Acne: Causes, Development and Myths

Teenage skin requires adapted solutions as the problems it faces differ from one individual to the other. Understanding the skin and its potential problems is an important initial step in developing efficient skincare.

The various skin types

• Oily skin is often shiny, seemingly thick with dilated pores, especially in the T-zone (nose, chin, and forehead) and the cheeks. Often dull-looking, it is prone to irritation and will evolve from open comedones (blackheads) to inflammatory and/or infectious pimples (nodules, papules, or pustules) in the case of acne.
• Combination skin will have different aspects depending on the location, particularly on the face. Pores are visible in the T-zone, but the skin appears much thinner and delicate on the cheeks.
• Acne-prone skin will have the shiny appearance of oily skin but the condition may extend beyond the face to the shoulders and back with numerous comedones and pimples at various degrees of inflammation.

Sebaceous Glands and Sebum: friends or foes?

It may not be so simple. Though it may cause shine, sebum is a beneficial agent when it comes to the skin’s balance.

There are three kinds of a pilosebaceous follicle in the dermis:

1. vellus follicles, comprising a tiny hair and a much larger sebaceous gland
2. sebaceous follicles, comprising a tiny hair and an exceptionally large multiacinar sebaceous gland
3. terminal hair follicles, comprising a long, stiff, thick hair and a proportionately sized sebaceous gland.​

The sebaceous follicles are the only ones involved in acne, although the other types contribute to the amount of lipids on the surface of the skin. Sebaceous follicles are found only on the face, upper arms, chest, and upper back, and acne vulgaris can only appear in these areas.

They are constituted of several cell layers.

1. At the periphery, non-differentiated cells multiply and transform into differentiated cells called sebocytes.
2. These sebocytes synthesise various fatty compounds (triglycerides, phospholipids, waxes, sterols, linoleic acid, squalene...), at the heart of their vacuoles.
3. Once gorged with sebum, the now-mature sebocytes will degenerate and be destroyed thus releasing their lipidic content within the gland.
4. The sebum then continues its journey through the hair canal.
5. It is excreted onto the skin where, together with sweat, it creates a hydrolipidic film, or arrier, a protective emulsion which preserves the skin from dehydration and environmental threats such as UV rays or bacteria. Stress factors, pollution, hormonal changes can sometimes result in an excessive stimulation of the glands leading to an increased production of ebum, a condition called hyperseborrhea. Oily or combination skins usually present the signs of such a condition along with dilated pores, black heads (blockage of the hair canal due to the accumulation of sebum and dead cells) sometimes, with inflammatory or infectious complications.

The development of acne vulgaris

The development of acne vulgaris can be divided into four stages: hypersecretion of sebum, abnormal keratinisation and comedone formation, bacterial proliferation and inflammation.

1. Hyperseborrhea: under hormonal control, the sebaceous gland rapidly transforms testosterone into dihydrotestosterone (DHT) via 5-alpha reductase. A high level of DHT is related to increased sebum secretion.
2. Hyperkeratinization: due to an increased keratinocyte differentiation, cells from the stratum corneum peel off in squasmes that, together with sebum, accumulate in the follicle duct.
3. Comedone formation: as corneocyte accumulation goes on, the follicle dilates, the pore opens and becomes an open comedone or blackhead. Alternatively, if the follicle wall thickens until the pore is closed, a blocked comedone, or whitehead is formed. These comedones can evolve into papules or pustules when an inflammatory process is associated.
4. Bacterial proliferation: once the follicle duct is blocked, the oxygen-deprived environment favors the development of anaerobic bacteria (Propionibacter acnes). These bacteria trigger several inflammatory factors (enzymes and chemotactic factors) which induce redness.

Eight Acne Myths

Myth #1: the consumption of chocolate assists in the breakout of acne. The fact is that several research studies found no reference between the consumption of chocolate and the breakout of acne.

Myth #2: fried foods and sodas cause acne breakouts. No findings suggest that fried foods nor soft drinks cause acne breakouts. However, eating or working in fast food restaurants may cause the pores to react to the grease in the environment and this could be the cause of flare-ups. Make sure to wash your hands if you have been handling oil or greasy foods.

Myth #3: sitting in the sun or under a sunlamp will fight acne. This is only partially true. Although the sun promotes the production of vitamin D, which may help in drying out the pimples for a time, the thickening of the epidermis it generates (a natural protection against sun exposure) will in the end worsen the condition. Finally, let’s not forget that over-exposure to the sun causes skin cancer and premature aging.

Myth #4: dirty skin causes acne. The claim that dirt causes acne is another partial myth. It is likely that the adherence of dirt on the skin is increased in the presence of sebum, thus leading to blockage of the pore. However, it is not the dirt itself that causes inflammation and infection. Keeping the skin pores clear of dirt may prevent blockage but will not totally rid the skin of acne (see myth # 5).

Myth #5: a person with acne is often considered unclean. As described in myth #4 the link between hygiene and acne is weak. In fact, most people with acne groom themselves with utmost care and maybe more health and hygiene conscious than others.

Myth #6: acne will no longer be a problem once someone reaches adulthood. This is not true. Many people experience acne as adults; though the severity of the condition may vary. Over 50 years old, however, due to the natural decrease in sebum production and the slow down of the differentiation process, acne usually recedes.

Myth #7: harsh soap is good for acne. Mild soap is better. In fact, excessive washing leads to delipidation and loss of the barrier effect which in turn will increase the risk of infection. Furthermore, the skin will react to this loss of lipids by producing more sebum, which may worsen the hyperseborrheic condition.

Myth #8: only prescription drugs are effective when fighting acne. Some prescription medications are extremely harsh and can dry out your skin. The true key to fighting acne is balance, hence the necessity to find the right combination of skincare products and medication to restore health and well-being.

Though the above-mentioned claims are misconceptions and myths, it is always better to be cautious about eating habits and to maintain hygiene at all costs to prevent acne breakouts.