Acne 101: Your questions answered

Acne. There are perhaps few words that conjure up such a striking mental image: one of spots, pimples and redness on the skin. Most of us will have experienced the irritation and battled the urge to pick that spot on the chin that feels as big as Mount Vesuvius, knowing it’ll only make matters worse.

However, for many, this skin condition is much more than the occasional spot or blemish. It’s a long-term health condition, categorized as a chronic inflammation of the skin. It has been associated with significant impacts on mental health and wellbeing and has been the focus of significant research to understand what actually causes acne. (Spoiler alert for those looking for one straightforward culprit: it’s not quite that simple…)

What actually causes acne?

Acne is a complex skin condition: there is no one cause and – sadly – no one miracle cure. However, there are a number of different types, or causes, of acne. But the basic biology in the presence of acne lesions is worth knowing.

There are four key factors in the development of acne:

  1. Excess sebum – or oil – production in the skin
  2. Disruption to keratinization within the follicle – keratin is the protein in hair – which can block the pore and lead to whiteheads or blackheads
  3. The presence of Cutibacterium acnes (although this type of bacteria is found on skin without acne too!), which thrives in oily conditions and where there are whiteheads or blackheads. It’s also known as ‘C. acnes
  4. The release of pro-inflammatory mediators (messengers that promote inflammation) to the skin, which leads to the recognizable inflammation of acne

So, like a chain reaction, oily skin is more likely to disrupt the keratinization, which in turn blocks the pores and leads to whiteheads – and C. acnes thrives in these conditions.

But let’s not forget that C. acnes can be present on skin that is acne-free. Why? The latest research into this puzzle indicates that it’s not just the presence of the bacteria on the skin that causes it, but more to do with the balance of the wider ecosystem of skin bacteria.

What are the different types of acne?

Now we know how acne develops on the skin, it’s worth noting a few of the different types or causes of acne inflammation.

Hormonal acne: Whether due to puberty, perimenopause or the menopause in women, or raging androgen for males, hormones can cause the over-production of oil and start the cycle of acne development.

Fungal acne: This is a rarer form of acne that is more commonly found on foreheads and temples, and characterized by small spots with white heads. A fungus – Malassezia – is actually responsible here (not the bacteria C. acnes) as it infects the hair shaft, follicle and sebaceous gland.

Inflammation and sensitivities: The link between the gut-brain-skin is real. Lifestyle factors, reactions to food or the environment, illness and even stress can all cause inflammation, which can create a perfect environment for the development of acne.

It is also worth busting a few misconceptions about acne here too. It’s not caused by dirty skin (in fact, over-washing the skin may make it worse), nor is it due to puberty and bad diet. While these factors may impact the presence of acne for some, that is certainly not the case for all. In fact, acne is now experienced by more than 50% of adults…

What are the treatment options?

First things first, there is no one perfect solution. Each individual’s skin is different and their approach to nurturing their skin and healing their acne will be, too.

There are a few tried-and-tested ingredients that have shown to improve acne:

Vitamin C: Known for its antioxidant and collagen-stimulating activity, vitamin C can also tackle skin redness. Tests on people with acne (in-vivo testing) showed it strongly restricted the growth of C. acnes.

Niacinamide or Vitamin B3: Primarily known for its barrier-strengthening properties and ability to reduce transepidermal water loss, or ‘TEWL’. This is the natural process of water loss through the skin barrier, which is more pronounced in some people, causing skin irritation. A number of studies have also shown positive effects on acne, suppressing the inflammation of acne lesions.

Allantoin: A botanical extract from the comfrey root. There are many benefits: skin-soothing, moisturizing, skin renewal and promotion of cell proliferation as shown in clinical studies. It has long been used to treat skin wounds and is well-suited to help alleviate scars and reduce skin irritation. 

It is also worth considering your broader wellbeing: stress management; ensuring that you are supporting your gut bacteria with a healthy diet packed full of fruit, veg and pre, pro and postbiotics; and even mapping your daily activity to understand any triggers that may cause inflammations.

With your skincare, remember to nurture your natural microbiome (the delicate balance of bacteria and other microorganisms within your body). That means avoiding over-washing or very harsh exfoliators. Gentle acid exfoliation, cleansers (preferably those that don’t foam) and oils can all still be used as part of your skincare routine.

Finally, speak to a professional – whether you go to your GP or straight to a dermatologist. There are further treatment options (including antibiotics) that can be considered with the proper professional advice and consultation.

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