What Causes Acne

Jen asks: What causes pimples?

pimpleAh, acne! The facial blemish that powers many a pubescent date request rejection. Like millions of people worldwide, in my youth I waged a war with this aesthetic foe, with many a “Pizza-face” comment thrown my way.  Medically known as Acne Vulgaris, this affliction is largely cosmetic and does not usually cause any debilitating problems, except maybe trouble getting a date in high school…

The most common cause of acne is a class of bacteria called Propionibacterium (P- bacteria). They are named this due to their ability to manufacture propionic acid. According to the National Institute of Health, there are currently 90 known types of P-bacteria that cause acne.

P-bacteria is an extremely common inhabitant of adult skin. They tend to reside in the sebaceous follicles (sweat glands) near your hair follicles. Most of the time they show no signs of being present and we go about our daily lives feeling like our face is clean.  In actuality, your skin is rife with them and numerous other microbes.  Shower anyone?

These types of bacteria release an enzyme called lipase. The lipase produces fatty acids by digesting sebum (oil from your skin). When your body produces an excessive amount of sebum, these P- bacteria produce an excessive amount of fatty acids. Combined with the presence of bacterial antigens (proteins produced by the body’s natural immune response to fight off bacteria), they produce a local inflammation that bursts your hair follicles. A lesion might then form which can result in a pustule. This whitehead will then annoyingly mock you until you become frustrated and pop it like an over-sized balloon!

While P-bacteria is the main culprit behind acne, there are a few other things that cause pimples such as excessive oil production, a clogged hair follicle, and any condition that causes your skin to inflame.

If you’ve ever wondered why those pimples seem to only form on your face, neck, chest, and back, the answer is simple. These areas of the body contain the greatest number of sebaceous glands.

The obvious question then becomes, why is acne most common in teenagers? When a person begins puberty, their body begins to produce a hormone known as androgen. Hair follicles contain large amounts of androgen receptors. When circulating androgens attach to these receptors, they can overstimulate your sebaceous glands causing abnormal levels of oil on your skin. The result is more oil for your P-bacteria to digest and create pimples. “Pizza-face” is the net result.

Getting Rid of Acne

Dermatologists will classify your acne based on your symptoms. Depending on the amount of non-inflamed, or inflamed comedones (the bumps from your white or blackhead), the amount of breakout activity, amount of inflammation, and the areas of the body affected, you will be diagnosed in one of 4 separate grades, grade 1 being the mildest form and grade 4 being the most severe.

Knowing the cause, the general treatment for acne is mostly common sense- reduce oil production, fight bacterial infection, reduce inflammation, and speed up skin cell turnover, or any combination of the four.  In mild cases, over the counter facial cleansers and lotions can work. They contain ingredients like benzoyl peroxide, sulfur, and salicylic acid. These ingredients cause oily skin to dry up, kill bacteria, and help remove dead skin cells.

Should you have a more moderate case of acne, you might require prescription strength topical treatments, from Vitamin A based lotions that help in preventing the plugging of your hair follicle, to any number of topical antibiotics that help kill excess bacteria.

If you have a more severe case of acne, your doctor can try several other types of treatment that are a bit more invasive. They can prescribe oral antibiotics or a stronger drug known as Isotretinoin. In women, oral contraceptives have been shown to help. Should your doctor want to go the extra mile, there is always light and laser therapy. Several different types of chemical peels and microdermabrasion can also be helpful.

In the end, acne will tend to clear up by age 25 and only about 20% of people over 25 will continue to show signs of these facial blemishes. Unfortunately for the ladies out there, you are much more susceptible than men to acne after the age of 25. One study found that 50% of women between age 20 and 29 have acne and 25% of women between 40-49 show signs. With periods, child birth, bras, make-up, maintaining elaborate hair styles, more pressure about body weight, and now significantly increased chance of adult acne- I’ve said it before, and I’ll continue to say it, “I’m glad I was born a man.” 😉

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Bonus Facts:

  • 7% of people with severe acne are either depressed or show signs of suicidal thoughts as a result of the affliction.
  • Propionibacterium have been shown to cause infection in other parts of the body besides your skin; they include heart valves, corneal ulcers, certain types of prosthesis, and different types of central nervous system shunts (small passages that help control cerebrospinal fluid).
  • Acne Vulgaris is the most treated skin condition in the United States. 40-50 million Americans are affected at any given time and accounts for approximately 14 million doctors’ office visits every year. 85% of people between the ages of 15 and 17 show signs of it. The direct cost associated with its treatment exceeds about $2.2 billion annually.
  • If you seek treatment from a doctor for your pimples, they might choose to perform “acne surgery”. If you’re looking to save a little cash, you can choose to perform the same procedure at home, and you probably already have. It involves squeezing the pimple until it pops. Admittedly the doctor will use a sterile instrument that helps prevent scarring, infection, and the spread of acne. Your greasy finger tips won’t provide you with this protection.  Should you choose to live on the edge- and such consequences be damned- pop away and save yourself the doctor’s visit.
[Acne Image via Shutterstock] Expand for References
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  • I have to agree with you there, at times I really wish I was born a man as well :). What frustrates me is I know I get hormonal acne, my skin is only clear when I’m pregnant. I wouldn’t stay that way to keep my skin clear! But it seems the only way to to control the hormones is to take birth control pills which I no longer need. Wish there was a way to treat the hormones without the prescription!

  • Heather! There ARE other alternatives! If you’re breaking out a lot on your chin, neck, cheeks, and shoulders these tend to be either hormonal or food allergies. I didn’t know I was allergic to milk for years and then boom! Was diagnosed and my skin cleared up. Try checking your diet too! Also, this article doesn’t explain the lymphatic systems role in break outs either, which is also a cause of acne. Otherwise, this is a great article.

  • If the bacteria’s enzyme lipase produces fatty acids by digesting sebum (oil from your skin), then wouldn’t one strategy be removing the oil from your skin periodically. But if the skin drys out, then the skin gland may respond by producing even more oil — if that is why the oil is being produced on the skin in the first place. So the trick may be to pull off most of the oil, but not all of it. Therefore washing using a very dilute dishwater solution (or something) four times a day is worth a try. I imagine they have tried removing the oils, but I’m betting that the treatment was just to severe.