What causes acne? It is a well-known fact that acne only appears on skin where there are sebaceous glands, mainly on the visible regions i.e. facial parts, neck, shoulders, chest, and back. Acne results when these sebaceous glands get choked up.
There are many factors which contribute to the blockage of skin pores containing sebaceous glands. Some of the factors responsible for the conditions which promote acne buildup and outbreak are following:
What Causes Acne: Excessive Sebum Production
Sebum production is a natural process which is carried out by the sebum glands near the roots of the hair follicles. Sebum excretion onto the skin has many purposes in the normal day to day functioning of the skin cells. It includes removal of trace amounts of waste materials, evaporative cooling of the skin for temperature regulation of the body and finally to protect the skin against over-drying and abrasive damage.
Sebum contributes as a factor which favors the development of acne when it is being produced in excess. This overproduction of sebum plays a key role in blocking of the excretory canals of the pilosebaceous unit as well as creating a micro-environment in the follicle which promotes the growth of P. acnes.
Hyperkeratinization is defined as the excessive development of skin cells especially in the cavity of the pilosebaceous unit. The hyperkeratinization may switch to an abnormal rate and contribute to the blockage of the pilosebaceous gland.
Plug Formation (Microcomedone)
Excretory canal of the pilosebaceous unit is blocked by a plug. This plug is also known as a microcomedone. Dead skin cells, cellular debris and excessive sebum production play a crucial role in the formation of microcomedone.
The microcomedone, as a result, cause the blockage of the hair follicle and with the accumulating debris as well as oil it grows to form a whitehead. If the top of the plug is exposed to the air it then rapidly oxidizes to form a black head.
Breeding Ground for Propionibacterium Acnes
Once the blockage of the hair follicle containing the sebaceous gland is effectively carried out by the microcomedone, it isolates the inside of the hair follicle from the outside and cellular debris as well as sebum starts to build up. This specific isolated environment with sufficient factors to enhance the growth of P. acnes provides a breeding ground for the bacteria.
Excessive growth of the bacterium causes the immune system to initiate the inflammatory response to tackle the growth of the microorganisms and to stop the introduction of the causative microorganism. The above mentioned four factors are the most commonly occurring causes of acne. These factors also play a major role in aggravating acne in some cases.
What Causes Severe Acne?
- Inflammatory response
- Deepening of the infection to follicle root
- Formation of nodules
The inflammatory response gives rise to raised red skin around the once non-inflammatory lesions. If the infection persists the inflammatory response as well as the growth of the microorganisms deepens and reaches the roots of the hair follicle, resulting in the formation of cysts. The formation of cysts is the first step through which mild to moderate acne gets converted into severe acne.
Role Of Androgens In Causing Acne
Androgens are male sex hormones which are naturally present in men and women. The first major fluctuation of androgens occurs in both genders during their pubescent growth. Androgens develop male features in boys during puberty while in girls they are necessary in maintaining the strength of skeletal as well as the muscular system.
The increased influx of androgens during puberty regardless of the gender contributes towards increased development of the sebaceous glands and results in excessive sebum production.
Androgen Fluctuation In Pregnancy
Androgen levels vary during pregnancy and acne outbreaks are usually reported in the first and the second trimester of the pregnancy.
The outbreak of acne during pregnancy should not be taken lightly. Most of the topical retinoids – first line of defense against acne – are teratogen in nature and may be responsible for serious consequences in the mother and the baby. The safety and efficacy of few most common retinoid based treatments of acne have been discussed in detail in the E-book on acne vulgaris.
Acne During Periods
The levels of female hormones vary greatly during menstrual shedding of the uterine wall – a process well known as periods- and may continue for some days to a week. During this time acne flares up and worsens in many patients. It does not exactly cause an outbreak of acne but has been related to disease severity.
Poly Cystic Ovary Syndrome
PCOS is a hormonal disorder in women. The condition leads to elevated levels of androgens in women, a condition known as hyperandrogenemia.
Elevated concentrations of androgens contribute to the outbreak of acne. The complaints of the flare up of acne lesions during or at the onset of menstrual period are most consistent in the case of women who have been diagnosed with PCOS.
Medications May Trigger Acne
There are certain drugs which are prescribed for the treatment of conditions other than acne. Some of these medications include:
- Anti-epileptic drugs
Corticosteroids, Lithium, and anti-epileptic drugs are known to interfere with the systemic levels of various hormones and neurotransmitters hence resulting in acne flare-ups. They have not yet been associated directly with the outbreak of acne.
The Ability Of Myths To Cause Acne
Acne is without any doubt the most commonly reported dermatological condition. People belonging to all walks of life from versatile age groups fall prey to acne once in their life. However, there are a large number of myths
Some of the most prevalent false statements target the consumption of different food products in causing acne outbreaks. Unhygienic lifestyle choices mainly involving the accumulation of dirt on the surface of the skin are also considered to be a major cause of acne eruptions. On the other hand getting rid of the blackheads and whiteheads on your own has also been a popular opinion on the social media platforms as the sure shot way of busting acne.
Does this mean that a person has to give up on their favorite food item in order to get rid of acne or is it necessary to combat acne face to face by popping whiteheads and blackheads as they emerge? We have carried out a deep scientific research to debunk most of the myths associated with acne treatment. The details can be found in the E-book.
Skin Care Products And Cosmetics Do More Harm Than Good
Acne Vulgaris presents itself as a very common skin disorder across the United States. Of all the patients registered for ambulatory dermatology procedures almost 10 percent registrations are made by acne patients every year.
At the same time, worldwide research on acne has led to serious progress and recommendations on skin care. However, questions arise on what kind of cosmetics can be considered safe as well.
Use Of Oil Based Moisturizers
Gerd Plewig, MD, and fellow researchers published their study in the JAMA Network comprising the examination of subjects for acne who were regular users of oily scalp moisturizers.
The eruption of acne at the temples and forehead were seen in 70% of the individuals. A positive correlation between the kind of oil based cream and acne breakout was also established with the simpler scalp creams (Vaseline etc) causing less acne than the more complex cream compositions.
In other words, the more complex the moisturizer administered to acne ridden part of the body, the more severe the outbreak.
What Causes Acne? Role Of Skin Hygiene Products
- Acne-ridden skin requires gentle cleaning.
- Accumulating sweat causes irritation.
- It is crucial to keep track of hygiene.
NIH suggests that the skin affected by acne should be treated gently. There are no restrictions or recommendations regarding clothing. But if the clothes are too snuggly to rub against the skin where acne is present then it may cause mild to serious irritation.
NHS comments on the importance of exercise in acne as it help in improving mood. But exercise also generates sweat which at the end of the day acts as a potent irritant. According to the recommendations of NHS, it is necessary to get rid of the sweat right after exercise because it can cause irritation.
Dermatologists and skin care specialists all over the globe have a similar view regarding the importance of hygienic measures towards the skin in order to treat acne. Mills recommended regular hygienic care of the acne-prone skin in the comments published in British Medical Journal.
Lack of maintaining a clean skin as well as improper cleaning of the face has been highlighted as two of the very common habits amongst the acne-stricken individuals. On the other hand, it also suggests that rigorous washing and cleaning behaviors may aggravate the condition.
Does Soap Cause Acne?
- Clogged pores require active cleaning.
- Excessive use of soap may cause more harm than good.
- Conventional soaps may be comedogenic.
- Non-comedogenic soaps ignite a debate on affordability.
In an extensive study published by Parker Magin in Family Practice – an Oxford Journal – she extensively described the necessity of cleanliness of acne prone areas but at the same time she highlighted that the process of acquiring special cleaning products and following the cleaning practice several times a day can be a burden on an acne patient financially.
While citing an earlier study of Otto H. Mills Jr. published in the JAMA Network she pointed out the presence of fatty acid salts in the conventional soaps and the role of salts of fatty acids in being comedogens – pore blocking agents – eventually leading to an acne outbreak in the patients.
Overuse of soap has been reported in some patients when they consider the directions about cleanliness way too seriously which then leads to aggravated spread of acne to other places on the body. Animal studies were done to check the comedogenic nature of the common soaps and shampoos available in the market. Rabbit ears showed evidence of comedogenesis when they were applied with common soaps and shampoos.