Acne is caused by the build-up of dead skin cells, excess oil, bacterial proliferation, and inflammation. The interplay of these factors leads to different types of acne lesions or pimples. In addition, other factors like certain medications, friction, hair care products, and hormonal changes may trigger acne breakouts.
Acne is commonly seen in teenagers and young adults. Understanding the underlying causes can help in preventing and treating acne.
Acne can affect one’s self-esteem and confidence. Acne can also leave behind dark spots which can take months to clear. Some types of acne can lead to permanent scars. Treatment can prevent these lasting effects of acne.
Table of Contents
What is acne?
Acne is a skin condition that can lead to different kinds of lesions or spots on the skin. The acne lesions are often referred to as pimples, breakouts, and sometimes even “zits”. When we talk about the “usual acne”, it is acne vulgaris.
There are several other acne types. These include:
- Fungal acne aka Malassezia folliculitis occurs due to the overgrowth of Malassezia, leading to itchy bumps on the skin.
- Acne rosacea is another name for rosacea characterized by flushing, blushing, red bumps, and broken blood vessels.
- Acne inversa also known as hidradenitis suppurativa affects the apocrine glands and can lead to large nodules which can lead to scarring.
In this article, we will talk about the causes of acne vulgaris, the common acne.
Location
The areas commonly affected by acne include the face, chest, back, and upper shoulders. These areas are rich in sebaceous or oil glands.
Causes
Acne occurs due to blockage and inflammation of the hair follicles. The hair follicles have oil glands also called sebaceous glands attached to them and the oil from these glands flows out and lubricants or moisturizes our skin.
The opening of these hair follicles is referred to as pores. So basically, our pores get blocked and/or inflamed leading to different kinds of acne lesions or pimples.
Why do the pores get blocked? It can be due to excess oil production or dead skin cells blocking the hair follicles. This can give an ideal environment for the growth of bacteria (Cutibacterium acnes) and inflammation.
The acne occurs due to one or more of the above causes. Let’s talk a little bit in detail about these causes.
Excess oil
Excess oil can block the hair follicles opening leading to acne. However, not everyone with oily skin gets acne.
Sebum consists of different components like waxy esters, fatty acids, cholesterol, and squalene. It is thought that the composition of sebum may be one of the factors which makes some people more prone to acne.
Dead skin cells
Dead skin cells can accumulate due to increased proliferation of skin cells or a decrease in the shedding of dead skin cells.
Bacterial proliferation and inflammation
Cutibacterium acnes live on everyone’s skin, however, in some people, it gets an ideal environment to proliferate and leads to an inflammatory response leading to red bumps and pustules.
The type of acne one gets depends on the interplay of the above-mentioned causes.
Blackheads and whiteheads which are non-inflammatory types of acne occur due to excess oil and dead skin cells blocking the hair follicles.
Inflammatory acne lesions like pustules or nodules usually occur due to a combination of the above causes i.e., excess oil, dead skin cells blocking pores, inflammation, and proliferation of acne-causing bacteria.
Triggers
In addition to the above causes, there are several factors that can make one more susceptible to acne or make existing acne worse.
- Genetics: As of now, there is no specific acne gene. However, there is some role of genetics. If your parents had acne, you are more likely to have acne.
- Hair care products: Some hair care products like styling gels or oils can trigger acne along the hairline or on the forehead. In fact, it has a special name called pomade acne.
- Friction or contact: Acne on the sides of the cheeks can be due to contact with phones or pillows. Chronic friction between skin and headgear like helmets or face masks can also lead to acne.
- Medications: Certain medications like corticosteroids, lithium, and androgens may contribute to acne.
- Hormones: Hormonal fluctuations during puberty, menstruation, or pregnancy can affect the sebum output which can trigger acne. Medical conditions like polycystic ovarian disease can lead to hormonal imbalance and acne.
- Stress: Any stress like lack of adequate sleep can worsen existing acne.
- Skin barrier damage: Damaging the skin barrier by using strong topicals can worsen existing acne.
- Food: Certain foods are associated with acne; however, the link is weak.
Relation to food
There are studies that link certain foods like skimmed milk and food with high glycemic index to acne. Foods with high glycemic index can lead to the release of insulin and insulin-like growth factor (IGF-1). IGF-1 can lead to an increase in sebum output and hyperproliferation of skin cells which may cause acne.
However, it is hard to make a direct correlation based on these observational studies as our skin can be affected by several other factors, not just diet.
So, one should not remove a large number of foods from the diet as it can lead to nutritional deficiencies. If you think, any particular food triggers your acne, just remove that one particular item. If you want to make huge changes to your diet, it is best to consult a dietician.
Generally speaking, eating a healthy diet rich in antioxidants and omega-3 fatty acids like fish and walnuts can boost not only your skin health but also your overall health.
Relation to smoking
There are contradictory studies as to whether smoking can cause acne or not. However, a study from 2009 suggests that there is a direct correlation between smoking and acne.
The type of acne found in smokers is called atypical post-adolescent acne (APAA) (aka smoker’s acne). It consists predominantly of non-inflammatory acne lesions – open and closed comedones.
The study suggests that smoking can contribute to the peroxidation of sebum and decrease in level of Vitamin E making one more prone to acne.
Myths
1. Hygiene
Often acne is linked to hygiene and it is thought that someone with acne doesn’t wash their face enough. However, acne has no relation to being dirty or unhygienic.
In fact, washing the face or affected area multiple times a day can disrupt the skin barrier and worsen acne.
2. Sun exposure
It is thought that exposing the skin to the sun can help in improving acne. However, this may be just due to the tanning of skin making acne less predominant.
UV rays can actually harm our skin by affecting immune function and disrupting the skin barrier.
3. Contagious
One cannot spread acne to others.
Key points
The main causes of acne include – excess oil, the buildup of dead skin cells, inflammation, and bacterial proliferation. Different acne lesions can have different underlying causes.
Non-inflammatory acne occurs due to the blockage of pores with excess oil and dead skin cells while inflammatory acne can occur due to a combination of the 4 mentioned causes.
In addition, several factors can make one more susceptible to acne or can worsen acne. These include hair products, certain foods, and medications, genetics, hormones, chronic friction, or stress.
Related: How to get rid of blackheads
References
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- Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol. 1999 Aug;141(2):297-300. doi: 10.1046/j.1365-2133.1999.02979.x. PMID: 10468803.
- Baldwin H, Tan J. Effects of Diet on Acne and Its Response to Treatment. Am J Clin Dermatol. 2021 Jan;22(1):55-65. doi: 10.1007/s40257-020-00542-y. Erratum in: Am J Clin Dermatol. 2020 Dec 26;: PMID: 32748305; PMCID: PMC7847434.
- Penso L, Touvier M, Deschasaux M, et al. Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study. JAMA Dermatol. 2020;156(8):854–862.
- Dall’Oglio F, Nasca MR, Fiorentini F, Micali G. Diet and acne: review of the evidence from 2009 to 2020. Int J Dermatol. 2021 Jun;60(6):672-685. doi: 10.1111/ijd.15390. Epub 2021 Jan 18. PMID: 33462816.
- Capitanio B, Sinagra JL, Ottaviani M, Bordignon V, Amantea A, Picardo M. Acne and smoking. Dermatoendocrinol. 2009 May;1(3):129-35. doi: 10.4161/derm.1.3.9638. PMID: 20436880; PMCID: PMC2835905.
Disclaimer: This article is for information purposes only and does not replace medical advice.