Plugged follicles can take the form of either whiteheads, where the plugged follicle remains beneath the skin's surface, or blackheads, where the plug in the follicle extends to the skin's surface and becomes visible. Once a follicle becomes plugged, it creates an ideal environment for a common sebum-eating skin bacterium, Propionibacterium acnes (or just P. Acnes), to multiply. This bacterium produces enzymes and chemicals that irritate and inflame the skin around a clogged follicle. Pimples, breakouts, or zits are common names for the lesions that result from this type of skin irritation and inflammation, though doctors have more precise ways of classifying acne lesions. For most people, acne is a generally mild condition. Of course, a pimple at the wrong time is never desirable, but in truth, there are far more concerning issues than acne. For some people, however, severe cases can result in permanent scarring if left untreated.
The primary lesions of acne are comedones. Closed comedones (whiteheads) are obstructive lesions formed from impacted lipids or oils and keratin that plug the dilated follicle. They are small, whitish papules with minute follicular openings that generally cannot be seen. These closed comedones may evolve into open comedones, in which the contents of the ducts are in open communication with the external environment. The color of open comedones (blackheads) results not from dirt, but from an accumulation of lipid, bacterial, and epithelial debris.
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