Acne – how and why do we get it?
What is acne?
Pimples, zits, spots, outbreaks – let’s be honest, it’s all acne. Acne is a chronic (on-going or recurring) inflammatory disease of the skin that has several features but the main one is spots. Perhaps some people don’t label their problem as acne because they don’t think it’s bad enough but it doesn’t have to be severe to be called acne – it can simply be mild acne.
What causes acne?
There are only a few areas of the body that don’t grow hair (mainly the soles of feet and palms of hands). Everywhere else, where there is hair, there is oil. Every hair follicle is accompanied by sebaceous (oil) glands. Their job is to produce sebum (oil) to lubricate and protect (waterproof) your hair and skin - the reason your soles and palms get wrinkly in the bath is that they have no oil to stop the water soaking into the skin.
Sebaceous glands are hugely sensitive to sex steroid hormone levels in the blood. Androgen hormones such as testosterone increase the production of sebum whilst oestrogens can inhibit it. Although testosterone is often called a male sex hormone, it is important to understand that women also have testosterone, just normally not as much. Those suffering with poly cystic ovarian syndrome (PCOS) have increased levels of androgens and so are more likely to suffer with oily skin and acne.
Together, the follicle and sebaceous gland are called a pilosebaceous unit (“pilo” from the latin for hair and “sebaceous” from the latin for tallow). Skin cells called keratinocytes line the inside of the pilosebaceous unit and produce a tough protective protein called keratin (which makes up the majority of hair, skin and nails).
Acne is caused when there are problems with this structure:
• Too much (or perhaps too thick) oil production
• Mixed with keratinocytes and or keratin, blocks the narrow opening of the pore
Whiteheads and blackheads
The thick porridge like mixture of oil and dead cells that can plug a pore is called a black or whitehead. The only difference is whether the plug is open to the air or not – if covered by a thin sheet of cells, the oxygen in the air cannot get to the plug and so it stays white or creamy coloured. If there is no covering and the plug is open to the air, it is oxidised and turns black.
Papules and pustules (spots!)
Once a pilosebaceous unit has been blocked by a black or whitehead, the sebum cannot drain. However, the sebum is still produced causing an increase in pressure in the structure. Eventually, this pressure becomes painful and causes inflammation (redness and more pain). This papule often appears as a raised painful red spot.
If the pressure and inflammation is not relieved, bacteria gather and feed on the oily soup creating infection with pus production as the body fights it. It is at this stage that squeezing a spot can be irresistible!
Who gets acne?
Anyone who has gone through puberty! Sebaceous glands are present but not particularly active until puberty when a surge of sex hormones trigger many different processes initiating puberty. Although acne is most common at this time of life, it can present in later life also. The idea that acne is a disease of the teenage years is not true and comes as a shock to those who suffer with it in their 30s or 40s.
Acne is multifactorial – there are many elements that contribute to it from genetics to lifestyle and diet. However, by far the most important approach to control of the disease is achieving control of the production of sebum.
Read about the treatments we offer for acne and acne scarring:
Dr Askari Townshend is a GMC registered doctor, qualified in 2002, and Member of the Royal College of Surgeons, England. He is founder and Medical Director of ASKINOLOGY in the City of London and has been practicing aesthetic medicine full time since 2008.