Acne vulgaris is a skin infection caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Pimples, spots, and zits are all terms used to describe acne lesions.
The condition is prevalent during puberty, particularly in Western societies, most likely as a result of a stronger genetic predisposition. It is considered an abnormal response to normal testosterone levels in men. For the majority of people, the response diminishes over time, and acne thus tends to disappear, or at the very least subside, once they reach their early twenties. There is no way to predict how long acne will last, and some people will continue to suffer from it decades later, well into their thirties, forties, and even beyond. Acne affects a large proportion of people at some point in their lives.
The most common type of acne is referred to as “acne vulgaris,” which translates as “common acne.” Excessive sebaceous gland secretion combines with naturally occurring dead skin cells to clog hair follicles. Additionally, there appears to be a faulty keritinization process in some cases, resulting in abnormal shedding of skin lining the pores. Under the blocked pore, oil secretions accumulate, creating an ideal environment for the skin bacteria Propionibacterium acnes to multiply uncontrollably. The skin becomes inflamed in response, resulting in the visible lesion. Particularly vulnerable areas include the face, chest, back, shoulders, and upper arms.
Comedones, papules, pustules, nodules, and inflammatory cysts are the most common acne lesions. This is the more inflamed form of pus-filled or reddish bumps, or even tender swellings resembling boils. Non-inflamed’sebaceous cysts,’ more properly called epidermoid cysts, can occur in conjunction with or independently of acne but are not a common occurrence. After acne lesions have resolved, prominent unsightly scars may persist.
Apart from scarring, the primary psychological consequences include low self-esteem and depression. Acne typically appears during adolescence, when people are already feeling the most insecure socially.
The exact reason why some people develop acne while others do not is unknown. It is believed to be partially inherited. Numerous factors have been linked to acne:
- Menstrual cycles and puberty are examples of hormonal activity.
- Stress manifests itself as an increase in the production of hormones by the adrenal (stress) glands.
- Sebaceous gland hyperactivity as a result of the three hormone sources mentioned previously.
- Dead skin cell accumulation.
- Bacteria in the pores that the body develops a ‘allergy’ to.
- Inflammation is triggered by any type of skin irritation or scratching.
- Utilization of anabolic steroids.
- Medications that contain halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.
- Excessive exposure to chlorine compounds, particularly chlorinated dioxins, can result in severe, chronic acne known as chloracne.
Historically, attention has been primarily focused on excessive sebum production caused by hormones as the primary cause of acne. Recently, increased emphasis has been placed on follicle channel narrowing as a second major contributing factor. Abnormal follicle lining cell shedding, abnormal cell binding (“hyperkeratinization”) within the follicle, and water retention in the skin (swelling the skin and thus pressing the follicles shut) have all been proposed as important mechanisms. Numerous hormones have been implicated in acne, including testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEAS) in males and insulin-like growth factor 1 in females (IGF-I). Additionally, it has been demonstrated that acne-prone skin is insulin resistant.
Acne vulgaris development in later years is uncommon, although this is the age group for Rosacea, which may present similarly. In older adults, true acne vulgaris may be a symptom of an underlying condition such as pregnancy or a disorder such as polycystic ovary syndrome or the rare Cushing’s syndrome.
Illusions about the causes
There are numerous myths and rumors about what causes the condition and what does not:
According to one erroneous study, chocolate, french fries, potato chips, and sugar, among other things, affect acne. A recent review of the scientific literature reveals no conclusive evidence in either direction. Health professionals agree that acne sufferers should experiment with their diets and avoid certain foods if they discover that they affect the severity of their acne. A recent study based on a survey of 47,335 women discovered a positive epidemiological association between milk consumption and acne, specifically skimmed milk. The researchers hypothesize that the association is due to hormones (such as bovine IGF-I) found in cow milk; however, this has not been established conclusively. On the other hand, seafood may contain a significant amount of iodine, but not enough to cause an acne outbreak. However, individuals who are prone to acne may wish to avoid excessive consumption of iodine-rich foods. Additionally, it has been suggested that a diet high in refined sugars may contribute to acne. According to this hypothesis, the remarkable absence of acne in non-westernized societies could be attributed to the low glycemic index of these tribes’ diets. Additional research is needed to determine whether reducing high-glycemic foods (such as soft drinks, sweets, and white bread) significantly alleviates acne, though consumption of high-glycemic foods should be kept to a minimum for general health reasons.
Inadequate personal hygiene.
Acne is not a result of dirt. This misconception is most likely due to the fact that acne is caused by skin infections. Indeed, the acne-causing blockages occur deep within the narrow follicle channel, where they are impossible to wash away. Cells and sebum produced by the body combine to form these plugs. The bacteria involved are the same as those found on the skin. Regular skin cleansing can help reduce, but not eliminate, acne in some individuals, and very little variation between individuals is due to hygiene. Anything more than extremely gentle cleansing can actually aggravate existing lesions and even promote the development of new ones by damaging or overdrying the skin.
According to popular myths, either celibacy or masturbation causes acne and, conversely, sexual activity can cure it. There is no scientific evidence that any of these are true. However, anger and stress do have an effect on hormone levels and thus on bodily oil production. The extent to which any increase in oil production caused by stress is sufficient to cause acne is currently being investigated.