Female face cut in half present clean skin and acne

What is ACNE?

Acne is a common chronic inflammatory skin condition that involves the pilosebaceous unit (hair follicles and oil glands). A variety of spots appear on the face, neck, shoulders, chest and back.

Inflamed papules and pustules are commonly called spots, pimples and zits.
Dark- or skin-coloured papules are comedones. These are better known as blackheads and whiteheads.
Acne can lead to secondary skin colour changes (red, white and brown patches) and scarring.

Acne is most prevalent in those aged 16 to 18 years. It may have profound social and psychological effects, particularly during puberty and adolescence, when physical appearance and fitting in with one’s peers are particularly important.

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The precise reasons that acne is most severe during the teenage years are being studied. There are several theories.

There are higher levels of sex hormones after puberty than in younger children.
Sex hormones are converted in the skin to dihydrotestosterone (DHT) which stimulates sebaceous (oil) glands at the base of hair follicles to enlarge.
The sebaceous glands produce sebum. Changes in sebum composition may lead to acne lesions.
The activated sebaceous gland cells (sebocytes) also produce pro-inflammatory factors including lipid peroxides, cytokines, peptidases and neuropeptides.
Hair follicles are tiny canals that open into skin pores (tiny holes) on the skin surface. The follicles normally carry sebum and keratin(scale) from dead skin cells to the surface. Inflammation and debris leads to blockage of the skin pores – forming comedones.
The wall of the follicle may then rupture creating a gateway for bacteria and exacerbating an inflammatory response.
While acne is most common in adolescents, it can affect people of all ages and all races. It usually becomes less of a problem after the age of 25 years, although about 15% of women and 5% of men continue to have acne as adults. It may also start in adult life.

  • Genetic factors – family members have bad acne
  • Hormonal factors – higher levels of male hormones due to
    • Polycystic ovaries
    • Hyperinsulinaemia and insulin resistance are characteristically found in women with polycystic ovarian syndrome
    • Psychological stress and depression
    • Excessive production of corticosteroids in the body (Cushing disease)
  • Environmental factors such as
    • High humidity causing swelling of the skin
    • Cosmetics, especially certain moisturizers, foundation and pomades. Watch out for products that contain lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol and oleic acid
    • Pressure from headbands and chin straps (eg “fiddler’s neck”, a condition seen in violin or viola players, where continual pressure from the violin against the neck causes skin irritation)
    • Excessive consumption of dairy products, meat protein and carbs. Diets low in zinc or high in iodine can worsen pustular acne
  • Certain medications may provoke acne
  • Much of the individual variation in acne severity is due to variation in patient’s immune system and the production of inflammatory mediators such as cytokines, defensins, peptidases, sebum lipids, and neuropeptides

Some studies suggest there is a link between the food we eat and acne. It is very difficult to study the role of diet and acne. 

Several studies, criticized for their quality, have shown benefits in acne from a low-sugar, low-protein, low-fat and low-dairy diet. The reasons for these benefits are thought to relate to the effects of these foods on insulin and insulin-like growth factor-1 (IGF-1).

It is a good idea to drink less milk and eat less of high glycemic index foods such as sugar, biscuits, cakes, ice cream and bottled drinks. Reducing your intake of meat and amino acid supplements may also help.

Seek medical help if you are concerned about your skin, as changing diet does not always help.

We do not understand why acne eventually clears up. It does not always coincide with a reduction in sebum production or with a reduction in the number of bacteria. It may relate to changes in the sebaceous glands themselves or to the activity of the immune system.