Acne: Causes, Symptoms, Diagnosis and Treatment

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Acne is a condition that affects many people at some time in their lives whether they are teens or young adults. Sadly, some people continue to be affected even into their forties and fifties. Fortunately, there is a lot you can do to improve the situation and even clear the condition completely. Whether you are a teen or in your twenties, acne can be a recurring condition. It is so common that it is considered to be a normal part of puberty and even adulthood. One in five adults can develop acne. Acne is common but that doesn’t make it any easier to live with. So what causes this annoying skin condition?

Table of Contents:

Causes
Types of Acne
Acne Scarring
The Social Impact of Acne
Acne & Depression
Treatment
Prevention
Medication

 

Causes & Diagnosis of Acne 

The pores in the skin contain sebaceous glands which, as the name suggests, make sebum. Sebum is the natural oil that lubricates your hair and skin and most of the time, just the right amount is made. However, if your hormones stimulate the glands to make extra sebum, the glands can become overactive and you are on the road to pores becoming clogged up with both too much sebum and too many dead cells. It is when bacteria gets trapped in these clogged pores and then multiplies that swelling and redness can result in white heads, blackheads and or pimples.

What causes glands to make extra sebum?

In adult acne the causes are often stress, bad cosmetics, hormones and birth control pills:

• Stress can cause those oil glands to overcompensate.
• Bad cosmetics can lead to bacteria-laden pores (that is cosmetics that have been around too long and become contaminated with air borne bacteria, and bacteria picked up off the skin).
• Hormones can also cause those oil glands to overcompensate.
• Birth control pills containing androgen can cause acne breakouts.

In teen acne the causes can be:

• The oil glands are stimulated to produce oil by hormones, specifically the male hormones called androgen.

• Women also have these hormones but much less of them.

• These hormones are produced by the testes in men and by the ovaries in women.

• In both sexes, androgen are also produced by the adrenal glands. During times of stress, the adrenal glands produce increased levels of these hormones, causing even greater enlargement of the oil glands.

• During puberty, the oil glands become overactive in response to hormonal changes.

Other contributing factors are:

 

• Drugs and some medications can actually cause or worsen acne. Examples are those drugs containing iodides, bromides or steroids.
• In some occupations, workers are exposed to industrial products like cutting oils or petroleum or cooking oils which could be a contributing factor.
• Cosmetics - as some of these together with skin-care products can clog the pores. Check the ingredients carefully and look for ones that are water based.

Remember that acne usually begins first with blackheads. Red pimples only develop when those blackheads become inflamed and they spread when you keep touching them (perhaps with dirty hands). Once a pimple then becomes infected, it can develop a white head or pustule.

Types of Acne

Many dermatologists assess the severity of a patient's acne vulgaris by using a grading scale. The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be on a scale of 1 (which is very mild) to 12 (which is extremely severe). Acne may be considered mild, moderate or severe while individual comedones and inflammatory lesions are usually considered separately. In clinical trials evaluating acne treatment, the numbers of unflamed and inflamed lesions are carefully counted at regular intervals.

Acne Vulgaris

Acne vulgaris lesions are more commonly known as pimples, white heads, blackheads, or the slang term of “zits”. More severe lesions are known as comedones or nodules. These lesions occur when there is a change in the skin cell units that contain sebaceous glands, a substance called sebum, and a hair follicle. When oil or dead skin cells build up and clog these units, a breakout or lesion can occur.

Causes of Acne Vulgaris

Hormone changes that cause an excess of oil in the skin are the leading cause of acne vulgaris and this is why the inflammatory skin condition is most likely in the teens when breakouts can be attributed to the levels of the hormone testosterone in varying degrees in males and females. 

Cystic Acne

Cystic acne gets its name from the cysts that appear during an outbreak. Unfortunately, cystic acne is the most severe and often the most painful type of acne that you can suffer from. Acne is a disorder of the sebaceous glands so that when these glands lubricate the skin and become blocked, bacteria overgrows and causes skin blemishes. However with cystic acne, breakouts can be deep and inflamed on or around the face or even other parts of the body.

Causes of Cystic Acne

Cystic acne is more likely to affect teenage boys and young male adults and are often passed down so genetics can play a role. Breakouts of cystic acne cause serious damage to the skin and destroy healthy skin tissue so should never be ignored and will need treatment. Always avoid picking at cysts as this can worsen the situation and even lead to scarring.

Hormonal Acne

There are quite a few types of acne, including ‘hormonal acne’. One of the main causes of acne is hormonal imbalances in the body. Acne occurs when the hormones in the body begin to overproduce and cause changes in the body such as an increased secretion from the oil glands.

Cause of Hormonal Acne 

The hormones that are responsible are androgens which affect the sebaceous glands that are responsible for keeping the skin moisturized. The inner skin linings are also affected due to the influence of hormones. Hormonal acne is common in teens but also affects adults. In women, factors such as stress, pregnancy, menstruation, or even an endocrine imbalance have been known to lead to hormonal acne. All this is related to hormonal changes in the body.

Rosacea

Very often we come across people whose face looks redder than it ought to be. This condition is referred to as Rosacea, and this is actually a skin condition that affects a large section of the white population (mainly those living in north western Europe). But according to estimates, as many as 45 million people are affected by this skin disease, including 14 million Americans.

Causes of Rosacea

Rosacea is a skin condition with symptoms appearing on the face. It causes facial redness and looks similar to pimples or acne. There are many theories behind the causes of Rosacea. Some believe that it is caused by a disorder of the blood vessels, causing swelling of the vessels in the facial region. Then there are those who believe that it is caused by a gastrointestinal system bacterial infection.

Body & Back Acne

Acne can also affect other places on the body such as the back, chest, neck, shoulders and upper arms. Acne on these body areas are more common in males than females. It is both more common and more severe in males, often spreading to the body from the face. You are not usually going to have body acne without the existence of face acne as well.

Causes of Body & Back Acne

Body and Back acne is caused by those same factors that trigger acne in the face, namely overactive oil glands, excess dead skin cells and other debris as well as multiplying bacteria once the pores are clogged. The oil and the dead skin cells and debris become trapped within the skin pore, cause a blockage and leave an open invitation for bacteria to invade. Blackheads, pimples and worse are the result.

Baby Acne

During pregnancy, women go through many hormonal changes and we all know that hormonal changes contribute to acne in teens. Some trace hormones stay with the baby (naturally passed through the placenta from the mother to the baby) and help stimulate lung maturation and other things but at the same time can cause baby acne, when they are born, by stimulating the sebaceous glands, leading to extra sebum production. In this case, prevention of baby acne is impossible.

Causes of Baby Acne 

It should be a comfort to know that baby acne is very common and usually goes away in just a few weeks but sometimes lingers for longer, running into several months. Baby acne can be present at birth or it can show up when the baby is about two weeks old. It usually appears on the nose, the cheeks or perhaps the forehead, the chin or even on the back. The skin may also appear red and rough. Baby acne or neonatal acne (as it is sometimes known) can have the typical acne signs and symptoms of whiteheads, blackheads and pustules. It should be left alone without any excessive cleaning or product use unless it really persists and then you can see a dermatologist for advice.

Acne Scarring

Facial scars can be particularly distressing and in severe cases, even be emotionally damaging. Although scars often appear as a result of an accident or an injury, acne scarring is common. Scars can also result when moles or skin tags are removed by cutting them away.

It may be possible to remove or at least lessen the appearance of facial scars. In some cases, scars may even improve if left alone but over time.

Surgery is one method where the doctor will cut away the scar and close with tiny stitches so that you are left with a much smaller scar.

The Social Impact of Acne 

Anything that makes us uncomfortable about our appearance, or our physical presentation, has been proven to have a socially detrimental impact on our psychological well being. Acne is looked at as a flaw in human appearance, an affliction if you will, which can affect not only our faces which is the part of us everyone sees first, but even can spread to other areas of our body as well.

Because acne is a "socially unacceptable" skin condition, a societal standard that has been set by beauty magazines showcasing models with flawless skin, the increasing celebrity obsession, and attention given to great skin, and other factors that have made us place a high importance on good skin. Good skin means acne free skin.

Acne & Depression

Unfortunately, when acne appears (particularly in teens) it can result in depression which is severe in some cases. It is important to be aware of the psychological effects of acne. As well as depression, there can be lack of self-confidence, self-esteem and self-worth problems, poor body image and introverted antisocial behavior.

Parents and teachers can go a long way to help a teen who may be overly self conscious about their acne by supporting them, and even helping with good treatment suggestions.

Some of the signs of poor self esteem can be:

• A reluctance to make friends and develop the usual social skills.
• The fear of being ridiculed by others.
• Extreme shyness and a phobia about socializing.
• Missed school or work

Treating Acne Symptoms Naturally

• Keep your face, or other affected area of the body, clean by washing 2 to 3 times a day with a gentle oil free soap (natural if possible). Never scrub, rub or scratch as this can increase the infection on your skin. 
• Keep makeup to a minimum and make sure to clean cosmetic brushes regularly in soapy water. Throw out old makeup because this can harbor bacteria. Leaving makeup products on your skin only contributes to clogging your pores, causing more pimples and blackheads. 
• Every day, put a clean pillowcase on your pillow and use a clean towel too. Change your sheets or duvet cover as often as possible as your bed linen can absorb the oils from your skin and then reapply them back to your face or your back.
• Tie your hair back when you sleep so it does not fall over your face as your hair contains oils too. Wash your hair every day.
• Never squeeze or scratch your pimples because this increases the infection and actually spreads any bacteria internally. It can also lead to scarring.
• You need to look at your lifestyle and diet as these play an important role. It is worthwhile to note that grains and sugars are the main reason why most suffer from acne whether they are teens or adults. If they can just eliminate grains, sugars, sweets and other junk or oily foods, they could well find a vast improvement as it becomes difficult for bacteria and inflammation to flourish. There are also foods that are especially helpful for skin health, including berries, citrus fruits such as lemons and oranges, fish, almonds, walnuts and leafy green vegetables. Also drink at least eight glasses of water per day to completely detox your body.

How to Prevent Acne

There are many causes of acne and just as many ways of treating this skin condition that affects teens and adults alike. The important thing to remember is to avoid too much sun exposure so that you burn. Keep your face in the shade or wear a big hat the rest of the time as sun blocks are full of toxic chemicals. If there is no sun, top up with a vitamin D supplement. 

Here are a few ways you can prevent acne:

• Drink lots of water: forget about the fruit juice or sodas as they have too much sugar and additives. Water is a natural way of detoxing your body's system, helping to flush out all the impurities that could cause blocked pores and ultimately acne.
• Sunlight is a preventative measure: there has been a complete turnabout by the medical community regarding sunlight and the importance of vitamin D, which we all need for our bodies to function properly and to prevent all kinds of unwanted conditions. 
• Stop stressing: reducing your stress levels is another way you can help prevent acne.
• Get enough sleep: make sure you get your eight hours of good quality sleep every night.
• Routine cleansing: will help to reduce any latent bacteria on the skin's surface so carry out a simple and gentle wash twice a day with a natural non soap cleanser to discard extra sebum and do away with dead skin cells and other debris. Never scrub or rub the skin. Always remove all traces of make up before going to bed and if you do use cosmetics, look for water based products rather than those that contain oil or petroleum. Natural is best.
• Long hair & bangs: hair that constantly touches the face are more likely to be an issue. It becomes difficult to keep the face oil-free or clean as dust particles can get mixed up with the natural oils of the hair. Keep your hair extra clean by washing every day.
• Vitamins: take a multivitamin every day to give your skin extra nutrition.
• Healthy diet: this should include fresh fruits and vegetables because all the antioxidants they contain will give your immune system a boost, strengthening your protection against acne-causing bacteria. Leave out the sugars, artificial sweeteners, and processed and refined foods.
• Exercise regularly: to stimulate the release of serotonin which helps alleviate stress and rid the body of waste and toxic materials.

Acne Medication 

If medications used to treat acne fail and the acne keeps reappearing, often the acne will be labelled as chronic. The treatments could be failing because the real cause of the acne is not being addressed. Unfortunately, often the medications prescribed are ineffective or even potentially dangerous, so that when the acne keeps on appearing, stronger and stronger medications are suggested in the hope of finding a possible solution.

The main types of conventional acne medications include:

1. Topical treatments such as lotions, creams and gels which are either available over the counter or prescribed by a doctor or dermatologist.
2. Oral antibiotics (tetracycline, doxycycline, minocycline, and erythromycin) usually prescribed when topical treatments listed above fail.
3. Accutane (isotretinoin) and its generic equivalents which are highly controversial and potentially dangerous and yet still prescribed for severe acne cases. Side effects include depression, the risk of suicide, inflammatory bowel disease and birth defects if taken during pregnancy. The labelling of Accutane was changed to strengthen the warning about its risk for causing depression. Isotretinoin now has the strongest warning available for any drug category

 Sources:

Rakel D, ed. (2018). Acne vulgaris and acne rosacea. In: Integrative Medicine. 4th ed. Elsevier. https://www.clinicalkey.com.(Accessed February 7 2021).
Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/acne. (Accessed February 7, 2021).
Kraft J, et al. (2011). Management of acne.
ncbi.nlm.nih.gov/pmc/articles/PMC3080563/ (Accessed February 7, 2021)

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