Acne is a common skin condition that affects millions of people worldwide. It is a complex inflammatory condition caused by several factors:
- Excessive sebum (oil) production
- Cutibacterium acnes ( A type of bacteria previously known as Propionibacterium acnes. It is not the sole cause of acne. Cutibacterium acnes is a natural part of the skin’s microbiome, which consists of a diverse range of microorganisms that help maintain healthy skin. However, when there is an overgrowth of this bacteria, it can lead to inflammation and the formation of acne lesions.)
- Alteration in follicular keratinisation ( This means that dead skin cells are not shed at an adequate rate, causing occlusion of pores and microcomedone formation.)
These key factors are interrelated and may be influenced by several hormonal and genetic factors.
There are many facts about acne that you may not be aware of. Here are some of the interesting facts about acne:
1. Acne can develop at any age
People always have the misconception that when you get older, you will not get acne anymore. While acne is most commonly associated with teenagers, it can develop at any age. In fact, adult-onset acne is becoming increasingly common, particularly in women.
2. Acne can be caused by genetics
Genetics play a role in development of acne on top of lifestyle and diet. If your parents or siblings have had acne, chances of you getting acne is more likely.
3. Stress can worsen acne
Stress can trigger the production of hormones that can increase sebum production and contribute to development of acne. In addition, stress can also weaken your immune system, making it harder for your body to fight off acne- causing bacteria.
4. Acne can be caused by certain medications
Some medications, such as corticosteroids, lithium and anticonvulsants, can cause acne.
5. Protein supplement can cause acne
Evidence suggests that whey protein may be a contributing factor in acne for some individuals. Whey protein is a popular supplement among gym goers and athletes as it is a high- quality protein and fast-digesting. However, whey protein increases insulin-like growth factor-1 (IGF-1) which can stimulate the production of sebum. Sebum is pro-inflammatory and has the potential to clog pores when it is excessive, thus can worsen or trigger acne breakouts. Moreover, whey protein is often processed with added hormones and often consumed with milk, which are other sources that contribute to acne.
If you suspect whey protein may be the cause of your acne breakouts, you can consider to exclude whey protein from your diet for a period of time and see if it makes a difference in your skin. Meanwhile, you can take alternative protein sources like egg whites, almonds, soy, walnuts, plant based protein and bone broth.
However, not all individuals who consume whey protein will have acne. Some are more prone to having acne due to other contributing factors such as hormonal changes and genetics.
6. Dairy products can cause acne
Dairy products, such as milk, cheese, contain hormones and growth factors that can stimulate the production of sebum, the oily substance that clogs pores and leads to acne. In addition, dairy products can also increase insulin levels in the body, which can trigger inflammation and contribute to acne.
Several studies have shown a link between the consumption of dairy products and acne. In one study, researchers found that teenage girls who consumed more milk were more likely to develop acne than those who consumed less milk. Another study found that the risk of acne increased in individuals who consumed more than three servings of dairy products per day.
But not all dairy products are associated with acne. For example, yoghurt is acne friendly, as probiotics in yoghurt can reduce IGF-1 level.
7. Sugar intake can cause acne
Similarly, sugar, particularly refined sugar and high- glycaemic index carbohydrates, can cause a rapid increase in blood sugar levels, which can trigger the production of insulin and IGF-1, hence leading to inflammation and development of acne.
I know it is not easy, especially if you are a sweet tooth person. But hey, think about good skin, it is worth considering reducing your consumption of high- glycaemic index carbohydrates.
8. Exercise and acne
Exercise itself does not cause acne, but it can contribute to the development of acne breakouts in some people. This is because exercise causes sweating, which can mix with sebum and dead skin cells on the skin’s surface, leading to clogged pores and later acne breakouts.
In addition, exercise can cause friction on the skin, particularly in areas where clothing or equipment rub against the skin, such as the back or chest. This can worsen existing acne or cause the development of new lesions.
However, it is important to note that regular exercise and physical activity can have benefits for the skin and overall health. It improves your blood circulation and oxygenation to the skin, and it can also help to reduce stress, which is a known contributor to acne breakouts.
Exercising is definitely a must in life to maintain good health. The key is to reduce the impact of exercise on acne by minimising friction to skin and practice good hygiene. These can be achieved by the following measures:
- Shower or cleanse the skin as soon as possible after exercising to remove sweat and bacteria from the skin’s surface
- Wear loose- fitting clothing that allows the skin to breathe and does not trap sweat against the skin.
- Avoid wearing hats or headbands that can trap sweat against the skin.
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9. Menstrual period causes acne
Wonder why is there flare up of blemishes and acne before your period? They usually strike about 7 to 10 days before the onset of your period and then subsides as soon as bleeding begins.
The average menstrual cycle is 28 days. In the first half of menstrual cycle, estrogen predominates; in the second half, main hormone is progesterone. As bleeding approaches, both of these female hormones levels fall to the lowest, whereas the male hormone, testosterone (exist in smaller amount in female) remain the same level throughout the whole month. This implies that before and during menstruation, testosterone is relatively higher than the female hormones.
In mid cycle when progesterone level rises, there is production of sebum. As progesterone level increase, skin swells up, compressing the pores and makes the pores look less visible. When both estrogen and progesterone level decrease and testosterone level is high, sebaceous glands make even more sebum on top of the sebum built up by progesterone. Excessive sebum disturbs the balance of bacteria Cutibacterium acnes, which is the bacteria that forms part of the normal flora of the skin. When bacteria overgrow, acne forms.
10. Acne can be caused by medical conditions
Here are some of the medical conditions that can cause acne:
- Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome is a hormonal disorder that affects women of reproductive age. It is characterised by high levels of androgen (male hormones) in the body, which can lead to acne, hirsutism (excessive hair growth), and other symptoms like irregular periods, weight gain, and difficulty getting pregnant.
Hypothyroidism leads to a number of hormone imbalances that could each lead to acne by themselves. In hypothyroidism, there is low progesterone level. This leads to high estrogen levels and estrogen dominance that increase sebum production. Hypothyroidism also influences insulin levels which in turns influence testosterone levels, leading to testosterone-induced acne and oily skin.
Acne caused by hypothyroidism is usually cystic that can involve face and other parts of body, not associated with menstrual cycle, but present all the time especially at times of stress. It can also be accompanied by other symptoms of hypothyroidism such as weight gain, cold intolerance, fatigue, menstrual irregularity etc.
- Cushing’s syndrome
This is a disorder caused by prolonged exposure to high levels of cortisol (a hormone produced by adrenal gland). It can be due to corticosteroid medications intake or by tumour in the pituitary gland or adrenal gland. Other than causing acne, it also leads to weight gain, muscle weakness and high blood pressure.
- Congenital adrenal hyperplasia (CAH) and adrenal tumour
Adrenal glands are responsible for producing hormones, including androgen such as testosterone. In these two conditions, there will be production of excess androgens, which can stimulate the oil glands in the skin to produce more sebum. In addition to androgen production, imbalance of cortisol also contributes to the development of acne.
11. You should never pop or squeeze your acne
Attempts to squeeze or extract whiteheads or cysts can push the sebum and follicular debris deeper thus increasing lesion depth, inflammation, and immune response, creating more aggravated acne flare and increasing the potential to develop postinflammatory hyperpigmentation and scarring.
12. Washing your face a lot will not clear up blemishes
Washing your face twice a day is more than enough. Over exfoliating and over cleansing can worsen your acne as it may irritate and dries out your skin, leading to more oil production.
13. There are many reasons why acne can scar
Family history is one of the biggest contributor to why you are prone to scarring. However, the most important predictor and an avoidable factor of acne scarring is the time to effective treatment. When there is too much time between initial flaring acne and effective treatment, scars tend to form due to the prolonged inflammation. So, treat your acne as soon as possible to prevent scarring. Self manipulation as mentioned in the previous point will increase the chance of severity of scarring. Severity and duration of your acnes largely determine if or how badly your acne will scar. Jawline hormonal acne also tend to form scars and is associated with deeper, painful and blind ended pimples.
14. Hot showers or baths, saunas or steam rooms can worsen acne
People think that going to saunas or steam rooms help to expel toxins and let your pores breathe. But the truth is totally opposite. Heat can increase sebum production thus causing more harm than good to your acne-prone skin.
15. Fungal acne VS common acne
Fungal acne, or Malassezia folliculitis, is an infection caused by overgrowth of yeast called Malassezia in the hair follicles on the skin. It is often confused with common acne. The symptoms of fungal acne can be similar to common acne, with small, red bumps or pustules. But unlike common acne, it causes itchiness of the bumps instead of pain. It tends to occur on the chest or back, rather than the face. Fungal acne can be persistent, and worsen with sweating and hot, humid temperatures.
Treatment of fungal acne differs from the common acne. There is lack of response to traditional acne treatments like benzoyl peroxide or salicylic acid, instead, its treatment typically involves the use of antifungal medications, such as topical or oral ketonazole in addition to changes to individual’s skin care routine to control the overgrowth of yeast. This includes avoiding heavy or occlusive skin care products, such as oils or heavy creams.
Well, acne can be very frustrating and depressing. Do not lose hope, there are treatment options that can help you manage it effectively.
Topical therapy available include Benzoyl peroxide, retinoids , antibiotic and azaleic acid. ( Examples of retinoids include tretinoin, isotretinoin, Adapalene (Differin), tazarotene) Retinoids can cause local irritation, so start off slow by applying 2 to 3 times per week and increase frequency to daily as tolerated. Comparing all retinoids, Adapalene is better tolerated.
Adding actives like AHA (glycolic acid, lactic acid, mandelic acid) and BHA ( salicylic acid) can help to exfoliate your skin and clear up the dead skin cells that are built up. Salicylic acid is a popular one especially for acne skin as it can penetrate deep into the pores and help to remove dead skin cells and debris. It also has anti-inflammatory properties, making it effective for mild to moderate acne. Moreover, it can help to regulate sebum production, thereby reducing appearance of pores and acne.
When there is severe form of acne like nodulocystic acne, oral isotretinoin or antibiotic may be added. Oral isotretinoin, which is more well known as Accutane, can benefit acne with scarring.
Combination of topical and oral medications is more effective and reduces the risk of bacterial resistance. For example, combining benzoyl peroxide with oral antibiotic or oral isotretinoin, or topical retinoids with oral antibiotic.
Steroids injection into nodulocystic acne lesion can rapidly reduce inflammation, resolve acne lesion and minimise chance of scarring.
Physical therapies like acne facial, microdermabrasion and chemical peel can hasten the recovery of acne.
Microdermabrasion is a non- invasive treatment that involves usage of tiny crystals or diamond-tipped wand to gently remove the top layer of dead skin cells. This can help to remove debris, excess oil and unclog pores. When dead skin cells layer is removed, skin tone and texture improve and topical treatment get absorbed better into the skin.
Chemical peel also works similarly to microdermabrasion, but it involves application of chemical agent on the skin. It can penetrate deeper layer of the skin and stimulate collagen, hence is effective in treating complications of acne like postinflammatory hyperpigmentation and acne scarring.
Most of you may be aware of the picture of hormonal acne, which mainly causes breakouts on your jawline or hairline, usually accompanied by oily skin and excess hair growth. If your acne is due to hormonal imbalance, then topicals most likely will not reduce your acne. Hormonal therapy like oral contraceptives and antiandrogen pill like spironolactone help with hormonal acne.
However, in certain conditions like hypothyroidism, treating hormonal imbalance is not enough as the main problem is your thyroid. So, in this case, thyroid medication is the key to the cure of your acne.
In other words, if your acne is due to underlying medical conditions, treat the underlying cause.