Blind pimples or closed comedones can occur as single swellings under the skin or they can be present as acne.
Unlike a normal pimple or pustule that forms a head, a blind pimple forms in a pore that is completely blocked by skin cells and sebum.
They can’t be squeezed or easily drawn with steam to remove pus and relieve inflammation and pain.
Skin is covered in hair follicles (pores) and each hair follicle has an attached sebaceous gland. These glands produce an oily, waxy substance called sebum. Sebum keeps skin moisturized and mixes with sweat on the skin’s surface to form the protective acid mantle that acts a barrier to infection.
Sometimes too much sebum is produced, and at the same time dead skin cells aren’t removed effectively by your body and this leads to the blockages.
An overproduction of skin cells is often happening at the same time as the overproduction of sebum, and the two abnormalities working in concert have predictable results. Pimples, acne, and breakouts.
An occasional blind pimple isn’t anything to worry about, but if you are beginning to suffer from them (or other pimples) regularly, then you should take it as a warning sign that your body is out of balance.
Let’s find out why that happens so that you can begin to tackle the root cause of your skin problems, instead of just fighting a never ending battle with the symptoms.
Why Are Your Pores Blocked With Sebum?
Everybody knows that pores clogged with oil result in spots. But too often people fail to ask the most obvious question which is “What’s causing that to happen?” Instead, they focus on a different question “How do I get the oil out?”
That’s like finding out that your boat is taking on water and only focusing on pumping the water out instead of looking for and patching up the breach in the hull.
Looking for quick fix, topical treatments for your skin is the same as bailing water. It isn’t a real solution. Instead you need to plug the leak.
As already mentioned, the sebum that your skin produces carries out an important function, it makes sure that your skin doesn’t lose too much moisture to evaporation and it keeps dirt, bacteria viruses and fungus out.
Sebum creates an acidic layer on your skin (your acid mantle) that allows beneficial bacteria to hang around but makes it very hard for problematic microbes to establish themselves.
So far so good, but when your body produces too much sebum you get problems. Blocked pores, pimples, blackheads, acne, and cysts.
It isn’t just a matter of producing too much sebum though. When you have skin problems that go beyond an occasional spot here or there, it means that you’re producing sebum with an altered composition. Your sebum is basically damaged.
Sebum is mostly composed of triglycerides (41%), wax esters (26%), free fatty acids (16%), and squalene (12%).
The most important free fatty acid is called linoleic acid, and along with squalene it has the most relevance for blocked pores.
Squalene is essential for healthy skin but when squalene undergoes oxidative damage, it creates ripe conditions for blocked pores and acne.
Oxidized squalene becomes squalene peroxide, and the severity of acne (with closed comedones or open) is directly linked to the amount of squalene peroxide present in the skin.
Normal sebum doesn’t clog pores. Oxidized sebum with its squalene peroxide does.
Scientists have induced acne in rabbits by using squalene peroxide on their skin.
Squalene peroxide is highly comedogenic (pore clogging) and research has confirmed that people who suffer from acne have high levels of squalene peroxide present.
One study found that people with acne had a squalene peroxide level that was 79% higher than people with normal skin.
The same study reported that after four weeks of retinol and vitamin E cream treatment (both antioxidants), squalene peroxide levels dropped by 56%. The treated area of skin also displayed less hyperkeratinization and inflammation.
Linoleic acid is a fatty acid that keeps the walls of skin pores flexible and intact. Without sufficient linoleic acid pores develop ‘holes’ and becomes weak. A weak pore is much more likely to rupture than a strong pore. When blocked pores rupture the toxins within the blocked follicle seep into surrounding tissue and cause inflammation.
The more sebum that your skin produces, the less linoleic acid that sebum contains. According to researchers, those with acne have 65% less linoleic acid in their sebum than those without acne.
So let’s put that together:
- For some reason too much sebum is being produced.
- An important component of that sebum, squalene, suffers oxidative damage and become squalene peroxide.
- Normal sebum doesn’t clog pores, sebum with squalene peroxide does.
- At the same time, excessive sebum production leads to lower levels of linoleic acid which results in weakened pore walls.
- Eventually the blocked and weakened pore ruptures allowing its inflammatory contents into surrounding tissue.
Why Are Your Pores Clogged With Skin?
When your skin is exposed to big, bad squalene peroxide, it reacts by dramatically increasing the production of keratin. Keratin is a hard protein that binds the skin cells together.
Usually dead skin cells are easily shed and pushed up out of the pore one by one in a continuous process.
When you have too much keratin present, those dead skin cells can’t separate for easy expulsion. They clump up and get stuck, filling up the pore with dead skin cells.
An excess of keratin also affects the pore walls, decreasing their flexibility and making them rigid. Rigid pores already wakened by a deficit of linoleic acid rupture very easily.
- Skin cells react to the presence of squalene peroxide by over producing keratin.
- All of this extra keratin leads to skin cells clumping together which blocks pores.
- Combined with the extra sebum you now have a breeding ground for bacteria.
Pimple And Acne Causing Bacteria
We all have bacteria living on our skin and in the pores of our skin. Usually it’s harmless and causes no trouble.
But when pores get clogged with sebum and dead skin cells, the bacteria suddenly have a massive food supply, and an increased food supply, means that the bacteria can multiply and get out of control.
The main bacteria that causes spots and acne is called P. acnes, and as part of its life process this bacteria secretes enzymes that alter the skin’s pH level, and that break down the lipids and proteins in the skin so that the bacteria can eat them.
An enzyme called lipase breaks down lipids into free fatty acids while the protease enzyme breaks down of collagen and keratin which are two proteins that make up the structure of skin.
- We have normally harmless bacteria now growing to huge numbers in the skin pores thanks to an increased food supply of sebum and dead skin cells.
- In small numbers, the life processes of these bacteria are beneficial, but in large numbers they cause problems.
- When the pore ruptures, bacteria will rush out and infect adjacent tissue.
This Leads To Immune System Response And Inflammation
The protease enzyme secreted by the bacteria also kills the immune cells that your immune system delivers to the area in order to try to kill the bacteria that have invaded the tissue outside the pore.
When your immune system detects bacteria where they shouldn’t be, it reacts by sending out neutrophils – a type of white blood cell – to kill the bacteria.
Because the bacteria’s enzymes kill the neutrophils that arrive, your immune system has to keep on sending more and more and more, in an ongoing attempt to rid the tissue of bacteria.
White blood cells cause inflammation.
Under normal circumstances when white blood cells respond to an injury, or work to combat an infection, the inflammation that they cause is fairly short lived. But in skin where sebum production is out of control and skin cell production is in overdrive, the inflammation is constant.
- Bacteria in your skin produces an enzyme that prevents your immune system from killing them.
- The constant flow of white blood cells that your body sends to combat the infection leads to chronic inflammation.
Let’s Recap What We know So Far
- Bacteria wouldn’t be able to flourish without the excess sebum and keratin.
- If the squalene wasn’t oxidized and turned into squalene peroxide, sebum wouldn’t block your pores.
- You wouldn’t overproduce skin cells if your skin wasn’t reacting to that squalene peroxide.
- Healthy sebum contains sufficient linoleic acid to maintain a robust follicle wall, but a wall weakened by low levels of linoleic acid allows the contents of a clogged pore to burst through and infect the surrounding tissue, triggering an inflammation causing immune system response.
All of those together cause the swellings that we recognize as spots and acne.
So you’ve got too much sebum, and that sebum is damaged which causes the other problems, but what causes the overproduction of sebum in the first place?
It’s All About Hormones
- Androgens are male sex hormones.
- Androgens are present in both males and females.
- Androgens boost the amount of sebum that the skin produces.
During puberty when the level of these hormones first increases people experience their first spots and if they are unlucky their first acne breakout.
But not everybody is plagued with these skin problems, even though everybody experiences a surge in these hormones during puberty.
When your skin produces more sebum, it produces more squalene and less linoleic acid.
According to research people with acne produce 59% more sebum that people with normal skin.
Squalene makes up 20% of that sebum compared with 15% squalene in normal sebum.
Taken together that is a heck of a lot of squalene being produced compared to the amount present in healthy skin.
What’s causing the androgen problem? Read on.
Another hormone that affects acne is insulin. Among its many roles and actions, insulin increases androgen production and increases the sensitivity of the skin to the androgens, which results in excessive sebum production.
Skin converts the androgenic hormone testosterone into Dihydrotestosterone – a much more potent form of the hormone – which stimulates even more sebum production.
High levels of insulin in the body increase the activity of the converting enzymes in the skin, allowing more Dihydrotestosterone to be made.
Your body releases insulin to control blood sugar levels. Cutting out sugar and carbohydrate rich foods – which are essentially sugar in another form, is known to help clear up acne.
This is because when your body doesn’t have to rush to clear out all of that dangerous sugar from the bloodstream, it doesn’t have to produce as much insulin.
- Levels of androgenic hormones in your body directly affect sebum production.
- Testosterone is converted in your skin by enzymes into the more potent Dihydrotestosterone.
- The more insulin in your system, the higher the activity of the testosterone converting enzymes and the more Dihydrotestosterone your skin makes.
Low Levels Of Antioxidants Are The Final Piece Of The Puzzle
So, higher levels of insulin are causing potent androgenic hormones to ramp up sebum production. But that sebum still isn’t damaged (oxidized). And it’s the damaged sebum that causes the oil to block the pore, and the skin to react with increased skin cell production.
The more sebum that your body produces, the more antioxidants you need to protect it from damage.
And remember that sebum doesn’t need to be oxidized to weaken pore walls.
Oxidation is a normal part of your body’s metabolic processes, and because oxidation is so dangerous, your body has a built in protection system.
Your body produces a number of very powerful substances called antioxidants, some of these antioxidants protect the watery substances in your tissues, while others protect the fatty substances.
In addition to these endogenous antioxidants, you also obtain other antioxidants from your diet.
But your diet needs to healthy and rich in proteins, healthy fats (non-hydrogenated) fiber, vitamins and minerals in order to make antioxidants. And if you don’t eat enough fruits and vegetables you won’t get enough dietary antioxidants.
Even when your body makes good amounts of antioxidants, and you get antioxidants from your diet, they get used up for a whole host of reasons, including:
- Dealing with the effects of unhealthy food
- Medications (including medications and topical treatments you might use to deal with acne and comedones)
- Electromagnetic pollution
- Chemicals in skincare and cosmetic products
- Too much sunlight
- Lack of sleep
- Tobacco smoke
- Chemicals in food packaging
- Leaky gut
- Food intolerances and sensitivities
Modern life puts a huge strain on antioxidant reserves. Free radicals damage cells, and along with associated inflammation cause degenerative diseases, forcing your body to use up your available antioxidants to protect itself, leaving fewer antioxidants to stop your sebum from oxidizing.
Having insufficient antioxidant protection leads directly to the highly comedogenic (pore clogging) squalene peroxide and to overproduction of keratin.
If you eat sugar and other carbohydrate rich foods which cause hormonal imbalances and consequently lead to excess sebum production, and then have insufficient antioxidants (endogenous and dietary) the sebum will oxidize and you will have skin problems.
Vitamin E is one natural antioxidant that your body uses to prevent oxidation in the skin.
Studies have compared antioxidant levels in people with acne and those without, and have found that antioxidant protection is much lower in those with acne.
When blood antioxidant levels of people with acne have been compared to those with normal skin, researchers have found that Vitamin A is 33% lower, vitamin C is 40% lower, vitamin E is 45% lower and beta-carotene is 65% lower.
Without enough antioxidants available in your system your body can’t stop the squalene in your sebum from oxidizing and becoming squalene peroxide.
Can you now see why tackling your skin problems will involve a lot more than rubbing some cream or serum on your face, or taking a course of antibiotics?
Neither approach can do a thing for the root cause.
Both approaches are just bailing out water.
Want To Know How To Fix Your Skin? Fix Your Diet
Some researchers are calling for acne and associated skin problems to be classed as a chronic disease.
And at the root of most chronic diseases you’ll find a bad diet. Or a good diet containing nutrients that can’t be absorbed due to gut issues.
Whether it’s heart disease, arthritis, high blood pressure, type 2 diabetes, stroke, or obesity, the western diet is usually the root cause.
Government health bodies have been complicit in handing out unhealthy dietary guidelines for decades, and an epidemic of chronic disease is the result.
We know what a healthy diet that builds and fuels a healthy body look like. And it isn’t one filled with ‘healthy’ whole grains.
Cardiologist, Dr William Davis who has to try to fix people who have had their health ruined by years of eating a western diet, says that eating 2 slices of whole wheat bread raises blood sugar (and insulin levels) as much as 6 teaspoons of sugar.
In addition to its impact on your blood sugar levels wheat also carries a protein that many people are intolerant or sensitive to, which causes dangerous inflammation in the body (depleting antioxidants) and sets the stage for chronic disease down the road.
Modern wheat grown today is very different from the wheat that used to be grown. It’s been bred to produce bigger yields and its protein makeup has been altered.
When you eat wheat products like bread and pasta, you’re hitting your body hard.
Other carbs don’t have the problem of gluten but they still mess with your blood sugar levels.
If you suffer from regular breakouts, then eating a low carbohydrate diet could help. You may even need to go as far as following a ketogenic diet, keeping your carb intake under 30 grams each day.
Studies have repeatedly shown that a low carb diet helps to clear up acne, but for some reason ($$) dermatologists keep pointing to other studies that they say prove that sugar and carbohydrates have no effect on acne. What they fail to mention is that those studies were some really bad science.
In 1969, Fullerton et al, undertook their famous chocolate bar study. For 4 weeks they gave study participants with moderate levels of acne, either a daily candy bar with 10 times the chocolate content of standard bars, or a candy bar without chocolate. Both bars were high in sugar, trans fats and calories. At the end of the study they measured the difference in rates of acne and found none. They concluded that chocolate doesn’t cause acne.
You might ask yourself why they didn’t test the effects of a candy bar against no candy bar, or against a handful of berries. Why indeed? It’s as though they set out to design a study that would give them the results that they wanted.
I wonder who funded the study?
Another widely quoted study that claims to disprove a dietary link between diet and acne is the 1971 Anderson study.
This time, university students who reported that their acne was triggered by dietary factors were given either chocolate, cola, milk or peanuts. For one week. One week. It’s enough to make you weep. At the end of this laughably short period of time he found no change in acne among the different groups. No records were kept of the other foods that the students ate.
The Anderson study is junk science.
But based on those 2 studies, sweeping conclusions were drawn and misleading advice has been the result for decades.
As a 2009 review study noted,
“The studies by Fulton et al and Anderson, although suffering from major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists.
“Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.”
Other well designed studies have found a strong link between carbohydrates and acne.
In 2002 Dr. Loren Cordain studied two groups of native people living in Kitavan, Papua New Guinea and Ache, Paraguay. He says that.
“In westernized societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. In men and women older than 25 years, 40% to 54% have some degree of facial acne, and clinical facial acne persists into middle age in 12% of women and 3% of men.“
And his observational study found,
“Of 1200 Kitavan subjects examined (including 300 aged 15-25 years), no case of acne (grade 1 with multiple comedones or grades 2-4) was observed. Of 115 Aché subjects examined (including 15 aged 15-25 years) over 843 days, no case of active acne (grades 1-4) was observed.”
Another study reports that rates of acne increased when Canadian Inuits and Okinawans in Japan were introduced to a western diet.
A number of studies (ref below) have demonstrated the beneficial effects of a low carbohydrate (low glycemic load) diet on acne.
Overall the findings were that,
Acne pimple count reduced by 20 – 50% in the low glycemic load diet group.
Hormones associated with acne improved in the low glycemic load diet group and worsened in the high glycemic load group diet group.
Sebum production decreased in the low glycemic load diet group. Sebum composition also changed, resulting in a higher level of saturated fatty acids which are more resistant to oxidative damage.
Is diet the only factor implicated in causing acne? No. But it’s a big one. And it’s one that you have complete control over.
Making dietary changes isn’t easy, but if you use the right resources, you can eat low carb and still enjoy really great food. Check out Marks Daily Apple, Livin La Vida Low Carb, and The Blood Sugar Diet to get started.
Reduce Skin Inflammation With Essential Oils
The great thing about essential oils is that their molecules are so tiny that they readily absorb into blocked pores where they can get to work.
Essential oils can combat the inflammation caused by your immune system response and they can also kill the bacteria that are over stimulating your immune system.
Studies have found a number of oils to be effective against different strains of P. acnes bacteria and the most effective oils include:
- Tea Tree
Lavender essential oil can be safely applied undiluted to the skin, other oils should be diluted in a non comedogenic carrier oil.
Carrier oils with the lowest comedogenic ratings are, Argan oil, Babassu oil, Black Cumin Seed oil, Blackcurrant Seed oil, Blackberry Seed oil, Borage oil, Camellia oil, Emu oil, Grapeseed oil, Hazelnut oil, Hemp Seed oil, Jojoba oil, Meadowfoam Seed oil, Rice Bran oil, Sea Buckthorn oil, Sunflower oil, Sweet Almond oil, Walnut oil.
Unblock Pores With Exfoliants And Clay
Enzymatic exfoliants dissolve oils and dead skin cells. Regular use will unblock your pores and if you have fixed your diet and antioxidant intake, then sebum should flow normally again.
For all of these natural exfoliants, blend the ingredients into a paste, apply to your skin for 15 minutes (less if you have sensitive skin) and then rinse with water.
- Apple (Granny Smiths are best)
- Lemon (only use at night to prevent photosensitivity)
A bentonite clay mask used after an enzymatic treatment will soothe any irritation that the enzymes may have caused and draw debris up out of the pores.
Mix one teaspoon of bentonite clay with one teaspoon of apple cider vinegar or water. Mix to form a smooth paste and then apply to your skin and allow to dry.
The clay will begin to tighten on your skin as it dries, if this is too uncomfortable then rinse it off when it gets to that stage. Otherwise wait for the clay to fully dry then rinse off with warm water.
By taking steps to deal with the root cause of breakouts and acne, and by using some simple topical treatments, you can make a big improvement in the appearance of your skin, and unless other factors are involved, you should be able to wave goodbye to pimples and acne.
Remember, a pimple from time to time is normal, regular breakouts and acne are not. They are a sign of a much deeper problem that you need to fix.