Acne 101

 In Articles

By Nicole Miller, RN

Over the years I’ve spoken with with men and women of various ages about acne.  There’s so much information out there today about what causes acne and what you should do to address the problem. Unfortunately there’s more myths than I could cover in today’s blog.  Instead of discussing the myths, let’s cover the basic facts.  The information we cover will be strictly medical, however, it’s not meant to diagnose a problem or substitute a visit with your physician or dermatologist.

First of all, what is acne?  More than anything acne is a process, a sequence of events if you will.  Usually this process starts with a build up of dead skin cells and sebum at the infundibulum (top) of the hair follicle (clogged pore).  Sebum builds up and attracts the P. acnes (Propionibacterium Acne) bacteria.  This bacteria promotes inflammation.  Before inflammation sets in, you have a blackhead or a whitehead; at this point you have noninflammatory acne.  Blackheads are open comedones (black due to oxidized sebum) and white heads are closed comedones.  These can advance to pustules and cystic acne once P. acnes promotes more inflammation.

So lets better explain this sequence of events:


So, essentially, you have four main players here:  follicular hyperkeratinization, sebum, P. acnes and inflammation.  Once you understand that, you can better understand why certain things can cause a flare up.acne-comp

  • Follicular Hyperkeratinization – This is when dead skin cells don’t leave the follicle due to increased keratin causing the cells to be more cohesive and stick together.  Basically you’re not shedding your dead skin cells efficiently enough so you end up with a plugged follicle.
    • Genetics play a key role in how much keratin you produce.
  • Sebum – Many things can increase sebum production, such as androgens (male hormones, PMS), some endocrine disorders, steroids and other medications.  The most common trigger for excess sebum production is hormonal changes during puberty; less common are menstrual changes, birth control and pregnancy.  Sebum attracts P. acnes.
  • P. acnes – P. acnes bacteria is a part of our normal skin flora and highly attracted to sebum.  Why so?  This bacteria grows and colonizes best in lipids (sebum) and when there is no oxygen.  P. acnes is part of our normal skin flora, but during an acne flare up it is attracted by the sebum into the hair follicles  located deeper in the skin.
  • Inflammation – P. acnes promotes inflammation by influencing your immune system to produce interleukin 17 (Il-17) cytokines.  It is at this point in the process that you see papules, cysts, pustules and nodules form.

So why is this an issue  for some people and not others?

According to Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Science, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistryacne 101

The main underlying cause of acne is a genetic predisposition, with a few aggravating factors including the following:

  • Medications that promote acne developments:
    • Steroids
    • Lithium
    • Antiepileptics
    • Iodides
  • Congential adrenal hyperplasia, polycystic ovarian syndrome (PCOS) and other endocrine disorders associated with excess androgens, hormonal changes during puberty, menstrual cycle and pregnancy.
  • Mechanical occlusion with headbands, shoulder pads, back packs, or under-wire bras can be aggravating factors.
  • Excessive sunlight may either improve or flare acne.

Other possible causes are:

  • Heavy sweating or high humidity
  • Dietary factors, disease or medications that encourage rapid skin cell turnover.

Dietary factors?  Yes diet effects everything.  Especially if your diet consists of foods with a high glycemic index.  This goes back to follicular hyperkeratinization and hyperproliferation (rapid production of cells).  There is some evidence that blackheads are more likely to arise when poor diet or disease leads to increased insulin levels, increased levels of IGF-1 and rapid growth of skin cells that lead to clogged pores.

So there you have it!  Your basic facts revealed according to scientific evidence.  Hope this helps and we will cover subjects like acne medications, including prescription, OTC and natural remedies in the future.



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