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What Triggers Acne?


Acne Vulgaris can begin as early as eight years old and may not appear in someone until they are twenty years old. But it is very common during adolescence. This is because acne is triggered by hormonal changes that occur during puberty and can continue throughout adult life if hormone levels remain high. For example, women with polycystic ovarian syndrome have chronically excessive levels of hormones.


Acne is not caused by poor hygiene! (But good hygiene can reduce the effects) This particular myth makes some teenagers feel "dirty" but whilst acne is a skin disease, it is not infectious. Taking good care of skin can help control the symptoms and lessen the chance of scarring.


A poor diet is not the cause of acne! There is much debate on whether particular foods contribute to the severity of acne or trigger "breakouts" but one's own experience should prevail. The usual suspects  are sugars, refined carbohydrates and saturated fats. Considering the wide health detriments of a diet rich in these substances, it is a worthwhile exercise to reduce or eliminate them from the diet anyway and see if there are improvements in the skin's condition.

If acne suddenly appears when someone is in their late twenties, a food or drug sensitivity should be investigated.


The reason why some people get worse acne than others has not been fully made clear, but it is likely that heredity plays a large role. This would be particularly relevant in two areas

  1. Hormonal regulation on the stimulating side
  2. Skin response on the receiving side (amount of keratin, tendency to scarring)

Hormonal action on skin -

The skin has two layers, the dermis and the epidermis. We see the top layer (epidermis) and sebaceous glands are found in the deeper dermis. They are usually (but not always) located by a hair follicle and the substance they produce is called sebum. Sebum is a fatty liquid which coats the hair as it grows up through the follicular canal, or pore. Sebum also contains keratin which is a tough, highly fibrous protein that is part of skin, nails and hair. The hardness helps protect from breakage, and it also provides a waterproofing quality and reduces fluid loss from the skin.

Sebaceous glands are controlled by hormones. In men, the hormone involved is testosterone and in women, both ovarian and adrenal androgens stimulate the sebaceous gland to increase the production of sebum. This is why puberty, when these hormone levels begin to rise, is the time acne begins to be a problem.

Overproduction of sebum may block the outlet of the sebaceous gland and follicle; this is referred to as a blocked pore. The amount of keratin in sebum may contribute to this happening more easily. A plug is formed at the top of the pore, at the surface of the epidermis. It is described as open, which means open to the air, or closed, which means it sits under a thin membrane. '"Open" are what we see as blackheads and this is because the air has caused oxidation and also dirt is contributing to the surface of the plug. "Closed" are what we see as whiteheads as the pus is building up under the membrane. Whiteheads are the precursors to more severe acne pimples and cysts.

As the liquid is kept in the canal, without ability to escape, certain processes take place. This may include some breaking down of the canal wall and spilling the contents into surrounding tissue so it is no longer encapsulated. (This is the main reason why squeezing pimples is a bad idea as it causes more of this to occur). At the same time, some bacteria colonize this liquid and begin proliferating and producing waste products, which also build up in the pustule. Inflammatory events begin taking place around this area which produces swelling, redness and pain. If the contents have built up so much or infiltrated so deeply as to affect the lower part of the dermis which is connective tissue, it is much more likely to result in scarring. This is because connective tissue tends to scar as part of its own healing mechanism.

Acne Vulgaris is a serious problem, especially common in adolescents and its therapy can be complex. It usually requires a many-pronged attack including antibiotics, topical creams, synthetic hormones or vitamin A derivatives. It is best treated by dermatologists if severe.

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