Types of Spots, Pimples

The gland produces an oily secretion called sebum. Under the influence of puberty hormones such as testosterone and estrogen, the sebaceous glands become hyperactive, to produce more sebum with altered characteristics.


The sebaceous glands are those which are found attached to hair follicles on a 1: 1 ratio. These are the places where hair is formed and emerges on to the skin through tiny orifices. The oily sebum carries out dead cells to the skin surface where they can be discarded. When these orifices become blocked by hair, oil and secretions, sebum piles up behind them, causing spots to appear.

The bacterium called Propionobacterium acnes, which is a skin colonist found on normal skin, starts to grow inside the plug of oil and dead keratinocytes releasing more inflammatory chemicals. In this way the accumulated sebum forms a small bump under the skin. It may become inflamed, forming a red swollen pimple. Some pimples are closed, or covered by skin, while others are open to the outside. In the latter case, the exposed sebum may be oxidized and become black, forming a blackhead.

Causes of acne may vary from hereditary predisposition or hormonal changes to certain medications. People who are on oral contraceptives (birth control pills), or become pregnant, may become prone to pimples at certain periods, especially when the hormone levels are fluctuating.

Types of Spots

All those who have acne do not show the same type of lesion.

The primary lesion in acne is the comedo, which is a closed up hair follicle which has swollen up.

  • The closed comedo has not opened to the outside. The skin covers the bump, making it look whitish. This is also called the whitehead. Squeezing a whitehead does not empty its contents, and it may be firmer to the touch than a blackhead.
  • Once the pent-up secretions and cells reach the surface of the skin, it starts to turn black, because of the oxidation of the sebum by air. This is not because of dirt, as many people believe. The black color may also be due to pigment from the lining epithelium of the follicle. This is then called an open comedo or a blackhead.

Blackheads and whiteheads are capable of remaining in the skin for a long time. Once the follicular wall breaks down, as happens with time, a pimple forms.

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