Acne is a skin disease that includes non-inflamed whiteheads and blackheads (comedones) to severely inflamed acne nodules (boils) and cysts (soft, pus-containing cavities). The layman’s term “pimples” refers to the same thing.
Acne is extremely common, affecting about 4 in 5 (80%) of adolescents and young adults aged 11 to 30 years. Although acne usually first appears during the teenage years, it can occur for the first time in one’s twenties or thirties (adult acne). Acne causes sufferers to have a poorer quality of life due to diminished self-image and negative perception by peers. Acne scars that remain well into adulthood may exert continued negative psychosocial effects years after the active acne has subsided.
Acne is not determined by one factor. Generally, there are several factors which together result in one to have acne. This explains why acne can be so difficult to treat. It is only by understanding the real causes of acne that one can learn to prevent, reduce and treat acne successfully. The causes of acne include
Acne is linked to genetics. If one family member has had acne, then the next generation are much more likely to have it too. Genetics also determine when your acne is likely to start and stop. However, the impact that genetics have on acne is not fully understood. There is some chance that other factors such as lifestyle or environmental conditions are required to cause acne outbreaks.
Acne is almost certainly caused by hormones, particularly androgens, which produce male characteristics and include testosterone. Both men and women produce androgens, although in varying quantities. Androgens such as testosterone and dehydrotestosterone (DHT) stimulate the sebaceous glands during puberty.
The increased production of sebum is likely to cause acne to form (see picture above). As adolescent boys naturally have more male hormones including testosterone, they tend to be more affected by acne than girls during their teenage years.
There have been several clinical studies that have identified stress as a major cause of acne, in particular affecting existing acne. Stress affects acne in two ways: physical stress which stimulates the adrenal glands to produce excess hormones, in particular testosterone, which causes acne. Psychological stress slows down the healing process by as much as 40%.
It is therefore apparent that stress not only is capable of causing acne outbreaks, it can also worsen existing acne and affect the skin’s overall condition. A vicious cycle forms when having acne causes a dip in self-esteem and self confidence. In turn, acne causes an increase in stress, which is likely to result in the skin condition worsening.
Smoking leads to acne in some people. The nicotine constricts the internal blood vessels, reducing the supply of oxygen the skin needs to produce new cells and causing blocked pores and spots. The reduction in blood supply to the skin consequently reduces the skin’s ability to produce collagen and elastin, which keep the skin firm and smooth. Smokers face the risk of blocked pores and large blackheads, although in a less inflamed form.
Women are particularly vulnerable to the condition. In a study of 1000 women aged 25 to 40 in the UK, 42% of smokers had acne compared to 10% of non-smokers. Smokers who had experienced acne in their teens were also found to be four times as likely to have the condition in adulthood than non-smokers who had experienced teenage acne. This is a good reason to stop smoking.
The bacteria that causes acne is P.acnes. Do note that although the bacterium P.acnes does play an important role, acne is not caused by the bacterium alone, and acne is not an infectious disease. P.acnes is a normal baceterial inhabitant of the skin which uses sebum as a nutrient. More bacteria is present during puberty, when the sebaceous glands are more active.
When the sebum becomes trapped within the hair follicle, the bacterium also becomes trapped and is able to grow unchecked, attracting white blood cells. This triggers a chemical and enzyme reaction with the sebaceous material in the follicle that attacks and damages the follicle wall, allowing the contents to spill out into the dermis and causing an inflammatory response. Red pustules, papules and modules then appear under and on the skin.
The bacteria breaks down the sebum into fatty acids, which cause further irritation to the follicular wall, causing it to swell. Eventually, when the blocked follicle can no longer contain its contents, it bursts, spilling onto the skin. The process intensifies the inflammation, resulting in redness and pain that is commonly associated with acne.
6) Environmental Pollutants And Irritants
A working environment which is smoky, damp, polluted and humid is likely to cause acne or aggravate the condition as pores are likely to be blocked and skin damaged. Even the general pollution in the area where you live can affect your acne: emissions from factories and refineries, the daily pollution from exhaust fumes and pesticides from gardens can all lead to the cause of acne.
Occasionally, medication and drugs such as oral steroids may induce or cause acne. Even contraceptive agents including medroxyprogesterone injections (Depo-Provera) and oral contraceptives may aggravate acne to the point where some women may have to change their contraception choice.
This is because these medication may have a direct effect on white blood cells and the hair follicles. Medicines that are known to have an aggravating effect include anticonvulsant drugs for people with epilepsy, antituberculosis drugs, antidepressants, lithium, halogens (iodines, chlorides, bromides, halothane) and vitamin B12.
Steroids, which are used to treat inflammation and auto-immune conditions, can also cause acne. Acne from steriods usually appears in the form of papules mainly on the trunk. Bodybuilders and athletes who use testosterone-related anabolic steroids to build muscle risk developing Acne conglobata and Acne fulminans, two severe types of acne. In most cases where acne is caused by medication, the acne only lasts for as long as the drug is taken.
Certain types of antibiotics may cause acne. Antibiotics affect the digestive system by destroying both the good and bad bacteria in the gut. This influences the body’s ability to absorb essential nutrients, vitamins and minerals, leading to poor digestion and a build-up of toxins.
If the body is unable to expel the toxins effectively through the kidneys, liver and bowels, it uses the skin and lungs. The result often causes acne outbreaks.
Acne cosmetica is a mild but persistent form of acne that commonly occurs on the neck, forehead, face, hairline and scalp. It is characterized by small pink bumps. There may also be whiteheads and blackheads on the skin, which feels and looks rough.
As the name suggests, The cause of Acne cosmetica is due to the use of comedogenic (acne-producing) cosmetics, skin care and hair products.
The cosmetic product stimulates abnormal growth of keratinocytes within the follicle, blocking it and creating a blemish.
Cream blushers, eye creams, heavy make-up, heavy moisturizers, sunblocks and hair oil are often to blame. Applying more comedogenic make-up to cover the pimples will only make it worse. Acne cosmetica clears up relatively quickly once you switch to a non-comedogenic product and there is very little chance of scarring.
10) Polycystic Ovary Syndrome (PCOS)
PCOS is a hormonal condition affecting the ovaries, which may develop in teenage girls but can go into adulthood, affecting women of reproductive age. Small cysts develop on one or both ovaries, which can result in infertility. There is also a production of excessive amounts of testosterone which is often associated with increased facial hair.
The increase in testosterone is what causes acne. This type of acne responds well to treatment with cyproterone acetate, which is contained in Dianette, a contraceptive pill. Acne caused by PCOS does not respond well to other conventional acne treatments.
Being overweight increases the likelihood of developing this condition. It is therefore desirable to keep one’s weight under control.
Recent research has identified diet to be a likely cause of acne, a factor that dermatologists and other health professionals have rejected for years. Foods are known to contain certain natural and synthetic hormones, and it is thought that these disrupt the natural hormonal balance of the body.
Researchers have found that a diet high in saturated fat in animal products and hydrogenated fat in processed foods, as well as sugar is directly linked to acne.
Sometimes not getting sufficient nutrients may also cause acne. As the digestive system becomes depleted, the natural bacteria in the gut (probiotics) are reduced and unable to process food and toxins properly. As a result, toxins are eliminated through the skin, causing acne and other skin problems.
12) Insulin Resistance
Insulin is a hormone that regulates carbohydrate metabolism and has an active role in protein and fat metabolism. When you are insulin-resistant, your body does not respond to the normal amounts of insulin released and blood glucose levels rise.
The high blood sugar levels increase the levels of insulin and IGF-1, which increases the production of male hormones and androgens which in turn increase sebum production. The rise in hormones also encourages keratinocytes – the specialist skin cells implicated in acne to increase.
13) Low Vitamin A and E Levels
Both of these vitamins are fat soluble vitamins. Vitamin E is thought to help prevent oil trapped within the pores from becoming hard and rancid, and lowers the occurrence of painful inflamed acne lesions, while at the same time repairs the skin.
Vitamin A is needed to maintain the health of the skin and strengthen the immune system. Insufficient levels of Vitamin A and E in the body are therefore likely causes of acne.
14) Pressure And Friction On The Skin
The causes of Acne mechanica include heat, constant pressure, covered skin or irritation from repetitive friction against the skin. Wearing a helmet or chinstrap, for example, will enclose the skin, trapping heat and causing irritation around the forehead and chin.
Playing the violin for long periods of time can create an irritation to the neck. Other irritation can be from shoulder straps, tight uniforms, head bands and backpacks.
Contrary to what many believe, acne can be successfully treated and controlled. For a start, stress and weight management, as well as a healthy and sensible diet will help you to control your acne.