Understanding What Causes Acne and How We Can Treat It

Acne is one of the most common skin conditions worldwide, affecting millions of individuals regardless of age, gender, or ethnicity. While it is most frequently associated with adolescence, acne can persist into adulthood and sometimes even emerge later in life. Understanding the causes of acne and exploring effective treatment options can significantly improve skin health and quality of life.

What causes acne?

Acne occurs when hair follicles become clogged with oil, dead skin cells, and bacteria, leading to inflammation. The causes of acne are multifaceted and often interrelated. Below are the primary factors contributing to the condition:

Hormonal changes

Hormonal fluctuations are a significant cause of acne and explains why acne usually starts at puberty. Increased levels of androgens (yes even in females) stimulate sebaceous glands to produce more sebum. Hormonal changes also occur during pregnancy, menopause, or when using certain medications and probably explain why persistent acne is more common in women compared to men.

Excess sebum production

Sebum is an oily substance produced by sebaceous glands to moisturize and protect the skin. However, excessive sebum production can clog pores, creating an environment conducive to acne development. Hormonal fluctuations during puberty, pregnancy, or menstrual cycles can elevate sebum production.

Clogged hair follicles

Dead skin cells are naturally shed by the body, but when they accumulate and mix with sebum, they can form blockages in the hair follicles. This is the primary lesion of acne and is known as the comedone. A blocked hair follicle which is open to the surface so that the plug is oxidised by the air is called a ‘blackhead’. If it is closed and the plug looks white, it is called a ‘whitehead’. These blockage serves as a breeding ground for bacteria, which then proliferate.

Bacterial proliferation

The bacteria 'Propionibacterium acnes' (or 'Cutibacterium acnes') is part of our normal skin flora but it thrives in clogged hair follicles. These bacteria can trigger inflammation, leading to red, swollen papules (spots), pustules (spots with pus) or cysts and nodules if they rupture under the surface of the skin. The proliferation of bacteria exacerbates the severity of acne lesions.

Diet and lifestyle

Emerging research suggests that diet sometimes plays a role in acne development. Foods with a high glycaemic index, such as sugary snacks and refined carbohydrates, may worsen acne symptoms. Additionally, stress, lack of sleep, and smoking can negatively impact skin health.

Genetic predisposition

If acne runs in your family, you may be genetically predisposed to the condition. Genetic factors can influence sebum production, skin cell turnover, and the likelihood of developing inflammatory acne.

Environmental factors

Exposure to pollution, harsh chemicals, occlusive clothes (truncal acne) and high humidity can irritate the skin and contribute to acne formation. Wearing heavy makeup or using skincare products that are not 'non-comedogenic' can also clog pores.

Types of acne

Acne manifests in various forms, each requiring different approaches to treatment. The key types include:

• Whiteheads: Closed comedones formed when hair follicles are clogged with sebum and dead skin.

• Blackheads: Open comedones that appear black due to exposure to air, not dirt.

• Papules: Small, red bumps caused by inflammation.

• Pustules: Pimples filled with pus, often with a red base.

• Nodules: Large, painful lumps beneath the skin caused by severe inflammation.

• Cysts: Deep, pus-filled lesions that can lead to scarring.

How we can treat acne

Acne treatment aims to tackle all the steps in the causation of acne listed above- so they reduce oil production, promote skin renewal, reduce keratinisation, reduce bacteria, and reduce inflammation. Treatment options vary depending on the severity and type of acne. Below are the main approaches:

Topical treatments

Topical treatments are applied directly to the skin and are effective for mild to moderate acne. Common topical treatments include:

• Retinoids: Derived from vitamin A, retinoids promote cell turnover and prevent clogged pores. Examples include tretinoin and adapalene.

• Benzoyl Peroxide: This antimicrobial agent reduces bacteria and inflammation.

• Salicylic Acid: Known for its exfoliating properties, salicylic acid helps remove dead skin cells and unclog pores.

• Azelaic Acid: This acid has antibacterial and anti-inflammatory properties, making it suitable for sensitive skin.

• Chemical peels using mandelic, salicylic or pyruvic acid also remove dead skin cells and unclog pores.

Oral medications

For moderate to severe acne, oral medications may be prescribed. These include:

• Antibiotics: Oral antibiotics like doxycycline and minocycline fight bacterial infections and reduce inflammation.

• Hormonal Treatments: Birth control pills or spironolactone can regulate hormonal imbalances that contribute to acne.

• Isotretinoin: This powerful medication, often used for severe cystic acne, reduces sebum production and addresses all major causes of acne.

Laser and light devices

• AviClear laser is the first FDA approved laser for the treatment of mild, moderate and severe acne. It works by destroying the oil glands and hence eliminates acne at its source, making it very effective!

Please see my December 2024 blog for my approach to treating acne and click on the AviClear page to fnd out more about AviClear laser.

Conclusion

Acne is a complex condition influenced by various factors, from hormones and genetics to lifestyle and environment. Understanding its causes and exploring tailored treatments can empower individuals to manage their skin health effectively. Whether through topical solutions, oral medications, professional treatments, or preventive measures, there are ample options to combat acne and achieve radiant, healthy skin. By taking an informed and proactive approach, you can pave the way to a clearer complexion and greater confidence.