Acne: What Causes it?

More than 85% of Americans suffered from acne sometime in their life. It can occur anywhere on the body but typically affects the face, neck, chest, shoulders, and back. Acne affects all ages with the teenage years being the most common. However, the disease is not restricted to any age group. Acne is very frustrating for my patients. They are just surprised that it just never goes away! Acne left untreated can cause scarring which for most of us last, for a very long time.

Acne is caused by inflammation in the sebaceous glands. The different terms that doctors use, describe the different types of inflammation.

1. Comedones (aka blackheads and whiteheads) is a sebaceous follicle plugged with sebum (a thick gelatinous oily substance produced by your skin), dead cells from inside the sebaceous follicle, tiny hairs, and or bacteria. When comedones are open, they appear black and hence are known as "blackheads". This is not dirt but oxidized material inside of the skin. Closed comedones are commonly called a whiteheads; They are skin colored or look like an inflamed white "bump" in the skin. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a skin care specialist under sterile conditions. Facials are NOT sterile conditions. I discourage my estheticians from extractions because it usually causes more scarring. If it comes up easily with a treatment, then I let them do it. I have many patients who come in and want an agressive exfoliation of their followed by deep extractions. I do not recommend this at all because the tissue is injured by squeezing or picking and can become infected with more bacteria, worsening the situation.

2. A Macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present, it looks like the person has very red, irritated skin. This is seen with acne and even my rosacea patients.

3. A Papule is a small, solid bump, slightly elevated above the surface of the skin. A group of very small papules and microcomedones may be almost invisible but have a "sandpaper" feel to the touch. A papule is caused by local skin inflammation.

4. A Pustule aka pus bumps, zits-are small, easily broken bumps containing pus. A pustule that forms over a sebaceous follicle usually has hair in the center. Acne pustules that heal without progressing to cystic form usually leave minimum scars as long as patients don't pick at them. The problem is most of my patients love to break these ugly pus bumps worsening the condition and more likely to cause scarring. I know I have done it and I take care of skin everyday, so I know all of you have done it as well!

5. A Nodule-is a solid, large bump that lies deep within the skin. Patients state it is like a big zit that never comes to a head, its deep inside and really painful. Because they are deep, they are more likely to scar. Nodules need aggressive treatment due to their propensity to scar.

6. A Cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, and tends to be more severely inflamed, extending deeper into the skin. It usually is quite painful, and there is great liklihood for scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic.

Ok, now that you know all the different types of acne. You are still wondering why it even occurs. Acne, regardless of the form you suffer from, occurs due to inflammation. What causes the inflammation? One of the most common reasons is hormonal fluctuations in the body. This is why teenagers are the most commonly afflicted due to the sudden shift in hormones. Women are usually pestered long after this because of the monthly menstrual cycle, pregnancy, or menopause. Women can get it for other reasons such as stress, friction (whether you talk on that cell all day long, keep touching your face, wear caps or clothes that cause more friction against your skin) are all culprits.

Men can be afflicted for different reasons. Yes, it can be due to hormones, but friction (from baseball caps and cell phones), sweating (especially for back acne), and body hair can be potential causes of acne. Remember pustules have hair in the center. So if you have more hair on your body or face, you may be more likely to get acne. (And yes, there are people who are "hairy" but don't have acne. I find that my acneic patients who do laser hair removal get a tremendous improvement in their acne). Clean your cell phone often and try whenever possible to be wireless or with a headpiece.

Other causes of acne are stress. How stress effects your skin is that it suppresses your immune system, thus the normal skin defenses you have are not as strong, predisposing you to acne. And usually, people when they are stressed, do not take care of themselves as well, do not eat or sleep as well, and usually start touching their face or hair in a nervous habit, which all contributes to worsening their acne.

All the literature states diet is not a cause of acne, but what I tell my patients is that, if you find that eating or drinking certain types of foods or liquids, worsens your acne, avoid it. I have seen plenty of people who have acne due to milk, nut, and wheat allergies. Studies look at large populations for changes but can not look at individual responses to allergens or other ongoing problems. I strongly believe in eating a well balanced diet, drinking 2 liters of water a day to keep the body cleansed and detoxified. Skin is an external manifestation of the internal balance. I often due elimination diets on patients to help acne and overall health. Typically, the person who is coming in for uncontrolled acne, also has many other issues in their life that are not being addressed. All of these are contributing to their acne. Most dermatologist do not have time nor the desire to address these "other complaints" and thus the studies are not set up to evaluate for these issues. So these are the causes of acne, coming up next are the treatments for acne.