Although It Often Seems that way, acne doesn’t just pop up overnight By the time you see an obvious blemish—whether it is a whitehead, a blackhead, or an inflamed red pimple—it is already many weeks old, the product of a complex series of events that has been taking place deep inside your skin, unseen, unfelt, and largely unaffected by anything you’ve done on the surface.

Yes, I know. You try out a new makeup, and the next morning, you wake up with a crop of brand-new pimples. But, the fact is, either those pimples are not really brand new—their infant selves have been lurking in your skin for weeks—or what you see is not real acne, but rather an irritant reaction that just looks like acne. \Real acne—acne vulgaris, as it is properly known—is born in a tiny world all its own called the “pilosebaceous unit,” more popularly known as the hair follicle. In the introduction to their classic textbook Acne and Rosacea, pioneering acne researchers Dr. Gerd Plewig, professor and chairman of the department of dermatology at the University of Munich, and Dr. Albert Kligman, the University of Pennsylvania’s retired chair of dermatology, somewhat fancifully suggest that the unseen pilosebaceous unit is a kind of “theater,” a minute arena in which the “unusual drama” of acne formation unfolds.

It takes a careful viewing of this drama to appreciate just what is happening to your skin when it breaks out.