The Origins and Causes of Acne

Once upon a time, acne was considered to be a skin condition caused by human flaws. Ancient Egyptians believed, for example, that pimples mark the faces of liars. Pharaoh Tutankhamun, who suffered from very severe acne, was said to be the living evidence that this was true. In those times, of course, people did not understand exactly what acne is, how it originates, and what causes it. And that is precisely what we are going to talk about today.

The origins of a pimple in more detail

First a little bit of skin anatomy. A sebaceous gland is attached to every hair follicle (from which hairs grow). A healthy sebaceous gland works optimally until it is stimulated (by factors we will explore together) to produce more sebum. At that moment, the skin starts to become more oily, which in itself is not an unmanageable situation, but a significantly increased sebum production can cause a narrowing or obstruction of the duct of the sebaceous gland. The area is then reinforced by keratin, and the growing number of bacteria results in an inflammation, which manifests itself in the form of a plump pimple. The greatest concentration of sebaceous glands is on the face, back, and chest. That is why most spots appear in these areas.

The propagation of Cutibacterium acnes

The bacterium Cutibacterium acnes (formerly Propionibacterium acnes) naturally forms part of the skin microbiome. It is found on the skin surface as well as deeper inside the follicles and pores. Its overpopulation is very closely linked to pimples (as its specific name acnes suggests). It uses free fatty acids in the sebum and cellular waste as a source of nutrients and energy. An increased sebum production or clogging of the pores can cause growth and propagation of bacteria. These then release a number of substances (such as propionic acid from which their former name was derived), among them several digestive enzymes that also feed on sebum and are even capable of disrupting cell layers - the walls of the pores. Disruption of the skin can lead to the proliferation of other bacterial strains (such as Staphylococcus aureus or S. epidermidis) which cause inflammation of the skin. This results in the formation of inflamed pimples (the immune response of the body) and the centres of acne are born because everything spreads very quickly.

Sebum oxidation

Sebaceous glands produce sebum that consists of triglycerides, free fatty acids, squalene, wax esters, and other lipophilic substances. Oxidation of these fatty components can occur after sebum has been excreted to the skin surface. The most problematic of them is squalene that makes up 10-15% of sebum. In the process of its oxidation, products (such as its peroxide forms) are produced that lead to the clogging of the skin, as they are highly comedogenic. In this way they contribute to the occurrence of acne and are also involved in the formation of wrinkles.

There are different types of pimples

There are several kinds of pimples. Open comedones, commonly known as blackheads, are noninflammatory in nature. Besides these, there are also closed comedones, smaller whiteheads. When the pimple is bigger, it can be a papule, pustule, nodule, or a cyst. These types of acne form deeper in the skin (tender pimples underneath the skin’s surface), they are inflammatory, full of bacteria, and contain large amounts of pus. Squeezing the bigger pimples usually leads to scars or other colour imperfections whose removal may be difficult. Severe forms of acne are not a simple question of skincare, but rather a problem inside the body. 

Blackheads vs. pores

Blackheads are bigger open comedones formed by hardened sebum and parts of dead cells. Pores (the pilosebaceous follicles) are places where sebum comes to the skin’s surface, and they are a natural part of every skin. They can be cleaned, shrunk, reduced, but they can never be completely eliminated. They tend to be more visible in mixed and oily skin. It is in pores where oxidation of accumulated sebum happens, and this causes the dark colour. However, the sebum in pores does not form a hard “plug”, as is the case with blackheads.

By squeezing sebum out of the pores, you can develop thread veins. I recommend focusing on proper skin cleansing (for example oil-based) and hydration.

What are the causes of acne?

• Sex hormones

The state of our skin is very closely related to sex hormones. In connection with this we can speak about various changes, fluctuations, or imbalances within the hormonal system of women and men. Men typically show signs of changes in skin condition in puberty when testosterone levels rise. This hormone’s active form DHT (dihydrotestosterone) causes excessive sebum production and hyperkeratinisation (skin clogging), which leads to the formation of acne.

Testosterone levels must also be taken into account in women, along with female hormones - oestrogen and progesterone, whose levels fluctuate not only during the menstrual cycle, but also during pregnancy, menopause, etc.

• The psyche and stress

Skin problems can also occur as a consequence of stress. The stress hormone cortisol tries to help the body deal with strain. Its short-term production is essential for the body, but elevated levels over a long period of time may be associated with major problems, not only skin-related. Cortisol production affects other hormones (for example the above-mentioned female hormones) whose production is pushed to the sidelines in times of “danger” (signalled by cortisol). This is not alright, of course. Throughout our entire life, stress can significantly affect the hormonal balance of the body, in addition to sex hormones also insulin, for example.

• Diet, lifestyle

Some foods have pro-inflammatory effects on our body. In relation to acne and the state of the skin, we speak mainly about sugar, alcohol, wheat, dairy products, processed vegetable oils, and others. Sugar, for example, can influence the hormones to such an extent that the skin becomes excessively oily and more inflammatory pimples appear. As a matter of course, we should always pay close attention to our water intake.

• Unsuitable cosmetic care

In my first article about acne-prone skin I outlined a skincare routine for problematic skin. So I just reiterate the importance of daily make-up removal and cleansing. Do not use irritating or drying products. Avoid aggressive scrubs and products with high alcohol content. Pick natural products, steer clear of those that contain petroleum derivatives, silicone, and other unsavoury ingredients.

Author: Veronika Slechanová