First of all, acne is not just a cool word for really bad or chronic pimples.  When we talk about acne, we’re talking about the medical term for acne. Acne is a chronic condition, which means it’s a recurring problem on your face, chest or back. Acne causes redness and inflammation in patches, not just a cluster of two or three pimples that are red and inflamed because you pick at them when you’re bored in algebra. 

Sorry, but it’s true.

So, what is acne? 

“Acne vulgaris is the result of the obstruction of specialized follicles (sebaceous follicles), which are located primarily on the face and trunk, by excessive amounts of sebum produced by sebaceous glands in the follicles combined with excessive numbers of desquamated epithelial cells from the walls of the follicles.”

Alright, alright. Too nerdy for you? You want that definition in English? Sure, I can do that, too.

Acne is what happens when certain pores in your face and torso are clogged up with gooey gunk called sebum. Sebum comes from glands that are just trying to do their job, but no one really likes them.  And since they feel rejected, sometimes those glands work overly hard to make people like them, but they end up just making more icky sebum that clogs up our pores. Then our pores get inflamed with too much goo and dead skin that doesn’t get cleaned out properly.

Is that plain talk enough for you?

So, why do we get acne sometimes and not others? Why do some people get acne and others don’t?  

Commercials and celebrity spokespeople like to tell us about things we can do to prevent acne, like changing our diet or not popping pimples. 

Unfortunately, not all of those things are true. 

So, what does the science say? What are the myths and misconceptions about what really causes acne and how you can prevent it?

Here are some ideas you might have heard about how acne forms – and some you might not:

Overly productive sebaceous glands,
A bacterial infection,
Unfortunate genetics,
Hormonal changes,
Stress,
Sunlight – too much or not enough,
Diet – too much sugar, chocolate, greasy food, etc.
Smoking.

Let’s look at each of these and the latest research that either backs or debunks its truth.

1. Overly productive sebaceous glands: This is, in fact, one of the primary causes of acne. What most of the problem with acne boils down to is that hair follicles in the face and torso get clogged with too much of the oil called sebum.  Each hair follicle is connected to a sebaceous gland. Sebaceous glands produce sebum. It should naturally be carried out through the hair follicle. 

When the sebaceous glands produce more sebum than can be cleared away from the pore, the pores become clogged up and inflamed. That inflammation leads to the redness you see as acne. 

Some people’s sebaceous glands produce more sebum than others, which can be the primary cause of their acne. Whether that is due to a genetic component, diet, sunlight, or other factors…well you’ll have to read on for more!

2. A bacterial infection: Too much sebum isn’t the only reason a pore can become inflamed. An infection can be another reason. 

The bacteria Propionibacterium acnes live harmlessly on the skin most of the time. Thanks to researchers Richard Gallo and his colleagues at the University of California, it was discovered that Propionibacterium acnes can turn nasty.  An infection of this bacteria triggers inflammation and zits when it finds itself trapped in airless, oily conditions like those found in clogged hair follicles. Yay! 

I, too, turn nasty when trapped in airless, oily conditions.  But, I digress.

The point is, that yes, those antibacterial facewashes are beneficial to clearing up acne, but you might have a combination of culprits causing your acne. Finding a skincare treatment unique to your combination of symptoms is important for a long-term skincare routine.

3. Hormonal changes: Ding ding ding! This one is totally true. Hormones are directly responsible for acne play a big role in how your acne changes throughout your life.

The first appearance of acne comes around puberty.  That’s because its during puberty that the body first starts producing hormones called adrenal androgens. Adrenal androgens are responsible in part for an increase in the production of sebum. 

Androgens include a more familiar hormone called testosterone. Though testosterone is referred to as a “male hormone,” both men and women have testosterone in varying levels.

Did you know that your testosterone fluctuates throughout your life? Your body might even have hormonal fluctuations throughout a single day! Since androgen production is related to sebum production, fluctuations in these hormones can have an affect on your acne that’s totally out of your control.

The only way to stay on top of fluctuating hormonal acne is a regular, routine skin care commitment. Get Y’OUR personalized skin care regiment delivered seasonally to your door by starting with this short skin quiz here. 

4. Stress: I really hate to admit that this one is true. I even tried to find research to prove that it wasn’t. We all hate stress enough as it is; why add insult to injury by letting our stress show all over our face in the form of acne?

It’s sad to say, though, that stress, can indeed trigger an acne episode. Researchers show us that more hormones are to blame. This time, it’s a stress-related hormone called corticotrophin-releasing hormone (CRH). 

CRH drives up the production of sebum – like a real jerk. 

That’s not all. There’s also an increase in nerve signaling that causes us to itch when we’re stressed.  “That can cause people to scratch or pick at their skin, which can create even more swelling and redness,” said Dr Kimball.

5. Unfortunate genetics: This one’s not as simple as “My mother had bad acne, so I’m doomed to have bad acne, too.” Though there is some truth to genetics playing a role in whether or not you suffer from acne.

For one, doctors believe that acne sufferers face a hypersensitivity to the hormones responsible for sebum production.

Another way genetics contributes to acne is a condition called follicular hyperkeratinization.   You see, typically, dead skin cells slough off at routine intervals and are forced off the surface of the skin by a new hair follicle pushing through. But for some, the dead skin cells build up and don’t fall off. Instead, they clog up the follicle and create plugs which contribute to acne. This is a genetic, clinical disorder due to an excess of keratin, which is called follicular hyperkeratinization.

There are prescription-strength ointments that can help force out the build-up, so you’ll have to talk to your doctor about this one.

6. Sunlight – too much or not enough: Have you ever thought that your skin looked better after a good tan?  Since getting a tan can help hide the discoloration acne can cause, and sun exposure sometimes dries up excess oil, it may look like the sun is helping to clear up the skin. However, both of these benefits are temporary.  The reality is that the sun does not make acne better. 

Actually, UV light damages the skin and can actually make acne worse. So be sure to use a day cream that includes UV protection. 

7. Diet: There is quite a bit of controversy over whether diet plays a role in acne. Some science points to diet affecting acne, while others argue that it doesn’t. For the past 30 years or so, the idea that clean eating benefits a clean complexion has been mostly anecdotal. That is, there hasn’t been any real, scientific evidence that the foods we eat has a direct affect on medical acne.  

In the past 2-3 years, though, that’s changed. In the past few years, three studies now support the link between diet and acne.

So far, the two biggest generalizations seem to be that diets that include milk and high glycemic loads directly increases acne symptoms. 

“Multiple studies have now found that diets with a high glycemic load can trigger acne in certain persons,” says Rajani Katta, a clinical professor of dermatology at the University of Texas at Houston. 

“The spikes in blood sugar which arise from eating high-glycemic foods causes oil production, which in turn causes acne,” says Anne Chapas, the founder of Union Square Laser Dermatology.  “We know that those cause a harmful hormonal environment.”

8. Smoking: As if you needed another reason not to smoke, research has shown that smoking cigarettes can cause acne breakouts by – you guessed it - increasing sebum production. Studies showed that 42 percent of smokers had acne, compared to 10 percent of non-smokers. 76 percent of those with non-inflammatory acne were smokers. 

So how do I find out what’s causing MY acne?

No one’s skin is the same. That’s why our team of geeks – I mean MIT data scientists, chemists, and hygienists ???? – have devoted our work to developing an AI-powered algorithm to help us figure out the cause of your acne.  Click here to take our Skin Quiz to tell us about yourself and the factors that affect your skin (age, diet, stress, etc.) so our team at Y’OUR can identify the root cause of your acne. Then we pair the perfect products with a combination of wellness and nutrition strategies – are you up for it? 

Then what - Can’t I Just Use a Product that Reduces Sebum Production?

No topical therapies influence the production of sebum. Soaps, detergents, and astringents can remove sebum from the surface of the skin but do not alter sebum production and are of no therapeutic value. 

So, I should scrub harder and more often to get rid of the sebum?

Nope. In fact, vigorous scrubbing can aggravate acne by promoting the development of inflammatory lesions. 

We’ll use the results of Y’OUR Skin Quiz to create a personalized skin care routine just for you to ensure everything is suited to the environment of Y’OUR skin type and lifestyle. We’ll show you the perfect skin wash, day cream (with UV protection), serum, and night cream to balance Y’OUR skin’s pH, unclog your pores, remove sebum, clear our bacteria, and protect your skin from UV. You’ll receive Y’OUR personalized kit seasonally so that you never run out!

Let’s get started on Y’OUR routine to make sure you never have to deal with acne again!

 

References:

Host-microbiome interactions and recent progress into understanding the biology of acne vulgaris. Alan M. O’Neill, Richard L. Gallo . Microbiome, 2018,

Implications for the role of diet in acne. Cordain, L.  Semin Cutan Med Surg. 2005.

The emerging principles for acne biogenesis: A dermatological problem of puberty.

Afifa, Qidwai. Manisha, Pandey.  Sarvesh ,Pathak Rajesh, Kumar Anupam, Dikshit. Human Microbiome Journal, 2017. 

Hormonal correlates of acne and hirsutism, M.D. Anne W. Lucky. American Journal of Medicine, 1995.  Acne and smoking, Bruno Capitanio, Jo Linda Sinagra, M Ottaviani, V Bordignon, A Amantea, and M Picardo. Dermatoendocrinology, 2009.