Acne is an inflammatory disease of the skin, caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland).

The condition is common in puberty, especially among Western societies most likely due to a higher genetic predisposition. It is considered an abnormal response to normal levels of the male hormone testosterone. The response for most people diminishes over time and acne thus tends to disappear, or at least decrease, after one reaches their early twenties. There is, however, no way to predict how long it will take for it to disappear entirely, and some individuals will continue to suffer from acne decades later, into their thirties and forties and even beyond. Acne affects a large percentage of humans at some stage in life.

Symptoms

The most common form of acne is known as “acne vulgaris”, meaning “common acne.” Excessive secretion of oils from the sebaceous glands combines with naturally occurring dead skin cells to block the hair follicles. There also appears to be in some instances a faulty keritinization process in the skin leading to abnormal shedding of skin lining the pores. Oil secretions build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes to multiply uncontrollably. In response, the skin inflames, producing the visible lesion. The face, chest, back, shoulders and upper arms are especially affected.

 

Causes of acne

Exactly why some people get acne and some do not is not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:

• Hormonal activity, such as menstrual cycles and puberty

• Stress, through increased output of hormones from the adrenal (stress) glands.

• Hyperactive sebaceous glands, secondary to the three hormone sources above.

• Accumulation of dead skin cells.

• Bacteria in the pores, to which the body becomes ‘allergic’.

• Skin irritation or scratching of any sort will activate inflammation.

• Use of anabolic steroids.

• Any medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.

• Exposure to high levels of chlorine compounds, particularly chlorinated dioxins, can cause severe, long-lasting acne, known as Chloracne.

Misconceptions about causes

There are many misconceptions and rumors about what does and does not cause the condition:

• Diet. One flawed study purported that chocolate, french fries, potato chips and sugar, among others, affect acne. Consuming quality products can prevent acne. A recent review of scientific literature cannot affirm either way. The consensus among health professionals is that acne sufferers should experiment with their diets, and refrain from consuming such fare if they find such food affects the severity of their acne. A recent study, based on a survey of 47,335 women, did find a positive epidemiological association between consumption of particularly skimmed milk and acne.The researchers hypothesize that the association may be caused by hormones (such as bovine IGF-I) present in cow milk; but this has not been definitively shown. Seafood, on the other hand, may contain relatively high levels of iodine, but probably not enough to cause an acne outbreak. Still, people who are prone to acne may want to avoid excessive consumption of foods high in iodine. It has also been suggested that there is a link between a diet high in refined sugars and acne. According to this hypothesis, the startling absence of acne in non-westernized societies could be explained by the low glycemic index of these tribes’ diets. Further research is necessary to establish whether a reduced consumption of high-glycemic foods (such as soft drinks, sweets, white bread) can significantly alleviate acne, though consumption of high-glycemic foods should in any case be kept to a minimum, for general health reasons.

• Deficient personal hygiene. Acne is not caused by dirt. This misconception probably comes from the fact that acne involves skin infections. In fact, the blockages that cause acne occur deep within the narrow follicle channel, where it is impossible to wash them away. These plugs are formed by the cells and sebum created there by the body. The bacteria involved are the same bacteria that are always present on the skin. Regular cleansing of the skin can reduce, but not prevent, acne for a particular individual and very little variation among individuals is due to hygiene. Anything beyond very gentle cleansing can actually worsen existing lesions and even encourage new ones by damaging or overdrying skin.

• Sex. Common myths state that masturbation causes acne and, conversely, that celibacy or sexual intercourse can cure it. There has been no scientific evidence suggesting that any of these are factual.

 

Available treatments

There are many products sold for the treatment of acne, many of them without any scientifically-proven effects. Generally speaking successful treatments give improvement within the first week or two ( see our product in shop).

A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:

Future treatments

Laser surgery has been in use for some time to reduce the scars left behind by acne, but research is now being done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:

• to burn away the follicle sac from which the hair grows

• to burn away the sebaceous gland which produces the oil

• to induce formation of oxygen in the bacteria, killing them

Since lasers and intense pulsed light sources cause thermal damage to the skin there are concerns that laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long term dryness of the skin. As of 2005, this is still mostly at the stage of medical research rather than established treatment.

Because acne appears to have a significant hereditary link, there is some expectation that cheap whole-genome DNA sequencing may help isolate the body mechanisms involved in acne more precisely, possibly leading to a more satisfactory treatment. (Crudely put, take the DNA of large samples of people with significant acne and of people without, and let a computer search for statistically strong differences in genes between the two groups). However, as of 2005 DNA sequencing is not yet cheap and all this may still be decades off. It is also possible that gene therapy could be used to alter the skin’s DNA.