What Makes Acne Become Severe Over Time
Acne starts simple but can turn severe when bacteria, oil buildup, and immune reactions team up inside blocked skin pores. Over time, these factors create deeper inflammation that leads to painful nodules, cysts, and lasting scars.
It begins with sebaceous glands making too much oil, mixing with dead skin cells to clog hair follicles. This oily trap becomes a perfect spot for Cutibacterium acnes bacteria to grow. The bacteria release enzymes that break down oil into irritating fatty acids, which poke the skin lining and spark swelling.[1][2]
The real trouble ramps up when the immune system overreacts. Cutibacterium acnes tricks skin cells through toll-like receptors, kicking off a flood of cytokines like interleukin-1, interleukin-8, and tumor necrosis factor-alpha. These chemicals call in immune fighters such as neutrophils, macrophages, and Th17 cells, turning a mild blockage into raging inflammation.[1][2]
As acne drags on, certain immune signals like IL-17 spike higher, especially in tougher cases. Studies show patients with severe acne have way more IL-17 in their blood, linking it to worse breakouts and scar risks. This suggests the Th17 pathway fuels progression from pimples to deep cysts.[1]
Picking or squeezing spots makes it worse by adding trauma, spreading bacteria deeper, and stretching inflammation. Sun damage or harsh products keep the fire going, while skipping early treatment lets swelling build unchecked. Nodular or cystic acne hits deeper layers, causing bigger blood vessel changes that prolong redness and pain.[2]
Unlike widespread body inflammation, acne stays mostly local in the skin, with no big jumps in markers like CRP. But repeated flare-ups wear down skin barriers, letting bacteria thrive more and immune responses get wilder over months or years.[1]
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12732949/
https://www.kins-clinic.com/blogs/post-inflammatory-erythema-from-acne-a-guide-to-causes-and-treatments
