Acne is a skin disease caused by clogged pores. It can be mild and easily managed with home remedies and good hygiene or severe and require medical treatment. When acne is extensive and the inflammation visible, social exclusion may occur and lead to self-esteem problems, anxiety and depression. Severe acne can occur on the face, arms and trunk of the body and leave behind scars that may prove difficult to heal.
What is acne? Acne takes on the form of comedones such as whiteheads, blackheads and various other types of inflammation of the skin in the form of papules or pustules. Increased sebum production manifesting as oily skin is also a sign of acne development. How does acne occur? Excess sebum (oil from the sebaceous glands in the skin) and dead skin cells our skin sheds off on a regular basis can clog the hair follicles and cause an infection that leads to acne.
Types of acne
In its development, acne vulgaris can go through various stages:
1) Microcomedones. This is basically acne in the forming and doesn’t usually show. The sebaceous glands in the skin produce more oil (sebum) than normal. When our skin sheds dead keranocytes (skin cells that make up the outermost layer called the epidermis), the sebum makes them stick together and clog our pores, promoting acne development. Increased sebum production also allows a certain bacterium (Propionibacterium acnes) that lives off it to prosper and infect the skin, further increasing the chances for acne development.
2) Closed comedones (whiteheads). Sebum and dead skin cells build up deep inside the pores and eventually clog the opening of the hair follicle. This leads to tiny, closed bumps with a whitish point known as whiteheads. They may become infected with the Propionibacterium acnes bacterium or not, depending on whether or not there is an overgrowth of the bacterium.
3) Open comedones (blackheads). Dead skin cells and sebum can accumulate in the hair follicles, but because the pores are still open, oxidation causes the melanin in the skin to turn dark, hence the dark color specific to blackheads. The bacterium Propionibacterium acnes can infect the blackhead and lead to acne.
4) Papules. A form of acne, papules appear as painful, red bumps on the skin. They occur when too much sebum and cell debris accumulate in the hair follicle and it can’t take the pressure, so it bursts. When this happens, all its contents, sebum together with the bacterium Propionibacterium acnes reach the surrounding skin, promoting an infection and inflammation. This type of acne is considered medium to severe and is best treated with appropriate medication.
5) Pustules. When the overgrowth of the Propionibacterium acnes bacteria occurs and infects the skin, the immune system steps in to fight it off. This leads to inflammation at the site of the infection. However, the bacteria too generates inflammation, further accentuating the problem and leading to the formation of pus, resulting in a severe form of acne known as pustules. Generally, pustules are red, inflamed bumps with a center filled with yellow pus, waiting to rupture.
6) Cysts. Nodules or cysts refer to a severe type of acne that may cause deep scars in the skin. They appear as large bumps in the skin, often with pus. They actually occur deep in the skin and generate extensive inflammation. They are painful, pink-colored and take long to heal. In more severe cases, they are red or purplish. Acne cysts require a strict hygiene and appropriate medical treatment. They can easily leave scars that are difficult to repair.
Signs and symptoms
A first sign we may be developing acne is an increase in sebum production. When our skin becomes to oily, there are greater chances our pores may become clogged with our own dead skin cells. This may encourage the overgrowth of a bacterium that already lives on the skin and feeds off sebum to infect our clogged pores. The infection has our immune system respond and creates inflammation, often resulting in the formation of pus. But there is only so much a clogged pore can hold so when it becomes too clogged with dead skin cells, sebum, bacteria, pus it ruptures and infects the surrounding skin. Unless taken care of with good hygiene and a good diet and proper medication prescribed by a dermatologist, acne may spread to other parts of the skin and leave deep scars that may or may not heal depending on their severity.
What causes acne?
There are several causes and predisposing factors which may contribute to acne development:
1) Hormonal imbalances. Acne is more common during puberty when there is an increase in androgen hormones that lead to the production of more sebum by the sebaceous glands in the skin. Thyroid problems (hypothyroidism) can creates hormonal imbalances that may encourage acne formation as well. Hormone fluctuations in pregnancy may cause moderate to severe acne, debuting in the first trimester. Women with a history of the condition are more at risk of getting acne.
2) Bacteria. Propionibacterium acnes is a bacterium that normally lives on our skin, feeding off sebum. When sebum production increases, so do the bacterium populations. An overgrowth means that it is more likely for it to become trapped within our pores when comedones occur and infect the skin, leading to more severe, often infectious acne that can spread to other parts of the skin.
3) Mites. A whole range of skin symptoms such as rash, itching, redness, even comedones can be caused by mites, tiny invertebrates that live on our skin. Eczema, atopic dermatitis, acne, even blepharitis, rosacea, asthma and allergic reactions have been traced back to them. Demodex folliculorum is normally found in hair follicles, while Demodex brevis is normally found in the sebaceous glands of hair follicles. The two are found particularly on the face where they feed off sebum and skin cells.
An increase in sebum may lead to an overgrowth in mite populations on the skin and trigger itching, redness and other symptoms as well as promote infections that may lead to acne vulgaris (A meta-analysis of association between acne ulgaris and Demodex infestation).
4) Not taking care of your skin properly. Different skin types have different needs in terms of hygiene, hydration and overall care. But whatever the skin type, it is important to maintain a strict hygiene to prevent and manage acne. Cleaning the face several times a day with products suited to our skin type, moisturizing and exfoliating, using the right acne products prescribed by our dermatologist are vital steps for recovery. Using soaps with a harsh formula, not cleaning the face of dust and other particles that could clog up pores can worsen acne. Touching the face too often, especially without thoroughly cleaning our hands is bad for acne evolution.
Not changing pillow cases at least twice a week, not cleaning make up brushes or sponges regularly, not washing after working out and sweating can all lead to complications. Dust, sweat, dirt and bacteria can all clog pores and can be found in the air, on our pillows, exercise mats, hair and face, even phone which is why it is so important to maintain good hygiene.
5) Dietary factors. The real cause for acne has not been identified yet, but factors that encourage it have. In addition to poor hygiene, family history or hormonal imbalances, acne can be worsened by certain foods. Processed, fatty foods may increase sebum production and cause acne. Partially hydrogenated fats found in animal fat, butter, margarine and various spreads, sweets, baked goods etc. are another culprit. Processed cold meats or luncheon meats such as salami, meat loaves, sausages, baked or smoked hams, prosciutto, mortadella, chorizo, pastrami etc. are all bad for our complexion and overall health, potentially increasing our risks of chronic diseases and cancer.
For some, eating too much chocolate, especially milk chocolate cause cause breakouts. Surprisingly, consumption of dark chocolate appears to have beneficial effects, most likely due to the antioxidants it contains. Eating too much dairy products or whole milk can lead to acne in certain people.
6) Genetics. There appears to be a genetic component that dictates our chances of getting acne and how bad it will be. Individuals with a family history of the condition are more likely to develop acne themselves than those that are not genetically predisposed.
7) Make up. Not cleaning make up brushes and sponges allows bacteria and other debris to accumulate and block our pores or encourage skin infections. Certain skin care and make up products contain problematic ingredients such as perfumes, synthetic pigments, dyes, lanolin and other harsh, pore-clogging, greasy ingredients that may cause cosmetic acne. Oil-based make up can also worsen the condition. Non-comedogenic, oil-free, hypoallergenic products work best for skin care and do not encourage breakouts.
The appearance of acne vulgaris can have a huge negative social impact, especially when it is not dealt with accordingly in its early stages. Acne can evolve from a couple of dozens of almost unnoticeable whiteheads or blackheads to papules, pustules, nodules and cysts, all very visible, painful and difficult to manage and remedy, potentially leading to extensive scarring. Strict hygiene and appropriate dermatological treatment sustained by religious follow-ups to the dermatologist are vital for maintaining skin health, promoting healing of scars and preventing acne from reappearing.