Basic Causes Of Acne

The four basic "causes" of acne

Acne is a disease of the sebaceous hair follicle. Each follicle contains a tiny hair and multilobed sebaceous glands. Sebaceous glands get their name from the oily substance they produce - sebum. Under normal circumstances, sebum travels up the hair follicle and out to the skin's surface. However, in acne, sebum is trapped within the follicle. Acne develops on those areas of the skin where sebaceous glands are most numerous: the face, scalp, neck, chest, back, and upper arms and shoulders. The acne lesions we know as blackheads are called "comedones" (singular: comedo). Red, swollen, pus-filled lesions are called papules, nodules, and pustules.

Four basic factors, work together for the development of comedones:

Each of these factors is discussed in more detail below.

Hormones (androgens)

Acne usually begins when the body starts to produce the hormones called androgens. When androgen production goes into high gear - about age 11 to 14 years - acne also goes into high gear. Androgens cause the sebaceous gland to enlarge, and this is normal. People who develop acne have sebaceous glands that are over-stimulated by androgens. Young women tend to have acne flare-ups that coincide with the hormonal changes associated with their menstrual cycle. These changes affect the sensitivity of their sebaceous glands to androgens.

Increased sebum production

After the sebaceous gland is stimulated by androgens, it produces more sebum. The oily sebum accumulate in the follicle, and travels up the hair shaft to the surface of the skin. As it travels up the hair shaft it also mixes with normal skin bacteria and dead skin cells that have been shed from the lining of the follicle.

The greater the sebum production, the greater the likelihood that the hair follicle will become clogged and result in comedones.

Changes inside the follicle

As androgen production increases and sebaceous glands enlarge, the inner lining of skin in the hair follicle also changes. Normally, dead cells inside the follicle shed gradually and get expelled onto the surface. However, during puberty these cells are shed more rapidly and tend to stick together. When they mix with sebum, they can clog the follicle--the cells and sebum form a plug in the follicle.

Bacteria

The clogged follicle becomes a breeding ground for bacteria. One type of bacteria specifically involved is Propionibacterium acnes or P. acnes for short. P. acnes ingests sebum and is a normal resident on skin even in people who don't have acne. However, when the sebaceous gland gets clogged, and sebum builds up inside the follicle, P. acnes multiplies rapidly. Chemicals produced by the bacteria can cause inflammation in the the follicle and surrounding skin.

Putting it all together...

Clogged follicles develop into two types of acne breakout:

(1) comedones, or non-inflamed 'blackheads', or
(2) inflamed lesions defined as papules, pustules, and nodules.

The genetic connection

While virtually everyone gets acne to some degree, some people are born with a predisposition to certain types of acne. There seem to be similarities in acne among family members regarding patterns of acne lesions, duration of acne, severity and so on. Acne occurs in all races, but there are ethnic variations that suggest genetic influences; Caucasian Americans, for instance, tend to be more affected than African Americans or people of Asian heritage. From a scientific standpoint, not much is known yet about the specific genetics involved in acne, but there seems to be a connection.

If a teenager's parents or older siblings have had severe acne, that teenager is likely to have severe acne, too. It is all the more critical for such teenagers to consider seeing a dermatologist before the acne becomes severe.

Acne from cosmetics

Comedones may be caused by certain cosmetics and toiletries containing ingredients that can clog pores. Such products, which include makeup, foundations, night creams and moisturizers, are called comedogenic. People should look for "noncomedogenic" cosmetics and toiletries.

Cosmetic acne is usually minor and usually does not cause scarring. It: can be persistent, however, sometimes lasting for decades. Aggravating the problem, some young women try to cover up the pimples with even more makeup. Plus, normal teenage acne can occur at the same time.

Acne with environmental causes

Acne may also be due to (or aggravated by) contact with a large variety of comedogenic substances. For example, the airborne grease in a fast food restaurant can be comedogenic, as can motor oil, which someone may be exposed to regularly at a job.

In fact, anything that can irritate acne-prone areas of the skin may make acne worse, including rubbing and friction from clothing, hair, sporting equipment and so on. Your dermatologist can best identify and treat these types of acne.

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