What causes Acne?

26 Mar

Acne is a chronic skin condition and is generally categorised by ongoing clusters of breakouts, commonly affecting the face but can also develop on the chest, back, and shoulders. Beyond its initial physical impact on the skin, acne is a complex and far-reaching skin condition that can often leave long-term suffers with scarring as well as negatively impacting mental health.

Throughout my years as a Facialist I have seen many of the psychological impacts for my clients suffering with acne, from low self-esteem, depression and anxiety to relationships and jobs being affected. Witnessing the extensive negative effects that acne can have prompted me to delve deeper into understanding it’s root causes and effective treatment methods. Treating acne has now become a speciality of mine and over the years I have successfully helped many clients navigate and overcome this challenging skin condition.

Types of Acne Breakouts

When we think of acne, we instantly think of red, inflamed, large breakouts, however there are actually a few different types of breakouts, and each breakout requires tailored treatment. It is important to note that most people will experience some form of breakouts throughout periods of their life, however acne is a chronic skin condition that is ongoing, and suffers of acne will usually have a combination of the breakouts I will explain further on.

The very basics of a breakout is oil + dead skin = over production of bacteria = breakout! But I want to explain this in more detail for you... every ‘pore’ on your face is actually a hair follicle that may produce a fine vellus hair. Each follicle has a sebaceous gland that secrets an oily substance called sebum. When follicles become clogged with excess sebum, along with dead skin cells, they can firstly form comedones. Comedones are skin coloured or whitish bumps which look to be just under the skin. If the follicle is ‘open’ on the surface, the debris can oxidise when exposed to air, causing the blockage to turn black, something we commonly call a blackhead.

Comedogenic acne is sometimes referred to as non-inflammatory acne as the lesions do not cause any inflammatory response, however they do still require treatment as comedogenic acne is a sign of the skin overproducing sebum and can lead onto inflammatory acne.

If left untreated, or in acne prone skin these clogged follicles are the perfect environment for the proliferation of the Propionibacterium acnes bacteria (P. acnes). Now everyone will have P.acnes bacteria naturally living on their skin, but the issues arise when the p.acnes bacteria start overproducing. It is actually the by products of the P.acnes bacteria that generate an inflammatory response in the follicle, which will then lead to the formation of inflammatory breakouts- pustules and papules or nodular and cystic acne.

Pustules are raised inflamed lesions that will have yellowish/ whitish pus on the surface. (sometimes called whiteheads)
Papules will appear as small red bumps on the skin’s surface and can lead to pustules.
Nodules are a hard, red raised lesions and usually painful to touch. They occur when the inflammation spreads deep into the skin.
Cystic Acne presents similarly to nodules and are also formed when the inflammation spreads deep into the skin, however the nodules are also filled with pus.

Due to the level of inflammation and size of lesions, nodules and cysts can also cause the follicle walls to rupture, causing tissue damage that unfortunately leads to scarring

Root Causes

Now you have an understanding of the type of breakouts you’re experiencing, you want to know what’s causing them. The root cause of an acne prone skin can differ from person to person, and more often than not, there won’t be just one root cause. It can often be a snowball effect; once the skin is in a state of poor health with possibly only a few inflammatory breakouts it may be more susceptible to further ‘triggers’. Below I will explain some potential root causes or ‘triggers’ of acne, however I must stress that for clarity on what may be the root causes of your acne I recommend seeking an assessment and personalised advice from a skin specialist.

Firstly, I want to clear up the misconception that acne is only a skin condition that teenagers get. Yes, teenagers can get acne throughout their adolescence, however acne can flare at any age due to changes in hormones.

Hormonal changes and fluctuations, particularly androgens (male hormones) have a direct impact on hair follicles and sebaceous glands. Androgens can influence the size and activity of the sebaceous glands, causing them to overproduce sebum which we know can then lead to acne.

There are many factors that can cause fluctuations in our hormones throughout our lifetime, from female menstrual cycle, to increased stress levels; if our hormones are temporarily unbalanced, this could contribute to breakouts. I have had many clients who only suffered with acne throughout adolescence, but the condition became active again once they became pregnant, or even when going through the menopause.

Not all acne is hormone related, it can also be genetic, when our skin and how it behaves is passed down from our parents or even grandparents. This genetic pre-disposition can influence how much sebum our skin naturally produces; genetics may also be the cause of condition called Retention Hyper-Keratosis. This is when the skin overproduces keratin, making the skin cells that line the inside of the hair follicles sticky and unable to shed correctly, leading to blockages.

Lifestyle can also be a significant contributor to the development of acne. Everyone is aware that habits such as smoking and drinking alcohol will negatively impact the health of your body and its functions in general, but this includes the health of your skin. Smoking is known to induce oxidative stress and inflammation, which can exacerbate inflammatory acne, whilst also reducing blood flow; affecting the body’s immune response and further limiting the skin’s ability to heal and repair. Similarly, alcohol consumption can exacerbate inflammation within the body, and the skin. Alcohol can also dehydrate the skin, when this occurs, the skin may start to overproduce oil to compensate, leading to follicle blockages and acne forming.

One of the first things that most people seem to try when they develop acne, is to cut out dairy or other food groups from their diet, and while this can sometimes help, restrictive eating will not usually fully clear the acne. The relationship between our diet and skin can be complex and differs from person to person, some people may have sensitivities to certain foods which may trigger an initial outbreak but may not be the cause of on-going acne. It is our overall gut health that is the biggest contributor to our skin’s health, and this is dependent on so much more than just our diet. There is still more evidence required to fully understand the mechanisms of our diet and our skin, however if you believe your acne may be triggered by your diet I advise seeking help from a nutritionist and thorough assessment of your gut health.

What we do know is that hormones particularly androgens influence sebum production, and consumption of certain foods can influence our hormones.

High-Glycemic Foods: Some studies suggest that a diet high in refined carbohydrates and foods with a high glycemic index (such as sugary snacks and processed foods) can lead to an increase in insulin levels, which may, in turn, stimulate the production of androgens and sebum, contributing to acne development.
Dairy: Hormones present in dairy, such as insulin-like growth factor 1, may play a role as elevated levels of IGF-1 can cause increase in sebum production. The whey protein that dairy contains can also influence insulin production, resulting in an increase in androgens and subsequently sebum.
Omega-6 Fatty Acids: An imbalance between omega-6 and omega-3 fatty acids in the diet may contribute to inflammation, potentially exacerbating acne. Omega-6 fatty acids are found in certain oils and processed foods.

Other lifestyle factors to consider include sleep, as the amount of sleep and the quality of sleep we get we get can impact our overall health and how our body repairs itself. Our skin does most of it’s regenerating whilst we sleep, so if we are not getting enough of it our skin won’t have adequate time to heal and repair. When we are overtired, this can lead to us becoming more stressed, high stress levels influence androgen production and could therefore lead to overproduction of sebum.

Exercise may be great for our overall health and mental wellbeing, however if you are acne prone correct practises must be followed to care for your skin before, during and after exercise to ensure that it does not lead to breakouts. If make-up or pore clogging products are worn during exercise this can block the pathway of sweat being excreted from the body. This can trap sebum, dead skin cells and bacteria on the skin leading to inflammatory breakouts. The heat generated from high intensity exercise could also be a potential contributor of breakouts due to heat stimulating the production of sebum. It is important to thoroughly cleanse your skin prior to working out, workout with your skin free from any product (unless you are exercising outdoors then SPF should be worn) then cleanse your skin post workout.

If you are struggling with acne then I would love your takeaway from this blog to be an understanding that everyone’s acne and triggers are different, having acne is not your fault; It is a cumulative effect of many internal triggers, most of which will be out of your control or unbeknown to you. I hope that this may be a starting point in understanding and eventually overcoming this complex skin condition. To discover the type of acne you have and the potential root causes, your first step is to seek advice from a skin specialist for a thorough and personalised skin assessment and treatment plan. Stay tuned for my upcoming blog on treating acne where I will discuss effective products, and professional treatments in the battle against acne.

In the meantime, for an in-sight into what may be causing your acne please contact me to schedule an in depth consultation.

With Love,

Lara x