Acne is a condition of the hair follicles and oil producing glands of the skin characterized by pimples, pustules, and blackheads. These eruptions are most common about the face and neck but may also occur in other areas like the back, chest, and shoulders. More frequent in males, it appears during puberty, and contributes to the awkwardness of those adolescent years. Acne can vary in severity. For many it's a mild transient experience marked by occasional blemishes that dissipates with adulthood. Others may experience intense breakouts that scar, linger into adulthood, and significantly impact self esteem and social interaction.
Diagnosing Acne
The bacteria involved in acne are usually normal skin dwellers so doctors don't waste time and money trying to identify them with laboratory tests.
While any skin blemish may be interpreted by teenagers as a social disaster, acne is generally diagnosed by the type and severity of lesions:
- Mild: Less than twenty blackheads, whiteheads, and a rare pimple (inflamed pustule) or two.
- Moderate: Increased eruptions with occasional pimples.
- Severe: Numerous inflamed cysts (pus filled pockets or nodules) that often lead to permanent scarring.
The Acne Lesion Demystified
Acne occurs when the minute passages around hairs called follicles, are blocked by debris like dead skin, oil, and dirt. Deep in the tissues, and connected to the hair follicle are small glands (sebaceous glands) that produce an oily mixture called sebum. Sebum is continually secreted and travels up hairs, contributing a protective and moisturizing effect. This oily substance also has pheromone properties and is modulated by androgenic hormones like testosterone and progesterone. When hair follicles are blocked, the sebum collects in the follicle and may either form a sterile lump or be broken down by swarming native skin bacteria into pus and inflammatory compounds.
Simple in description, the underlying causes may involve the complex interaction of physical, hormonal, and bacterial components. Other influences may include occupation, chemical exposure, and diet.
Endocrine Connection
Hormones like testosterone and progesterone often play an important role in acne formation, increasing the frequency and severity of outbreaks. Those with moderate to severe afflictions often possess excessive amounts of an enzyme (5-alpha-reductase) that converts regular testosterone to much more potent dihydrotestosterone (DHT). Progesterone, a weak androgen, is often the culprit in cyclic acne experienced by women during the childbearing years.
Dietary Impact
While everyone has an opinion on what foods cause acne, there is little in the way of substantiated proof. Some studies indicate that the condition is more severe in those on a high carbohydrate and saturated fat diet. Others point to animal products like milk and meat which may supply inflammatory building blocks and hormones.
Acne may also be induced by:
- Cosmetics
- Coal tar (used in many dandruff shampoos)
- Repetitive rubbing of the skin
- Emotional stress
Treatment strategies must account for these influences and may incorporate conventional and alternative approaches for maximum effectiveness.
Additional Resources
Anderson, “Foods as the cause of acne.,” American family physician 3, no. 3 (1971): 102.
Chiu, S. Y. Chon, and A. B. Kimball, The Response of Skin Disease to Stress Changes in the Severity of Acne Vulgaris as Affected by Examination Stress, vol. 139 (Am Med Assoc, 2003).
Cordain, “Implications for the role of diet in acne,” in Seminars in cutaneous medicine and surgery, vol. 24 (Elsevier, 2005), 84-91.
Merk Manuals Online: Acne Vulgaris
Smithard, C. Glazebrook, and H. C. Williams, “Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study.,” British Journal of Dermatology 145, no. 2 (2001): 274.
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