Acne is an extremely common, extremely annoying problem that nearly everyone deals with in some capacity. Most people have learned how to handle and treat acne, but what is still very often misunderstood is what exactly causes it. There are numerous false thoughts about acne, particularly about the majority of the causes of acne, but also the best ways to treat it and to keep it from returning. We will dispel some common myths and talk about the true culprit today.
Physiologically, acne is caused by four main steps. These four steps each cause a different type of physical imperfection. We will discuss the main way each occurs below.
The first step of acne is blockage
The first is obstruction of sebaceous follicles, which are oil-producing glands normally located by hair follicles. The highest proportion of sebaceous follicles are located on the face, upper chest, and back, which explains the areas of the body that are most often affected by acne. These follicles can become obstructed by skin cells around the opening of the follicle, which is thought to be due to an influence by androgen hormones. This causes a bump or papules on the skin known as a comedome. Comedomes can be white, due to the presence of epithelial skin cells, or black due to the presence of melanin or coloring within the skin cells. These bumps are caused entirely by skin proliferation and not dirt. It is also a common misconception that these bumps are caused by diet or cause by chocolate. There have been several studies over the past fifty years trying to either prove or disprove the relationship between food and acne. Currently, the going known relationship is that food does not in any known way cause acne to form. However, it is thought that diets with high glycemic index or high in dairy may sometimes worsen it.
The second step of acne is hormones
The second major cause of acne is that it is triggered by hormones. Androgen hormones, like testosterone and dehydroepiandrosterone sulfate, cause the production of sebum. Sebum is like an oil for the skin that helps keep it moist and pliable, but in excessive levels can form a plug in the follicles. The increase in the sebum can contribute to the blocking of sebaceous glands and worsen comedomes. Another common misconception is that acne is caused by poor hygiene or improper bathing, though that is a common myth. Cleaning your skin is important to help keep oils and dirt off of your skin in general, and cleaning your skin can help improve acne but not doing so does not actually cause acne.
The third cause of acne is bacteria
The third major cause of acne is bacteria. The bacteria thrive well in the sebum and blocked follicles in the skin. The bacteria that typically cause acne are not the typical ones that cause other skin infections, and are usually caused by a bacteria called propionibacterium acnes. These deeper seated infections can actually cause cysts in the skin which are even more difficult to treat. This is the reason that severe acne is often treated with antibiotics. Acne is not contagious though the bacteria live deep within the skin and cannot be spread by touching or interacting with another person. That is another common misconception.
The fourth problem of acne is inflammation of the skin
The fourth cause of acne is inflammation. The body recognizes the presence of bacteria and triggers the complement pathway, which is a system that can help fight and kill the bacteria within your body. This process also activates pro-inflammatory cytokines which causes overlying inflammation and erythema to the skin. The presence of inflammation causes pink or red pustules or cysts within the skin, which are another common symptom of acne.