Acne – Causes and Treatments

Common skin condition

As the most common skin condition today, acne affects people of all ages but is most common in teens and young adults, with about 85% of individuals 12-24 years of age experiencing this skin condition (1).

Acne is an inflammatory skin disorder that happens when the oil (sebaceous) glands connected to hair follicles stick together with other skin cells (keratinocytes) inside the pores and prevent the normal shedding of the skin cells (2). This oily plug encourages a strain of bacteria (Cutibacterium acnes) and the growth of opportunistic bacteria like Staphylococcus aureus, which leads to inflammation and creates a pimple (2) (3).

Acne can be found on hair-covered parts of the body where sebaceous glands are present like the face, scalp, upper back, and chest.

Types of acne

There are various types of acne like whiteheads that stay beneath the skin, blackheads that open on the surface of the skin, pimples that are pus-filled lesions with a white or yellow top and red base, and severe nodule acne, or cystic acne, which is a deep, pus-filled lesion that can be painful (2).

Factors that contribute to the development of acne

Several factors can contribute to this inflammatory skin disorder, genetics, infections, stress, hormone changes, and diet can all play a role (5) (6) (7).

Since acne is caused by the clogging of pores due to excess sebum and cells, and the growth of bacteria that leads to inflammation, let’s focus on what causes the oil glands to over-produce sebum in the first place.

Sebum is an oily, waxy substance composed of fatty acids, sugars, wax, and other chemicals, and is beneficial to us as it coats, moisturizes, and protects the skin (4). But, as is true for many other things, more is not always better and sometimes an excess of something, like sebum, can be problematic.

The genetic role in acne involves the regulation of the individual’s immune responses and metabolism of steroid hormones (5).

Infections play a role in the development of acne, as the clogged pores become a breading ground, of sorts, for opportunistic bacteria to grow. The skin has a diverse microbiome that plays a vital role in protecting us from pathogens, but when this complex ecosystem is compromised and pathogens infect the skin, acne can develop (9).

Stress affects the HPA axis which affects the function of sebaceous glands (6). For example, corticotropin-releasing hormone (CRH) is increased with stress which then stimulates sebum production that leads to clogged pores (6).

Certain hormones, like testosterone or DHEA-S (androgens) and progesterone (a female sex hormone), affect overall sebum production. For example, when androgens are elevated, more sebum is produced which can lead to the development of acne (8).

The food we consume each day can also play a role in the development of acne. Dairy contains growth hormones and other growth factors that stimulate the development of acne in some individuals (10). Additionally, food and beverages with high glycemic loads, like simple carbohydrates, increase blood levels of insulin which promotes the production of androgens that lead to increased sebum and clogged pores (10).

Healing acne

Increased sebum production is the main feature of the development of acne, with genetics, infections, stress, hormones, and the diet all playing roles in how sebum is produced in the body.

This multifactorial condition requires a multifactorial solution.

Infections can spread if the acne “pops” and the bacteria moves to the surrounding skin, so keep the skin clean with a gentle cleanser like a pure castile soap, but don’t overdo it because that can cause the skin to be too dry (11). A face mask of bentonite clay can be useful in healing acne as it has detoxification, broad-spectrum antibacterial properties, and can heal skin lesions when used topically (17).

Minimizing stressors will help to keep hormones balanced. Chronic stress increases steroid hormones like cortisol which thickens sebum and can cause dysregulation of inflammation and damage to the skin, which can then lead to acne development (12). The chronic stress condition also depletes the body of essential nutrients like zinc, magnesium, and selenium that are needed to control acne. So, managing stress with deep breathing, biofeedback, utilizing adaptogenic herbs like ashwagandha and holy basil, and saunas or massage can be useful to reduce stress and reduce the risk for acne.

Acne sufferers have been found to express an increased activity of an enzyme, 5-a-reductase, that converts testosterone to a more potent androgen, and growth hormones (IGF-1) which can increase sebum production (13). Natural products can be used to inhibit the enzyme (5-a-reductase) that leads to increased sebum production (14). For example, green tea contains a polyphenol, epigallocatechin-3-gallate (ECGC), which is a direct antagonist of androgen action and a 5-a-reductase inhibitor (15) (16).

Certain types of foods aggravate acne as they cause insulin-like growth factors to stimulate the overproduction of sebum and skin cells around the hair on the skin (follicles) (18). High glycemic foods like sweets, soda, refined grains and sugar, and junk food, can all lead to the overproduction of sebum and skin cells that clog pores and lead to acne development (18). Additionally, dairy contains growth hormones and growth factors that can lead to the development of acne (19). So, minimizing or eliminating these foods will aid in the healing process.

Just as some foods can aggravate or lead to acne development, some foods can help to prevent or reduce the development of acne. Sebum is comprised primarily of triglycerides and fatty acids, and studies show that when certain fatty acids, like linoleic acid, are reduced, acne is more likely to form (4) (20). The body is unable to produce linoleic acid, so it must be consumed in the diet. Foods that provide linoleic acid include nuts and seeds like walnuts, hemp seeds, sunflower seeds, and almonds.

Deficiencies of nutrients like vitamin E and vitamin D have been found in acne sufferers (4) (7). These essential nutrients can be found in foods like sunflower seeds, almonds, peanuts, salmon, and avocado. Of course, the best source of vitamin D is sunshine, so be sure to get outside and get some sun on your skin each day.