Acne- facts, treatment and myths

What causes acne?

Acne vulgaris also known as acne, zit, pimples is a very common skin disorder, affecting 40-50 million people each year in the US alone. Although acne is considered a disease of youth or teenagers, it can affect people well into adulthood. In a recent survey-based study, 35% of women and 20% of men reported having acne in their 30s, while 26% of women and 12% of men were still affected in their 40s.

The organ in the skin affected by acne is the pilosebaceous unit, this is the hair follicle and it's attached oil (sebum) producing gland called the sebaceous gland. On the skin surface, this is the pore that we see. Four main factors contribute to the development of acne:

1. Ever wonder why acne is so prevalent in teenagers or why you keep breaking out around your menstrual period? Here is the main reason. Increased sebum production: the oil produced by the sebaceous gland is called sebum. The activity of the sebaceous glands is controlled by hormones. When one reaches puberty, hormone production increases dramatically, also around the menstrual cycle (peri-menstrual), the production of certain hormones increase. 

2. The clogged pore. You might have suspected this as a cause of your acne, if so, great thought! On a molecular level, skin cells shed into the pores created by the pilosebaceous unit (hair follicle with its attached oil gland) and the cells are removed so the pores do not become clogged. In acne skin, the skin cells become sticky and are retained in the hair follicle. The sticky skin cells accumulate leading to a process called hyperkeratosis. The sebum and sticky cells continue to accumulate in the narrow pore until the pore ruptures and spills very irritating content into the surrounding skin, this results in inflammation. 

3. Inflammation: this is the way your body's immune cells respond to the content of the ruptured pore described above because the ruptured content is a "foreign substance" and does not belong in the skin. The action of the immune cells lead to what you see clinically. Whether you have a whitehead, blackhead, red acne bumps, tender cysts depends on the way your immune cells respond to content of the ruptured pore that contains accumulated sticky dead skin cells and sebum.

4. Propionibacterium acnes: these micro-organisms live deep within the pilosebaceous unit.
They release enzymes that contribute to pore rupture and stimulate the immune cells to promote inflammation.

Acne treatment

Effective acne treatment should target multiple contributing factors for a long-lasting effect. Combination topical antibiotic/benzoyl peroxide, topical retinoids, oral antibiotics, oral hormone modulators and Oral Isotretinoin are a few of the prescription medicines available in the U.S today. Visit your board-certified dermatologist to determine the best regimen for your acne.

Acne myths

1. Getting a tan will clear my acne: this is not true. Getting a tan may temporarily mask the redness of acne but it will not treat acne. Also, getting a tan increases the risk of premature aging and skin cancer. Always wear a "non-comedogenic" sunscreen with SPF 30 or above if you will be in sun.
2. Washing my face frequently will prevent acne: hygiene is not related to the development of acne. Washing your skin too frequently can irritate your skin and promote inflammation (acne causing factor #3 above). Use gentle cleanser to wash your skin and do not scrub your skin.
3. Popping my acne will make it go away quicker: this may cause the acne to get worse and lead to skin discoloration and scarring. Avoid picking or popping your acne. 
4. Avoid makeup if you have acne: it is okay to wear makeup that is labeled "non-comedogenic." Non-comedogenic means it has a much lower risk of causing acne breakout.
5. Use more acne medicines to prevent breakouts: When it comes to over-the-counter acne medication containing active ingredients such as benzoyl peroxide and salicylic acid, more isn't better. Using too much medication can worsen acne because it leads to dryness, irritation, and more blemishes.
6. Acne is caused by diet: Extensive scientific studies have not found a connection between diet and acne. In other words, food does not cause acne. Not chocolate. Not french fries. Not pizza. Nonetheless, some people insist that certain foods affect their acne. In that case, avoid those foods. Besides, eating a balanced diet always makes sense. However, according to the scientific evidence, if acne is being treated properly, there's no need to worry about your diet.
7. Acne is just a cosmetic disease. Yes, acne does affect the way people look and is not otherwise a serious threat to a person’s physical health. However, acne can result in permanent physical scars and acne can affect the way people feel about themselves.