessly on our skin; however, when the
conditions are right, it can reproduce more rapidly and become a problem. The
bacterium feeds off the sebum and produces a substance that causes an immune
response, leading to skin inflammation and spots. Researchers at the
Washington University School of Medicine identified two unique strains of P.
acnes in the skin of 20% of people with pimples, while those with
healthy skin tended not to harbor these strains. The situation was reversed for
another strain of P. acnes: those with pimples tended not to harbor
this strain, but it was present in healthy skin. As such, it seems
that particular types of bacteria determine the severity and
frequency of pimples.
Pimples and acne have also been linked to yeast infections,
with a group of yeasts called Malassezia thought to be the key
culprit. These yeasts grow on the skin of the forehead and chest, but rarely on
the sides of the face, and do not inhabit the same pores as P. acnes.
As such, treatments that seek to eradicate these yeasts or P. acnes can
unwittingly create ideal conditions for the other.
People prone to acne have been found to have skin that is
especially sensitive to normal blood levels of testosterone - a
natural hormone found in both males and females. In such people, testosterone
can trigger the sebaceous glands to produce excess sebum, increasing the
likelihood of clogged pores.
Despite being related to bacterial infection, pimples are
not contagious. You cannot catch pimples from another person.
Researchers from New York University reported in the Journal
of the Academy of Nutrition and Dietetics that dairy products and
high glycemic index foods are linked to pimples. The researchers found
that people who eat a lot of high glycemic index foods and dairy products are
more likely to have acne. They also suggested that using
medical nutrition therapy may help in the treatment of acne.
In addition to following a low-Glycemic Index, dairy-free
diet, it is also helpful to ensure a good intake of healthy polyunsaturated and
monounsaturated fats. Despite pimples being caused by blocked pores due to
excess sebum production, fat-free or very low-fat diets are not recommended for
acne as too little fat in the diet can actually dry out the skin and prompt the
body to ramp up sebum production.
A good intake of fats from nuts, seeds, and olive oil
appears to help by keeping inflammation in check; supporting the body in
maintaining healthy blood sugar levels; and maintaining good skin moisture
levels so as to provide an effective barrier and immune response to prevent
bacterial infection.
Having pimples or acne can be hereditary.
Symptoms of pimples
There are several different types of pimples and they have
different signs and symptoms:
- Whiteheads -
also known as a closed comedo. These are very small and remain
under the skin, appearing as a small, flesh-colored papules.
- Blackheads -
also known as an open comedo. These are clearly visible on the
surface of the skin and are black or dark brown due to the oxidation of
melanin, the skin's pigment. Some people mistakenly believe they are
caused by dirt, because of their color, and scrub their faces vigorously -
this does not help and may irritate the skin and cause other problems.
- Papules -
these are small, solid, rounded bumps that rise from the skin. The bumps
are often pink.
- Pustules -
these are pimples full of pus. They are clearly visible on the
surface of the skin. The base is red and the pus is on the top.
- Nodules -
these are morphologically similar (similar structure) to papules, but
larger. They can be painful and are embedded deep in the skin.
- Cysts -
these are clearly visible on the surface of the skin. They are filled with
pus and are usually painful. Cysts commonly cause scars.
How common are pimples (acne)?
Acne is the most common skin condition in adolescents.
According to a review in the British Medical Journal:
- More
than 80% of teenagers get acne at some point.
- A
community sample of 14 to 16 year-olds in the United Kingdom revealed that
acne affected 50% of them.
- A
sample study of adolescents in New Zealand found acne was present in 91%
of boys and 79% of girls.
- A
sample study of adolescents in Portugal found that the average prevalence
of acne (in both sexes) was 82%.
- 30%
of teenagers with acne required medical treatment because of its severity.
- General
practitioners (GPs, primary care physicians) in the UK reported that 3.1%
of 13 to 25 year-old patients visited them complaining of acne.
- The
incidence of acne is similar in both adult males and females.
- Doctors
report that acne appears to peak at 17 years of age.
- Acne
incidence (presence, occurrence) in adults is increasing, doctors report.
We do not know why.