What are the causes of acne?
Acne is one of the most common and recognisable skin conditions, it can affect the face, shoulders, back and chest. What are the causes of acne?
Acne bacteria (known as Propionibacterium acnes or P Acnes) live on everyone’s skin. However for those prone to acne, a build-up of oil creates an ideal environment in which these bacteria can multiply, triggering inflammation and the formation of spots that we term acne.
Eight out of ten teenagers are affected as acne usually occurs around puberty, with 80% of 11-30 year olds affected by this skin condition.
Acne can cause social embarrassment, associated physical and psychological scarring and can be life changing and distressing if left untreated.
What is acne?
There are a number of different types of Acne, including; Acne Vulgaris, Acne Rosacea, Hormonal Acne, Fungal Acne and Cystic Acne. The most common, Acne Vulgaris is a simple identifiable skin condition that starts when oil and dead skin cells clog up your pores. Acne can also be known as blackheads, blemishes, whiteheads, pimples, spots or zits.
When you have just a few red spots or pimples, you have what’s termed a mild form of acne. Severe acne can mean a large number of pimples that can cover the face, neck, chest and back. Or it can be larger, solid red lumps that are painful, and these are known as cysts.
Blackheads open at the surface of your skin, giving them a black appearance because of oxygen in the air. Whiteheads are closed just under the surface of your skin, giving them a white appearance. While whiteheads and blackheads are the most common lesions seen in acne, inflammatory lesions are more likely to cause scarring of your skin. These include:
- Papules are small, red, raised bumps caused by inflamed or infected hair follicles
- Pustules are small red pimples that have pus at their tips
- Nodules are solid, often painful lumps beneath the surface of your skin
- Cysts are large lumps found beneath your skin that contain pus and are usually painful
How does acne form?
Acne starts with the formation of a microcomedo, which is simply a clogged hair follicle (or pore) in the skin.
A sebaceous gland, which supplies sebum to lubricate the skin, becomes blocked at its opening on the surface and the blockage hardens. The gland may become infected and sebum and pus build up behind the blockage.
In mild cases there may only be what are called non-inflammatory lesions such as whiteheads (closed comedones) and blackheads (open comedones) and small pimples, but in more severe cases these can fill with pus or turn into cysts and become inflammatory lesions.
Depending on how severe your acne is, the inflammatory lesion range comprises of small pimples on your skin, small raised spots containing pus (pustules) or nodulocystic lesions, which is characterised by lots of inflamed and non-inflamed firm lumps and cavities which can cause scarring.
Acne occurs when:
- too much oil is produced by your follicles
- dead skin cells accumulate in your pores
- bacteria build up in your pores
These problems contribute to the development of spots and pimples. A pimple appears when bacteria grows in a clogged pore and the oil is unable to escape.
What are the risk factors for developing acne?
A diet rich in animal products, fatty and sugary foods – such as the typical ‘Western’ diet – has been associated with the presence of acne in adults. A recent study, published in June 2020, looked at a cross section of over 24,ooo adults, determined that increased consumption of animal protein, and fatty, sugary foods correlates with an increased incidence of acne symptoms. The exact mechanism that causes this is still unclear, however, there is increasing consensus that these foods may be a significant cause of acne.
There is also some evidence that consuming casein and whey in dairy products may promote clogged pores and that a deficiency of omega-3 polyunsaturated fatty acids in your diet may contribute to symptoms. A diet high in protein and carbohydrates with a low glycemic index has also been shown to help prevent acne.
Whilst the strongest medical leads suggest acne is caused by changes in hormones called androgens, it may be due to alterations in follicular linoleic acid levels, and the inflammatory cytokine interleukin-1a (a group of proteins which controls your body’s response to infections).
People are most at risk for developing symptoms during puberty. During this time, your body undergoes hormonal changes. These changes can trigger oil production, leading to an increased risk of acne. Hormonal acne related to puberty usually subsides, or at least improves when you reach adulthood although there is an increasing prevalence towards adult acne.
Persistent acne, which is defined as symptoms that persists beyond adolescence into adulthood, affects mainly women. With around 40 percent of women in their 20’s, a third in their 30’s and a quarter in their 40’s suffering from the condition.
Late-onset acne is defined as symptoms that begin after the age of 25.
Although there isn’t an ‘acne gene’ you can inherit, it does appear that genetics can have an influence on your likelihood of having acne.
A study in 2001 found that you have a four-times higher risk of getting acne if a first-degree relative has it. Some families may have inherited a tendency to overproduce dead skin cells, leading to clogged pores, which can cause acne.
There may also be a genetic tendency to overproduce sebum. This leads to oily skin that can trap bacteria in pores, resulting in more frequent breakouts. As some types of breakouts are hormonal, you may also be genetically predisposed to producing excess androgen.
Certain medications, such as certain birth control pills, including corticosteroids, lithium, anticonvulsants, barbiturates, androgenic steroids, DHEA, and medications that contain bromides or iodides, can cause regular acne or acne-like skin eruptions.
Travelling anywhere by aeroplane is notoriously bad for your skin. The low humidity dehydrates your skin, stripping it of essential moisture. The dehydrated cells caused by this dry air can then build-up, trapping oil and dirt underneath the skin.
Ensure your skin is well moisturised and kept clean throughout the flight. It will help to avoid a dermis disaster when you reach your destination.
Touching Your Face
We do this countless times throughout the day, often without realising it, and as we progress through the day our hands come into contact with dirt, germs and bacteria.
Your face very quickly becomes one of the most unclean parts of your body and the bacterial build-up can easily contribute to acne breakouts, particularly spots and pimples circulating around your jawline.
Try to avoid touching your face and wash your hands regularly. Remember to wipe down your phone & keyboard regularly to avoid the spread of germs.
A little stress is unavoidable. It’s even thought to be good for us as many people perform better under pressure. This is due to an increase in hormones such as adrenaline and cortisol, keeping us focussed and alert.
However, too much stress over a prolonged period of time can have a detrimental effect on your body and your skin.
Stress can cause flare-ups and breakouts as overproduction of cortisol causes your glands to produce more oil, which is a breeding ground for bacteria. This bacteria build-up can lead to more inflamed, aggressive breakouts such as pus-filled pimples, as opposed to the usual whiteheads.
Stress isn’t the only emotional factor which may affect your skin health. Check out our post to find out how your mood can affect your skin.
Eating Dairy Foods
Painful pimples that linger may be linked to the amount of dairy in your diet. It’s considered that the natural hormones contained within milk, which are similar to those produced during teenage years, are what cause outbreaks.
If you are eating a little more dairy than your body can usually tolerate and you are not digesting dairy properly, this may manifest itself in spots and blemishes around the lower region of your face.
There are numerous studies on the negative effect smoking has on acne and skin health in general. A study of 1046 randomly selected 25 – 50 year old women concluded there was a clear correlation between smoking and non-inflammatory post-adolescent acne, with an increase in sebum production and a reduction in vitamin E levels in those subjects with acne. The most severe cases were identified as a new classification of smoker’s acne.
In a separate study of 1,000 women, 18.5% of the group had acne. When this group was divided into smokers and non-smokers, it was found that 41.5% of the smokers had acne whilst only 9.7% of the non-smokers suffered from the skin condition.
Whilst working up a good sweat in the gym helps reduce stress and increase blood flow to skin cells it is also creating the perfect environment for acne-producing bacteria.
During a workout, you will sweat more than you normally do in your everyday activities. Breakouts occur when your sweat mixes with oil, dead skin cells and bacteria that can leave your pores clogged. Check out our post to find out how to prevent gym acne.
Topical Skin Care Products
It may seem ironic, but when some chemical or abrasive skincare products are introduced into your skincare regime this can cause a skin reaction.
Some topical skincare products contain synthetic ingredients which may not be suitable for your skin whilst some may cause too much exfoliation which strips your skin of moisture and essential oils.
Want to learn more about the detrimental effect of certain skincare ingredients? Check out our post ‘Can skincare products cause acne?’.
Menstrual related acne
A tell-tale sign for many women that they are at the start of their menstrual cycle is a breakout of spots.
According to a study published in the Archives of Dermatology, 63% of acne-prone women experience these premenstrual flares.
They usually strike about seven to 10 days before the onset of a woman’s period and then subside as soon as bleeding begins.
During the first half of a woman’s menstrual cycle, the predominant hormone is estrogen whilst in the second half, the main hormone is progesterone. Both hormones fall to their lowest levels of the month as bleeding approaches.
The male hormone testosterone (made in smaller amounts by women) stays at a constant level all month meaning that before and during menstruation, testosterone is relatively higher than the female hormones.
These hormonal shifts can have an adverse affect on a woman’s skin as the mid-cycle progesterone rise stimulates the production of sebum.
Whilst sebum acts as a natural skin lubricant, it’s also food for the bacterium P. acnes. This bacterium causes increased breakouts and inflammation around the time of women’s periods.
Is there a cure for acne?
There are acne treatments that successfully treat and control the condition if the right skincare routine is carried out and maintained. Scarring can be prevented by early treatment of severe acne.
What are the present therapeutic approaches to acne?
Treatments include topical therapy (which means treating the surface of the skin with products such as creams, gels and lotions) or systemic therapy (such as using antibiotics).
Dependent upon the severity of your symptoms, a single or combined therapy is suggested. In general, topical and systemic therapies aim to reduce hyperkeratosis (thickening of the outer layer of the skin) and follicular plugging – while reducing bacteria and inflammation.
The main active ingredients in gel, cream or liquid formulations consist of retinoids, steroids and antibiotics. Hormonal treatment is occasionally used for both adult and adolescent females. However these types of non-natural therapies are often accompanied by adverse side effects.
Whatever the type or perceived cause of your symptoms, it’s important to seek out the right type of treatment to alleviate the long term effects.
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