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.
The cause of acne in men can be traced back to heredity, and over activity of sebaceous glands, mainly due to lifestyle and stress. Stress sends signal to the androgens hormones, which is abundant in men, to increase its production. Coupled with bacteria and follicle blockage due to dead skin cells formation of acne is now inevitable.
a) Retinoids
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