What causes acne?

We’ve been writing about treatment for acne scars, but perhaps as good place to start with is to look at what actually causes acne to develop in the first place. 

The cause(s) of acne have been a subject of debate for many years. With recent scientific advances, a greater understanding of the many causes of acne has been gained. The effect of diet, hydration, food allergies, bowel malfunction, infections amongst many other factors are being understood. 

Acne is skin disorder that manifests by way of the sebaceous glands, hair follicles, and hair.  These three things make up something in our skin called a pilosebaceous unit.  These pilosebaceous units are found everywhere on our skin except for the palms of our hands, the top & bottom of our feet and our lips.  The largest concentrations of these pilosebaceous units are found on our faces, upper neck and chest.

The sebaceous gland produces sebum.  This is a natural substance that moisturizes our skin and hair.  During our teenage years the hormones in our body cause the sebaceous glad to enlarge and produce more sebum.  Once we reach our 20’s the sebum production begins to slow down.

Our skin also has naturally occurring bacteria. One is known as propionibacterium acnes.  Because propionibacterium acnes uses the sebum produced by the sebaceous gland as a nutrient there is a lot more of it during out teenage years.  This bacterium attracts white blood cells to the follicles in our skin which ultimately can cause inflammation, leading to red bumps on our skin.

Normally the sebum produced by the sebaceous gland fills the hair follicles.  When the follicle is full the sebum spreads over our skin and hair moisturizing it. But sometimes the sebum is trapped in the hair follicle by rapidly growing cells on the surface of the skin, obstructing it.  This is part of what causes acne on our skin.

There are actually several different types of acne:

Acne lesions are subtle.  The skin pores look normal from the outside, but the excess sebum is building up inside the follicle. 

Whiteheads develop as the sebum becomes compacted and thick under the top layer of the skin.  The opening of the skin pore is narrow or closed.

Blackheads also develop as the sebum becomes compacted and thick inside the follicle.  But with blackheads the opening of the skin pore is open.

Pimples develop as the sebum puts pressure on the cells surrounding the skin pore.  With enough pressure the sides of the pore rupture and the sebum and propionibacterium acnes leak into the surrounding skin, infecting it, and creating a pimple.

Acne cysts can form when the infection caused by the rupture of the pores spreads to a larger area than a normal pimple.  This can cause acne cysts and lead to acne scarring. Cystic acne may have a genetic component.

Popping pimples, using harsh skin care products, vigorous skin cleaning and generally irritating your acne can increase your chance of developing acne scars.   While acne is not a result of bad skin care, a good skin care cleaning routine with mild cleaners and regularly exfoliating your skin will help to minimize your chances of developing acne.