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Acne and its causes

Updated: Jun 8, 2021

"Beauty is the source of illumination and clarity" said Heisenberg and the importance of human beauty while achieving happiness was highlighted by Plato.

We live in a world where people believe physical attractiveness alone influences success, power, happiness and satisfaction in life. Skin disorders like Acne impede in the way of people's happiness that affects millions of people in varying degrees across the globe.

According to Dermatologists, acne is the most common skin condition that affects almost three quarters of 11 to 30 year people at some point in their lives. In 2010, acne was ranked 8th in the list of most prevalent diseases in the world with a global prevalence of 645 million. The prevalence of acne globally was 681.2 million in 2016 observing an increase of 10% from 612 million in 2006.

What is Acne? How does it occur?

Common Acne, medically known as Acne vulgaris, is generally caused by hormonal changes in our body and is directly attributed to the rise of androgen hormone levels. The production of these hormones begins when a person hits puberty, the reason for acne being more prevalent in adolescence. The hormonal fluctuations can arise at other times as well including menstruation, pregnancy and menopause. Acne appears on the skin as Occluded pores (blackheads, whiteheads or comedones), Tender red bumps (pimples), Papules (raised bump on the skin), Pustules (bumps containing pus) and occasionally as cysts (deep pimples and boils of cystic acne).

What are the possible causes for Acne?

Illustration of Comedones: Blackheads and Whiteheads

Our skin surface consists of small pores and each individual pore opens to a follicle beneath the epidermis. A singular hair and a sebaceous gland that produces sebum, an oil designed to keep the skin lubricated and soft, lies within these follicles. As androgen levels rise, the oil glands underneath our skin enlarge and produce increased levels of oil. When the pores gets filled with excessive sebum, it causes the walls of the surrounding skin to rupture and create a breeding ground of Propionibacterium (acne causing bacteria) . As the sebum attempts to push out of the pore, it can attach to debris, infectious bacteria and dead skin cells causing a blockage that begins the formation of the pimple. Blackheads are formed when the dead skin cells react with the oxygen in the air when the pores are open and turn black. Whiteheads are formed when these pores close due to the formation of a thin skin layer over them.

Genetics can also be a reason for acne breakouts, which explains why some people are more prone to acne while others are not. One of the studies found that genes explain a significant 81% of the difference in acne prevalence, while the other 19% aided to the non-shared environmental factors. Further study determined that having a first-degree relative (parents) suffering from acne increases the risk of getting acne by four times. Shared habits and cultures might also be plausible contributors for acne prevalence, although there is no scientific evidence behind this claim.

According to an article in the Journal of the American Academy of Dermatology, researchers have observed a substantial connection between acne breakouts and milk and dairy intake. Some researchers believe that the high levels of hormones found in the dairy products can affect acne as these hormones can signal the oil glands to start producing more sebum. Skim milk might also worsen the skin conditions due to its low estrogen level and different processing activities.

Alcohol can alter the hormonal levels thereby making consumption of alcohol yet another reason for acne breakouts. Despite the lack of research evidence to establish the link between acne and diet, restaurant and fast food employees who are constantly exposed to greasy products and equipment can experience higher rates of acne as oils can attach to the skin and hair follicles resulting in pimple formation.

Certain medications containing iodides, bromides and injected steroids have also been reported to cause or worsen acne breakouts. Other drugs that can aggravate acne are anti convulsant medications and lithium. Excessive use of foundations, concealers and other cosmetics results in clogged pores, hence it is best recommended to use cosmetics that consist of non-comedogenic ingredients to avoid clogging the pores.

It is essential to note that stress is not a definite catalyst for acne breakouts but rather a factor that worsens a previously existing condition. Heightened stress levels result in the production of androgen hormone signaled by the adrenal glands which in turn signals sebaceous oil glands to secrete more sebum. Acne is more likely to develop due to this build up of excess oil. Frequency of acne due to stress is higher in women as they produce a larger percentage of androgen in the adrenal gland than men. Stress can aggravate the acne appearance by expanding capillaries which causes increased blood flow resulting in redness and inflammations.

Acne Mechanica is a type of acne among athletes, students and soldiers which is directly caused by excessive heat, pressure and covered skin due to wearing tight clothes and carrying heavy equipment. Acne Mechanica can develop anywhere on the face or body and varies in appearance from small, inconspicuous comedones to inflamed papules and pustules. While common acne has hormonal roots, the main cause of Acne Mechanica is friction that is a complete physical factor. Anything that traps heat against the body for a prolonged period of time, rubs or puts pressure on the skin can trigger Acne Mechanica.

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