Because acne typically occurs during a time of dramatic physical and psychological changes associated with the development of one’s body image, it can exacerbate social withdrawal and even depression. Left untreated, severe acne can lead to disfiguring scarring which can be difficult to treat. Several myths exist about acne. Acne is not a result of uncleanliness or infrequent washing. In other words, acne does not result from too much dirt on the skin or in the pores. Too much scrubbing may actually make acne worse. Acne is not caused by eating “fast” foods, chocolate or high-fat foods.
Acne Causes Several factors contribute to the development of acne. The primary problem is the abnormal development of cells inside the hair follicle, leading to the formation of a plug or blackhead (comedo). The plug inhibits the normal movement of hair, skin cells and grease (sebum), resulting in enlargement and eventually rupture of the hair follicle. A ruptured hair follicle spills its contents of oil and debris into the skin where it leads to swelling and causes redness (inflammation). Propionibacterium acnes, a type of bacteria that normally lives in the skin hair follicles, also plays a role in acne. These bacteria produce substances that cause redness and irritation (inflammation). They also make enzymes, which dissolve the sebum from the oil glands in the skin into irritating substances. These substances also make the inflammation worse. Certain hormones called androgens are an additional factor in causing acne. Androgens are male hormones that are present in both men and women but are higher in men. Androgens do two things: First, they enlarge the sebaceous glands in the skin. Second, they cause these glands to increase sebum (oil) production. The increased sebum production exacerbates plug formation and serves as more “food” for the bacteria. Androgens surge at puberty, which is why teens develop armpit and pubic hair and why boys develop facial hair and deeper voices. This hormonal surge also contributes to the development of acne in teens. Estrogens, which are the female hormones, actually can help to improve acne in girls. A woman’s monthly menstrual cycle is due to changes in the estrogen levels in her body. This is why acne in a female may get better and then get worse as she goes through her monthly cycle. A doctor may recommend acne treatment with birth control pills, which contain the helpful estrogens. It is now also believed that severe acne can run in some families. This may be due to genetic factors that has not yet been discovered. Anatomy of the hair follicle: Hair follicles exist on virtually all skin except for the palms of the hands and soles of the feet. Inside the follicle, the hair extends up from the deep layers of the skin and comes out of a pore. Near the surface, the oil gland (sebaceous gland) enters the hair follicle where it empties sebum at a relatively constant rate. The sebum lubricates the skin and provides a protective barrier to prevent drying. Skin on the face, chest, and back has an especially large number of sebaceous glands. These are the areas where acne occurs.