What causes acne and what can you do about it?

Acne, also known as acne vulgaris, has a variety of different causes. The four primary drivers of acne include:

1.     Abnormal maturation of skin cells called keratinocytes. Keratinocytes become stickier and grow at different rates leading to textual changes.

2.     Increase in P. acnes, a type of bacteria found in the sebum of the follicles in our skin. This bacteria is a normal resident flora in the follicle but patients with acne have higher concentrations of this bacteria.

3.     Increased inflammation, largely from the presence of bacteria that triggers our immune system respond.

4.     Hormonal effects on sebum due to testosterone. Testosterone causes increased sebum production which clogs the follicle. This is why during puberty and other hormonal changes your acne can flare.

Acne can have a variety of different presentations. The different types of acne lesions have different kinds of treatment associated with them. Pustular acne, classically referred to as whiteheads that contain pus is best treated with topical or oral antibiotics. Non-inflammatory comedones, commonly referred to as blackheads (or whiteheads that don’t contain pus), are best treated with topical tretinoin. Nodular or cystic acne almost always requires oral medicine. Options for nodular or cystic acne are oral doxycycline or Accutane. Hormonal acne which typically flares with one’s menstrual cycle, is best treated with a combination of topicals, oral contraceptive pills, and/or spironolactone. Talk to your dermatologist to determine what the best treatment is for you and to discuss all the risks and benefits.

There is a lot of miss information about what causes acne. There is no good data to suggest that your diet may be causing your acne. There is weak evidence to suggest that high glycemic index foods, like refined sugar, may worsen acne. Some data also supports the role of dairy in acne propagation, but this is also weak evidence. Enjoy your food and make healthy choices, but if you want to have a cheeseburger, it’s unlikely that that will flare your acne.

The most important thing when I address patients with acne is whether or not they have scarring. My goal is to always prevent scarring before it occurs, and if there is evidence of scarring I typically suggest my patients start Accutane sooner rather than later. Dealing with acne scarring is difficult and expensive, and requires cosmetic laser or peels. It is much easier to simply prevent it from occurring in the first place. With that in mind definitely do not pop your pimples as this can lead to scarring!

The content of this blog post is not medical advice. For medical advice please see your dermatologist. The information provided here is educational content to help dispel some myths around acne causes and treatments. Only your dermatologist can diagnose and treat your acne and discuss the relevant risks, benefits, and alternatives that are unique to your specific situation.