Acne

 Contributed by Dermveda

Acne, or acne vulgaris, is one of the most common skin conditions in the world. It consists of acne lesions or pimples, including comedones, whiteheads, blackheads, cysts, and nodules and is often accompanied with redness and pain. Acne not only afflicts teenagers, but many people also continue to experience breakouts into adulthood. Some even develop acne for the first time as an adult.¹ In addition to physical symptoms, acne is emotionally distressing for many and can gravely affect quality of life. Studies show that acne can profoundly impact mental health in over 50% of individuals, with significant associations with poor emotional well-being, depression, and even suicidal ideation.^2-4

 

What Causes Acne?

Acne is usually caused by a combination of what are known as the “four pillars of acne.”⁵ Any individual may have acne caused by one or a combination of these various mechanisms, which is why acne treatments are targeted directly at one or more of these pillars:

• Clogged pores
• Increased oil production
• Bacterial overgrowth
• Inflammation

 

Clogged pores

The skin regenerates on a continual basis.  Sometimes the skin cells around the pores divide too quickly, leading to clogged pores.

Increased oil production

The oil glands in the skin (called sebaceous glands) are essential to keep the skin moisturized and to provide a protective film over the outer layer of skin. However, in some individuals, overproduction of oil (also known as sebum) is a contributor in acne. Hormones can trigger the sebaceous gland to produce more sebum. Increased sebum production is common during puberty and can spike just prior to menstruation in response to increased androgen hormones.⁶

Bacterial overgrowth

Our skin normally hosts thousands of bacteria that are typically in a healthy balance, referred to as the skin microbiota. However, clogged pores and oily skin create the perfect environment for an unhealthy overgrowth of bacteria, with the most common culprit being bacteria called Propionibacterium acnes.⁷

Inflammation

Altogether, clogged pores, excess oil, and bacterial overgrowth lead to an inflammatory response that results in inflamed lesions, redness, and sometimes pain.

Acne Symptoms

Acne is extremely common in adolescents and young adults, and studies have estimated that over 90% of all teenagers will develop acne.¹ However, although most teenagers will experience acne at some point, it is also a prevalent skin condition in adults.  

 Acne usually affects the face, but can also affect the neck, back, shoulders, and chest.  Pimples, or acne lesions, are generally divided into two groups: inflammatory lesions and non-inflammatory lesions. Inflammatory acne lesions are usually more red and painful and consist of pus-filled bumps (pustules), bright red or pink bumps (papules), and even deep painful bumps called inflammatory nodules and cysts. On the other hand, non-inflammatory acne lesions are usually flesh colored bumps, referred to as open comedones (blackheads) and closed comedones (whiteheads).

 Even when acne clears up, it can leave behind dark spots and scarring. These lasting marks are notoriously difficult to treat, highlighting the importance of using effective skin care and treatments for acne-prone skin.

 Table 1 – Lesions Commonly Seen in Acne

 

Type of Acne Lesion	Common Name	Description
Open Comedone	Blackhead	A clogged pore that has a dilated opening on top, allowing the skin debris to oxidize and turn black.
Closed Comedone	Whitehead	A clogged pore that is closed with a layer of skin over the top and looks like a small flesh-colored bump.
Inflamed Papule	Pimple	Small pink or red dome-shaped bump with no obvious opening that is surrounded by inflammation.
Pustule	Pimple	A bulging bump of skin that can appear white or yellowish because it contains dead white blood cells (referred to as pus).
Nodule and Cyst	Cystic Inflamed Nodule	A nodule is a large and painful bump that forms deep beneath the skin. It can be very painful and firm to the touch. A nodule can linger for weeks or months and harden to become a cyst or scar.
Postinflammatory Hyperpigmentation	Dark Spots	These appear as dark spots in areas where acne was previously active. These spots are more common in those with darker skin color and can take months to go away even after the acne has improved.

 

 

Risk Factors

Age

Acne affects people of all ages. Although it is most common in adolescents around the time of puberty, even newborns can develop acne shortly after birth caused by the mother’s hormones. Unfortunately, some people continue to struggle with acne into their 40s.^{1, 8}

 

Diet

High glycemic foods and cow’s milk, specifically skim milk, may worsen acne.^9-11 In addition, supplementation with whey protein, such as in fitness shakes, may exacerbate acne.^{12, 13}

 

Environment

Humidity, heat, and sweat can exacerbate acne, such as with exercise and sports when sweat is trapped under helmets or headbands.¹⁴

 

Genetics

For many people, acne tends to run in families and may be related to naturally producing more skin oils.⁶

 

Hormonal Fluctuations

Hormones have a direct role on oil production and fluctuations in hormones, such as progesterone during menstrual cycles, can cause acne breakouts.¹¹

 

Products

Certain ingredients and products used on the face can clog pores and directly lead to the formation of comedones and acne.

 

Stress

Studies have shown that acne can flare during periods of psychological stress.^{15, 16}

 

Treatment Approaches

 Treatment of acne varies from person to person and is dependent on the severity of acne, ranging from mild to moderate to severe.

 

Table 2 – Treatment Approaches in Acne

Pathogenic Factor in Acne	Typical Treatment Approach
Clogged pores	Normalize rate of skin cell regeneration and exfoliate to help reduce clogged pores
Increased oil production	Decrease or inhibit oil production and modify sebum profile
Bacterial overgrowth	Antibacterial agents
Inflammation	Reduce inflammation

 

View Kamedis Products for Acne treatment

 

References

 

1. Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. Aug 1997;38(3):115-123.
2. Su P, Chen Wee Aw D, Lee SH, Han Sim Toh MP. Beliefs, perceptions and psychosocial impact of acne amongst Singaporean students in tertiary institutions. J Dtsch Dermatol Ges. Mar 2015;13(3):227-233.
3. Kubota Y, Shirahige Y, Nakai K, et al. Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents. J Dermatol. Jul 2010;37(7):617-622.
4. Do JE, Cho SM, In SI, et al. Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents. Ann Dermatol. May 2009;21(2):125-129.
5. Gollnick HP, Dreno B. Pathophysiology and management of acne. J Eur Acad Dermatol Venereol. Jun 2015;29 Suppl 4:1-2.
6. Janiczek-Dolphin N, Cook J, Thiboutot D, et al. Can sebum reduction predict acne outcome? Br J Dermatol. Oct 2010;163(4):683-688.
7. Sardana K, Verma G. Propionibacterium acnes and the Th1/Th17 Axis, Implications in Acne Pathogenesis and Treatment. Indian J Dermatol. Jul-Aug 2017;62(4):392-394.
8. Perkins AC, Maglione J, Hillebrand GG, et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt). Feb 2012;21(2):223-230.
9. Adebamowo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. Feb 2005;52(2):207-214.
10. Smith RN, Mann NJ, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. Jul 2007;86(1):107-115.
11. Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci. Apr 2008;50(1):41-52.
12. Simonart T. Acne and whey protein supplementation among bodybuilders. Dermatology. 2012;225(3):256-258.
13. Cengiz FP, Cevirgen Cemil B, Emiroglu N, et al. Acne located on the trunk, whey protein supplementation: Is there any association? Health Promot Perspect. 2017;7(2):106-108.
14. Sardana K, Sharma RC, Sarkar R. Seasonal variation in acne vulgaris--myth or reality. J Dermatol. Aug 2002;29(8):484-488.
15. Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. Jul 2003;139(7):897-900.
16. Yosipovitch G, Tang M, Dawn AG, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-139.