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What is acne?

Acne, or acne vulgaris, is a medical skin condition caused when oil glands become clogged with dead skin cells, excess sebum, and other debris. Sebum is a natural oil that keeps the skin healthy, soft, and moisturized. When too much sebum is produced, it can become trapped in oil glands along with dead skin cells and bacteria, resulting in inflammation, redness, and pain. While most people associate acne with adolescence, individuals of any age can experience an acne breakout. Acne can occur anywhere on the body where there are sebaceous glands, although it is most common on the face, chest, and back. Untreated or poorly treated acne can lead to permanent scarring or hyperpigmentation. If you are experiencing any active acne breakouts, consulting with a board-certified dermatologist like Dr. Green as soon as possible is crucial to prevent scarring and achieve clear skin.

What causes acne?

Although anyone can potentially be affected by acne, some factors increase the likelihood of having a breakout. Acne is considered to have a genetic component, usually running in families. Patients can simply be more prone to experiencing acne breakouts as a result of the way their skin naturally produces and secretes sebum. Hormone changes, such as those during puberty, pregnancy, and around one’s menstrual cycle, can also cause breakouts. In particular, androgens, or male sex hormones like testosterone, have been linked to higher rates of acne breakouts as they increase sebum production in the sebaceous glands. Breakouts can also be caused by factors like stress, diets that are rich in sugar and fat, and poor sleeping or hygiene habits.

When you consult with an experienced board-certified dermatologist, such as Dr. Green in NYC, you will thoroughly discuss your family and medical history, your skin care regimen, and other environmental factors that may be contributing to your acne breakout. Dr. Green may collect and send a sample of blood to the laboratory to be evaluated for any hormonal abnormalities that could indicate increased breakout. Determining the underlying cause of your acne with Dr. Green is the best first step in understanding and managing your breakouts.

Acne is caused by a combination of factors that lead to clogged pores and inflammation. Here are the main causes:

1. Excess oil production: Your skin produces oil (sebum) to keep it moisturized. When your body produces too much, it can mix with dead skin cells and clog your pores, leading to acne.
2. Clogged pores: Dead skin cells can accumulate on the surface and mix with sebum. This creates blockages in hair follicles (pores), which can lead to the development of blackheads, whiteheads, or pimples.
3. Bacteria: A type of bacteria called Propionibacterium acnes can thrive in clogged pores. This can lead to inflammation, causing redness and swelling around pimples.
4. Hormonal changes: Hormones, especially androgens, can increase during puberty, menstruation, pregnancy, or when taking certain birth control methods. This leads to an increase in oil production and can trigger acne.
5. Diet: Some studies suggest that certain foods, especially those high in refined sugars or dairy, may aggravate acne in some people.
6. Stress: Stress can trigger hormonal fluctuations that may increase oil production and worsen acne.
7. Medications: Certain medications, like corticosteroids or those that affect hormone levels, can contribute to acne.
8. Genetics: If your parents had acne, you might be more prone to developing it.
9. Environmental factors: Pollution, humidity, or exposure to certain chemicals can also contribute to acne.

1. Excess Oil Production (Sebum)

• Sebum is produced by sebaceous glands in the skin, and its primary function is to lubricate and protect the skin. However, overproduction of sebum can clog hair follicles, trapping bacteria and dead skin cells inside. This leads to the formation of pimples, blackheads, and whiteheads.
• Reference: Zouboulis, C. C. (2009). Acne and sebaceous gland. Dermatologic Clinics, 27(1), 1-10.

2. Clogged Pores

• Hair follicles are lined with keratinocytes (skin cells) that continuously shed. If dead skin cells do not slough off properly, they can mix with sebum and form a plug in the follicle. This is a major factor in the development of comedones (blackheads and whiteheads).
• Reference: Kurokawa, I., Danby, F. W., Ju, Q., et al. (2009). New developments in our understanding of acne vulgaris. Journal of Investigative Dermatology, 129(1), 1-10.

3. Bacterial Infection (Propionibacterium acnes)

• Propionibacterium acnes (now known as Cutibacterium acnes) is a bacterium naturally found on the skin. It thrives in clogged hair follicles, where it feeds on sebum, leading to inflammation. When the immune system responds to this bacterial growth, it can cause redness, swelling, and pus formation around the pore.
• Reference: Berg, D. E., & Staudt, J. E. (2014). Cutibacterium acnes and the skin microbiome in health and disease. Clinical Microbiology Reviews, 27(4), 585-595.

4. Hormonal Changes

• Hormones, particularly androgens (like testosterone), can increase the size and activity of sebaceous glands. This is why acne is common during puberty, menstruation, pregnancy, and in conditions like polycystic ovary syndrome (PCOS). Hormonal changes during these periods can trigger excess oil production and exacerbate acne.
• Reference: Eichenfield, L. F., & Concordia, D. M. (2018). Hormonal influence on acne. The Journal of Clinical and Aesthetic Dermatology, 11(6), 12-20.

5. Diet and Lifestyle Factors

• Diet: Studies have shown that diets high in refined carbohydrates (like sugar, white bread, and pasta) and dairy products can increase insulin levels and promote the production of insulin-like growth factor 1 (IGF-1), which may stimulate sebaceous glands and increase acne risk. However, the role of diet in acne is still debated, and not everyone with acne has a dietary trigger.
• Reference: Smith, R. N., Mann, N. J., & Braue, A. (2007). The role of diet in the development of acne: A review of the literature. Dermato-Endocrinology, 5(4), 168-175.
• Stress: Stress increases cortisol, a hormone that can trigger inflammation and exacerbate acne. It can also lead to increased oil production and clogged pores.
• Reference: Yosipovitch, G., & Dawn, A. G. (2012). Stress and the skin: The role of stress in the pathogenesis of acne vulgaris. Dermatologic Therapy, 25(4), 360-368.

6. Medications

• Certain medications can either induce or worsen acne. Corticosteroids, some anticonvulsants, and oral contraceptives with certain hormone formulations can all have an impact on sebum production or the skin’s response to inflammation.
• Reference: Friedman, A. L., & Strauss, J. (2003). Drug-induced acne: Etiology, prevention, and management. Drug Safety, 26(15), 1029-1039.

7. Genetics

• Acne often runs in families, and genetic factors play a major role in susceptibility. Variants in genes responsible for sebum production, skin barrier function, and immune response may predispose individuals to acne.
• Reference: Micheletti, A. (2008). Genetic factors in acne vulgaris. Dermato-Endocrinology, 2(1), 1-3.

8. Environmental Factors

• Exposure to pollution, high humidity, or certain chemicals can irritate the skin and lead to clogged pores. Additionally, wearing tight clothing or equipment (like helmets, headbands, or masks) that traps sweat and oil can worsen acne.
• Reference: Visscher, M. O., & James, W. D. (2011). Environmental factors in acne. Dermatologic Clinics, 29(1), 35-42.

Conclusion

Acne is a complex condition influenced by a combination of genetic, environmental, hormonal, and lifestyle factors. Understanding these causes can help in managing and preventing acne. Treatment typically involves addressing the underlying causes, such as regulating oil production, reducing bacteria, and managing inflammation through topical treatments or oral medications.

I hope this detailed explanation helps! Let me know if you need further information.