Acne

Medical Meanderings - 16 April 2008

My Forehead

I am beautiful no matter what they say / Words can’t bring me down…
- “Beautiful,” Christina Aguilera (2002)

Sebaceous (suh-BAY-shus) glands are spread across my skin, including my forehead, attached to each of my hair follicles. About two weeks ago, due to excessive rubbing of my forehead with a towel, or my dog Ludwig’s aggressive licking of my face, or a casual scratch or rub of my forehead, a few dozen dead skin cells were pushed into one of my 150,000 hair follicles. This specific sebaceous gland and follicle was located about 3 inches above the lateral edge of my right eyebrow. A very visible bit of real estate.

The skin cells were full of a protein called keratin (which also makes up the shafts of my hair and my fingernails) a flexible, gummy kind of protein. This caused a keratin plug in the curving tube leading from the hair root and gland opening to the surface of the skin. Since the opening was plugged, the greasy sebum made by the gland could not work its way out onto the surface of my forehead. Sebum is made of a mixture of fats, cholesterol and wax (yes, wax) that is broken down on its way to the surface by bacteria (they gotta make a living, too) called Propionibacterium acnes.

As I went about my daily life, the plugged sebaceous gland kept on producing sebum, and the bacteria kept chomping on it, but the oily stuff just accumulated. At this point, if the skin-and-oil plug reached the air at the surface of my skin, the plug surface would have oxidized like a bitten apple in the open, turning the plug black. This pleasant phenomenon is the classic “black head,” which is not (as alleged by many parents of teens) dirt. It’s oxidized fatty acids. Yummy.

However, if the oily plug didn’t quite reach the surface, but rather pushed up a thin dome of skin cells over the gland opening without being exposed to air, the plug would still look white. These little beauties are called “white heads,” and they’re not full of pus, but only pent up skin oils.

My sebaceous gland didn’t follow either of these relatively harmless, cosmetically benign courses. No, no. Instead, the pressure in the gland built up, the bacteria kept working, and finally the walls of the sebaceous gland burst. Sebum and bacteria exploded into the surrounding skin. Loose sebum in the skin is very irritating, and my immune system responded—white cells started cleaning up the damage, releasing chemicals that dilated my skin capillaries. Increased blood flow to the damaged area of my once pristine forehead caused swelling and a bright, attention-grabbing redness.

Unfortunately, at this point, I made a horrible misjudgment. Upon noticing this developing insult to my self-image in the mirror, I decided to help the life-cycle of the beast along…by squeezing it. So, I applied digital pressure to each side of the swollen, red nodule. Then more pressure. Nothing. All I had done is push the bacteria-laden oily goo further into my normal skin, worsening the inflammation and dooming myself to a week of an extremely noticeable forehead flaw. Acne strikes again. Physician, heal thyself.