Acne

Sutaria, A.H., Masood, S., Saleh, H.M. and Schlessinger, J. (2023). Acne Vulgaris. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459173/ [Accessed 13 Jun. 2024].

Acne arises from an interplay of several factors, with hormonal fluctuations playing a key role. When sebaceous glands become overly sensitive to normal androgen levels, especially during puberty or pregnancy, they produce excess oil. This sebum, along with dead skin cells, clogs hair follicles. The bacterium Cutibacterium acnes thrives in this clogged environment, triggering inflammation and the visible signs of acne.

Beyond Hormones: Contributing Elements

While hormones are a major player, other factors can worsen acne:

• Medications: Certain medications like lithium, steroids, and anticonvulsants can contribute to breakouts.

• External Stimuli: Excessive sun exposure, friction from clothing or headgear, and oil-based cosmetics can irritate the skin and worsen acne.

• Underlying Conditions: Endocrine disorders like polycystic ovarian syndrome can disrupt hormone balance and lead to acne.

• Genetics: Your genes influence your sebum composition and susceptibility to acne.

• Hygiene Practices: Harsh scrubbing with soaps and detergents can damage the skin and worsen acne.

• Dietary Influences: Studies suggest a link between high glycemic index diets and milk consumption with acne in adolescents. The link could be related to hormones present in milk. However, there's no evidence to support the common belief that chocolate worsens acne.

• Stress: Psychological stress can exacerbate acne by elevating stress hormones.

• Insulin Resistance: Some studies suggest insulin resistance may play a role, as it can increase levels of a hormone that stimulates sebum production. The link between body weight and acne is less clear, with conflicting research findings.

Acne Vulgaris: A Breakdown of the Breakout Process

Acne vulgaris, the common form of acne, arises from a complex interplay of factors happening within your skin's tiny hair follicles. Here's a breakdown of the key steps:

The Trigger: Androgens and Sebum Overdrive

During puberty, pregnancy, or due to hormonal imbalances, hormones called androgens stimulate the sebaceous glands in your follicles to produce more sebum, an oily substance that normally keeps your skin lubricated. However, when sebum production goes into overdrive, it can clog the follicles.

Microcomedones: The Early Stage Blockage

Microscopic plugs of dead skin cells (corneocytes) and excess sebum get trapped within the lower part of the follicle, forming the first stage of acne called a microcomedo.

From Microscopic to Visible: Acne Progression

These microcomedones can gradually progress into more visible acne lesions:

• Closed Comedones (Whiteheads): When the blocked follicle remains closed, a whitehead forms.

• Open Comedones (Blackheads): If the follicle wall opens, the trapped sebum and dead skin cells oxidize and turn black, creating a blackhead.

• Papules and Pustules (Red Bumps): Bacterial growth (mainly Cutibacterium acnes) and the body's immune response trigger inflammation, causing red, tender bumps known as papules (without pus) or pustules (with pus).

• Nodules (Large, Painful Lumps): In severe cases, the inflammation can rupture the follicle wall, releasing bacteria, sebum, and dead skin cells deeper into the skin. This leads to larger, painful lumps called nodules.

Key Players in Acne Development:

• Increased Sebum Production (Seborrhea): As discussed earlier, this is a major trigger.

• Follicular Hyperkeratinization: Dead skin cells clump together excessively, clogging the follicles.

• Cutibacterium acnes (C. acnes): This naturally occurring bacteria thrives in the clogged follicles and contributes to inflammation.

• Inflammation: The body's immune response to the blockage and bacteria leads to redness and swelling.