A lot is known. It is due to the interaction between the oil glands in the skin and the male hormone, testosterone. That is why we don't get it until after puberty: our testosterone is not high enough.
The problem is, however, not with the testosterone (except
in females with polycystic ovaries or those males supplementing) but in the
genetic table set in the oil glands - when stimulated by testosterone they
produce excessive oils (at least deep in the pores).
These excessive oils are digested by bacteria, corynebacterium
acne; the free fatty acid produced from the digestion then irritates the nearby
hair follicles yielding an abnormal product, parakeratin, which clogs the
pores. Blackheads and whiteheads (grade 1 acne) are composed of parakeratin.
Retinoids topically help prevent parakeratin.
More about retinoids, stages 2, 3, and 4 (zits - big &
small) and rationales of treatment in ACNE Part 2 - coming soon to a computer
screen near you!
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