Acne affects almost everyone — more than 90% of all adolescents, nearly 50% of all adult women and 25% of all adults. Crossing gender lines as well as national borders, it’s one of the most widespread medical conditions in the world. Yet there’s still no cure.
But there is hope. While acne is not curable, it is treatable. We now know more about controlling this condition than ever before. The secret to managing acne is prevention — stopping this condition before it exhibits visual symptoms. Once you have found an acne treatment that helps you accomplish this, it’s important to stick with it. Even after pimples disappear, you may need to continue treatment to keep new blemishes at bay. It’s also crucial to begin treatment as soon as the first signs appear; the sooner you address your acne, the less likely you are to experience permanent damage to your skin. Of course, in order to stop acne, we must first find out how it starts.
What causes acne? One of the most important things you can learn about acne is this:
It’s not your fault. Contrary to popular belief, acne is not caused by anything you’re doing — what you eat, how often you wash your face or work out — but by a combination of factors at work far beneath the surface of your skin.
A healthy follicle
A blemish begins approximately 2–3 weeks before it appears on your skin’s surface. It starts in your sebaceous hair follicles — the tiny holes commonly called pores. Deep within each follicle, your sebaceous glands are working to produce sebum, the oil that keeps your skin moist and pliable. As your skin renews itself, the old cells die, mix with your skin’s natural oils, and are sloughed off. Under normal circumstances, these cells are shed gradually, making room for fresh new skin.
But sloughing is different for everyone. Some people shed cells evenly; some don’t. Uneven shedding causes dead cells to become sticky, clumping together to form a plug — much like a cork in a bottle. This plug, or comedo, traps oil and bacteria inside the follicle.
A plugged follicle
The plug traps oil and bacteria within the follicle, which begins to swell as your skin continues its normal oil production. Your body then attacks the bacteria with a busy swarm of white blood cells. The whole process takes 2–3 weeks, culminating in a pimple.
An inflamed acne lesion
Why me? There is no one simple “cause” of acne — the condition is influenced by many factors, many which are out of your control. The regularity with which you shed skin cells can change throughout your life. The rate at which you produce sebum is affected by your hormone balance, which is often in flux — especially for women. Research has also shown that genetics play a big part in the development and persistence of acne, so your family history is a valuable prediction tool as well when considering the various causes of acne.
One of the best weapons in the fight against acne, however, is knowledge; if you know what causes acne, it’s easier to formulate a good plan of attack. There are five primary culprits contributing to this process. Each of these factors may vary dramatically between individuals. While you don’t have control over these factors, understanding them can help you in your search for the proper acne treatment.
Acne Causes – Culprit #1: Hormones. For the majority of acne sufferers, the trouble begins at puberty, when the body begins to produce hormones called androgens. These hormones cause the sebaceous glands to enlarge, which is a natural part of the body’s development. In acne sufferers, however, the sebaceous glands are overstimulated by androgens, sometimes well into adulthood. Androgens are also responsible for acne flare-ups associated with the menstrual cycle and, on occasion, pregnancy.
Acne Causes – Culprit #2: Extra sebum. When the sebaceous gland is stimulated by androgens, it produces extra sebum. In its journey up the follicle toward the surface, the sebum mixes with common skin bacteria and dead skin cells that have been shed from the lining of the follicle. While this process is normal, the presence of extra sebum in the follicle increases the chances of clogging — and can cause acne.
Acne Causes – Culprit #3: Follicle fallout. Normally, dead cells within the follicle shed gradually and are expelled onto the skin’s surface. But in patients with overactive sebaceous glands — and in nearly everyone during puberty — these cells are shed more rapidly. Mixed with a surplus of sebum, the dead skin cells form a plug in the follicle, preventing the skin from finishing its natural process of renewal.
Acne Causes – Culprit #4: Bacteria. The bacterium Propionibacterium acnes, (P. acnes for short) is a regular resident of all skin types; it’s part of the skin’s natural sebum maintenance system. Once a follicle is plugged, however, P. acnes bacteria multiply rapidly, creating the chemical reaction we know as inflammation in the follicle and surrounding skin.
Acne Causes – Culprit #5: Inflammation. When your body encounters unwanted bacteria, it sends an army of white blood cells to attack the intruders. This process is called chemotaxis; or, simply put, the inflammatory response. This is what causes pimples to become red, swollen and painful. The inflammatory response is different for everyone, but studies have shown that it is especially strong in adult women.
What can I do? Fortunately, you have options! There are many kinds of acne treatments available today. But first, you should try to determine the type and severity of your condition. Acne, like a person, is highly individual — it can take many forms, and have a highly variable response to treatment. The more you know about your specific form of acne, the more likely you are to find a treatment that works for you. Learn more about the types of acne.