Acne is a common skin condition, but knowing that it’s common doesn’t necessarily make it any easier to deal with. Although especially common among teenagers, adult-onset acne is becoming more and more of an issue for older people. Very severe acne, or cystic acne, can be particularly troublesome, because it is often painful, tenacious and can lead to scarring.
Causes for acne vary, but include excess oil production, bacteria, clogged pores and hormonal changes. Genetics are also believed to play a large role in causing acne. Acne is usually classified as mild, moderate or severe. Mild acne is typically characterized by clogged pores that sometimes turn into pimples. Moderate acne is characterized by a greater occurrence of pimples like papules and pustules that occur on the face and also the back or chest. Severe acne is when painful nodules, or cysts, occur deep in the skin, back and chest. This type of acne is generally considered the worst kind not only because of the pain involved, but because they are much harder to treat and can leave behind scars that sometimes don’t go away.
Acne scars are often a result of inflammation. Sometimes after pimples heal, they can leave behind a red or brownish mark (caused by an increased production of melanin) that can take months to fade. These types of scars are probably the most common and easiest to get rid of with dark spot fading creams or serums. Other types of acne scars include ice-pick and keloid scars. Ice-pick scars are narrow but deep scars that are like indentations in the skin. Keloid scars form as raised scars and often occur in men with darker complexions.
With all that said, let’s explore the causes of acne more in-depth to further help you understand what is responsible for this frustrating issue.
Related: Best acne treatments – The Truth About 13 Top Acne Treatment.
Though acne causes vary, they can also come together in a perfect storm to form lesions on the face and upper body. For example, it starts with excess oil production caused by homes that then leads clogged pores. Clogged pores include oil and dead skin cells that can turn into open comedones, or blackheads. If they become infected with bacteria, they become inflammatory lesions, or pimples.
Hormonal activity, which can increase during certain moments like one’s menstrual cycle or during puberty, can lead to excess oil production. Androgens are sex hormones that make skin follicle glands produce more oil. This type of acne may also be called hormonal acne. Hormonal acne may mainly form on the chin or around the mouth area, especially in women before, during or after their periods. Hormonal acne can also be influenced by the stress hormone cortisol. Stress can exacerbate acne to cause more lesions.
Excess Oil Production
Hormones aren’t the only factor in excess oil production. Sometimes excess oil on the skin is simply genetic. Oily skin can have its advantages, like providing natural hydration. But, of course, the drawback is the formation of more pimples. As oil increases in the skin, it can become quite sticky. Dead skin cells that multiply inside hair follicles, or pores, mix with the sticky oil and form hardened plugs that stretch out pores and make them look larger.
You might be making your oily skin worse if you wash your face too often with harsh soaps. Even though it feels like foaming cleansers are the only thing that can wash off all that surface oil, too much can actually cause more oil production.
Once pores become clogged with oil and dead skin cells, they can become blackheads or whiteheads. Blackheads are open comedones, meaning they are exposed to oxygen, which gives them that dark color (the color is not related to dirt or grime). Whiteheads are closed comedones, which means they covered with a thin layer of skin. They are usually pretty small and yellow-ish or white in color. They’re not considered pimples because they’re not inflamed. Clogged pores often need some type of acid like salicylic acid to help slough away dead skin cells and unplug them. Oil-based or comedogenic (pore-clogging) skin care products can also cause blackheads or whiteheads to form. This is why many skin care products now say non-comedogenic on their labels to help people identify what they need for their particular skin type.
The bacteria that causes pimples is called Propionibacterium acnes, often shortened simply to P. acnes. This bacteria can be found on the skin, oral cavity, large intestine and even the ear canal. It can cause infections in other places beside the skin, including the mouth, eye and brain. P. acnes inside pores feeds on oil and leads to inflammation. This inflammation causes the swelling and redness that characterizes pimples. Researchers have found that P. acnes is nearly non-existent in people who don’t get breakouts. Meanwhile, they found two strains of P. acnes in those who did get pimples often. Some strains of P. acnes can actually help protect skin, similar to probiotics that help balance levels of “good” and “bad” bacteria in the gut.
Benzoyl peroxide is one of the treatment options that reduces P. acnes bacteria unlike salicylic acid, which only helps unclog pores. Both of these, however, are popular treatment options for acne.
Finally, stress, though not considered one of the four main causes of acne, nonetheless can exacerbate or trigger the condition. Researchers have found that the more stressed out you get, the greater the occurrence of lesions. A stress-related hormone known as corticotrophin-releasing hormone (CRH) is believed to bind to receptors in the skin and increase oil production. Secondary factors related to stress, such as eating unhealthy foods to cope or getting less sleep, can also trigger or worsen acne conditions. Moreover, stress can affect the overall immune system, leading to slower healing times for acne. This makes acne lesions last longer.
If you can somehow reduce the stress in your life, or be more aware of the stress-causing incidents and do calming exercises beforehand, you may be able to prevent stress from worsening your acne problems.
References: Expert Review of Anti-Infective Therapy, “Propionibacterium acnes: infection beyond the skin”; Journal of Investigative Dermatology, “Propionibacterium acnes strain populations in the human skin microbiome associated with acne”