How acne occurs

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Causes Of Acne

Acne is a common skin disorder which though not physically disabling can cause severe emotional stress due to its persistent disfigurement and scarring of the face, neck, chest and back. Additionally it tends to affect the in 70-80% of young adults adding to the stress of adolescence. Appropriate treatment can improve the lives of affected individuals dramatically.

What is acne?

The primary lesions of acne are called comedones. Comedones are plugs of sebum and keratin lodged in hair follicles caused due to over production of sebum. They are non-inflammatory. If comedones rupture the follicular wall get inflamed due to irritation of the sebum. Additionally anaerobic bacteria, propionibacteria, inhabiting the microenvironment of the follicle tend to produce an infection in ruptured follicular walls leading to pus filled pockets called pustules, papules and cysts depending on their location and size. The immune response mounted as the body’s response to the bacteria leads to inflammation which if intense enough can lead to scar formation.

The question is, what causes the increased production of sebum and why does this eventually lead to acne? Several factors may be involved.

Do hormones produce acne?

Androgens and acne: While most androgens are produced by the gonads and adrenal glands, some are also produced locally within the sebaceous glands from the adrenal precursor hormone called DHEA. These androgens interact with sebaceous glands through androgen receptors located on the cell membranes of the basal layer of cells of sebaceous glands and hair follicles. The exact mechanism by which this stimulates increased sebum production is not clearly understood, yet.

The following five pieces of clinical evidence noted in various studies prove that androgens are a major factor in the production of acne:

1) Severe acne is often associated with higher serum androgen levels.
2) Androgen producing tumors of the ovary or adrenal glands are often associated with acne
3) Administration of testosterone and DHEAS increases the size and secretion of sebaceous glands
4) Subjects lacking functional androgen receptors do not produce sebum and do not develop acne
5) Adolescents have higher serum levels of DHEAS, a precursor of testosterone and is associated with acne development.

Growth hormones and Acne:

Growth hormone is produced by the pituitary glands and stimulates the liver to produce insulin growth factor (IGF). IGF comes in two forms, the more prevalent IGF-1 and IGF-2. IGF-1 can stimulate sebaceous gland oil production and can increase the proliferation of skin cells (keratinocytes). Since acne is produced by clogging of hair follicles with dead cells and sebum, growth hormone can cause acne development. Acne is most widespread during adolescence when growth hormone secretion required for growth is high. Consequently, the growth spurt that accompanies teenagers may contribute to the development of acne

What about stress?

Studies in women over 25 years of age, some in their early forties have shown that low grade persistent acne can occur due to emotional stress. Emotional stress has been anecdotally linked to acne though an objective assessment has been lacking until recently. Studies on stress induced acne have shown a statistical correlation.

Diet as a cause of acne

Diet as a cause of acne has traditionally been dismissed as myth. However, the near absence of acne in non-westernized cultures and the presence of acne in western or westernized cultures suggest that diet and the environment could cause acne. It is thought that the high carbohydrate content of western diets can increase Insulin levels in the blood and lead to formation of acne via a similar mechanism to that of IGF-1.

Genetic factors

The degree of oiliness that an individual experiences may be partly due to their genes. Obviously individuals prone to an oily skin from a higher level of sebaceous gland activity have a higher propensity to acne. Genes also affect the nature of the sebum that is produced.

Some genes cause higher levels of cholesterol production. When there is more cholesterol produced by the sebaceous glands, the oils and dead cells from the hair follicle canal are more likely to stick together and clog the hair follicle.

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