Acne is a very common condition that tends to be hereditary, usually beginning during adolescence and subsiding by the late twenties. In some cases, however, acne may also begin later in life and last well into middle age.
The years of adolescence are full of changes, and living with acne need not be an accepted rite of passage to adulthood. When acne is present early, effective medical intervention will greatly improve the outcome and prevent scarring.
How Acne Begins
Hairs grow out of tiny pores in the skin called follicles. Acne occurs in hair follicles and in the sebaceous (oil) glands attached to the follicles. The sebaceous glands secrete a waxy, oily substance called sebum that helps keep the skin moist and supple. Because sebaceous glands are most concentrated on the face, chest and back, most acne is concentrated in these locations.
Sebum usually passes to the skin’s surface through the opening of the follicle in small, unnoticeable amounts. The hair follicles are lined with layers of dead skin cells. In people with acne the dead skin cells that line the pores stick together abnormally and accumulate within the follicle and block the opening of the pore. This blockage consists of a collection of sebum, dead skin cells, and bacteria and is known as a comedo:
- A “whitehead”, or closed comedo, has a small or normal sized pore at the skin’s surface.
- A “blackhead,” or open comedo, is nearly identical to a whitehead except that the pore opening is expanded by the size of the plug. The dark color of a blackhead is not the result of dirt or other matter that has accumulated in the pore but is the result of a chemical reaction between the mixture of sebum and dead skin cells and oxygen in the air.
- When a pore becomes plugged, there is further accumulation of debris in the follicle beneath the plug. Eventually, the wall of the follicle may burst from the increasing pressure of the substances building up within it. The sebum, dead skin cells and bacteria are very irritating to the tissue beneath the surface and produce redness, swelling and pain (the inflammatory papule or pimple).
Why Acne Develops?
Genetics
The basic cause of acne is still unknown. The predisposition to develop acne is often hereditary but a combination of factors has been shown to contribute to the acne process. A parent who had a severe case of acne during his or her teenage years is more likely to have children who will also have acne. Parents who had a smooth complexion tend to have children who also have acne-free skin.
Hormonal Changes
During puberty, the body undergoes a great number of changes that are the result of rising levels of sex hormones in the body. Both males and females experience an increase in the levels of hormones called androgens (mainly testosterone in both sexes) that increase the size of the sebaceous glands, promote the production of sebum and contribute to acne.
Skin Bacteria
Bacteria that live on the skin surface are normally “friendly” because they check the growth of more dangerous (disease-causing) microorganisms. These friendly bacteria play little or no role in acne. It is a specific type of bacteria that lives inside the hair follicle and sebaceous gland that is responsible for acne. These germs are not present on the surface of the skin. These tiny organisms inside your pores alter the chemical nature of sebum turning it into a more irritating substance. In addition, these bacteria cause abnormalities in the cells that line the follicles that lead to obstruction of the pore and rupture of the follicle wall.
Diet
Until recently, dermatologists believed there was no connection between acne and diet. New research has provided convincing evidence that diet may, in fact, play a role in acne:
It turns out that “bad carbs” are bad for acne and a reduction in “bad carbs” of 15-20% may significantly help reduce acne severity. The problem foods are those that can be said “to start out white”, foods that contain ingredients like flour, sugar, and starch.
So, in the greasy hamburger, it is not the burger but the bun and the sugar in the ketchup that are the problem. It is the starch in the potato, not the grease in the French fries. Try to cut back on “bad carbs” if you have acne.
Drugs and Industrial Chemicals
Acne-like conditions may infrequently result from the use of certain drugs, primarily bromides, iodides, corticosteroids, androgens, and drugs used to treat epilepsy or depression. Industrial substances, including coal tar and petroleum oil, may cause some cases of acne. Therefore it is important that Dr. Rachel Chew be aware of all medications and supplements that you regularly take or have been recently prescribed.
Local Factors
Pressure on the skin from clothing, backpacks, football shoulder pads, headbands, sport masks and helmets can aggravate acne by friction. Similarly, the friction caused by resting of the chin or cheek on a hand while doing homework, playing a musical instrument, or talking on the telephone may also aggravate acne. Excessive perspiration can also result in worsening of acne in some people.
Cosmetics
Available evidence does not show a connection between acne and the use of cosmetics. However, if your skin seems to break out when you use certain products, you should avoid them as it may be a sensitivity to certain ingredients within the cosmetic that is causing your breakouts. Any cosmetic products that are expired, smell or look odd, or have lost consistency should be immediately discarded.
Picking or Squeezing
Although many people think that picking or squeezing pimples will help make pimples go away, it may actually make the condition worse and lead to long-lasting red marks or even scars. It is much better to treat pimples with topical agents as directed by Dr. Rachel Chew and her team than it is to pick or try to extract a pimple on your own. No matter how tempting it may be to squeeze — do not pick your pimples!
Acne Myths
While the foregoing factors may promote acne or worsen an existing acne condition, other factors that are widely believed to cause acne have no scientific basis at all. Special “cleansing” diets, vitamin supplements and so-called “health foods” invariably prove to be useless in the treatment of acne. Sexual activity does not prevent or clear acne. Also, although good hygiene is recommended, surface dirt and oils on the skin do not exclusively cause acne. As explained previously, acne starts deep within the follicle.
Treatment
Although acne usually passes with adolescence, a variety of treatments are available to prevent the development and spread of acne pimples. Prevention or early treatment of acne tends to be much more successful than attempts to eliminate scars later.
Alternative Treatment in Rachel Chew Clinic by Dr Rachel Chew:
- TCA Skin Peel
- Platelet Rich Plasma Therapy
- Dermaroller
- Medical Grade Facial
- Fractional CO2
- Subcision
- Obagi Skin Care
Skinartesse 