Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen production at adrenarche. The microcomedo may enlarge to form an open comedo or closed comedo . Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.
Primary causes
The root causes of why some people get acne and some do not are not fully known. It is known to be partly hereditary. Several factors are known to be linked to acne:
Family/Genetic history. The tendency to develop acne runs in families. For example, school-age boys with acne often have other members in their family with acne as well. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.
Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the follicular glands to get larger and make more sebum.
Inflammation, skin irritation or scratching of any sort will activate inflammation. Anti-inflammatories are known to improve acne.
Stress, through increased output of hormones from the adrenal glands. While the connection between acne and stress has been debated, scientific research indicates that “increased acne severity” is “significantly associated with increased stress levels.” The National Institutes of Health list stress as a factor that “can cause an acne flare.” A study of adolescents in Singapore “observed a statistically significant positive correlation…between stress levels and severity of acne.”
Hyperactive sebaceous glands, secondary to the three hormone sources above.
Accumulation of dead skin cells that block or cover pores.
Bacteria in the pores. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. In-vitro resistance of P. acnes to commonly used antibiotics has been increasing.
Use of anabolic steroids.
Any medication containing lithium, barbiturates or androgens.
Exposure to certain chemical compounds. Chloracne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.
Exposure to halogens. Halogen acne is linked to exposure to halogens e.g. iodides, chlorides, bromides, fluorides.
Chronic use of amphetamines or other similar drugs.Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant.
Development of acne vulgaris in later years is uncommon, although this is the age group for Rosacea which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flashes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).
Acne, also known as acne vulgaris, is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, called sebum, increases under the influence of hormones. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes. Medications such as lithium, cortisone, hormones, iodides, some seizure medications, or isoniazid can also cause acne lesions.There is no cure for acne, but certain measures can help prevent more breakouts. Acne can result in scarring, so minimizing breakouts is important. Acne which is mostly a common skin disease mostly it affects the teens.
