What is acne?
Acne (acne vulgaris, cystic acne) is a common inflammatory skin condition characterised by outbreaks of pimples, blackheads, whiteheads and cysts. It affects the areas of skin with the densest population of oil glands (sebaceous follicles) - the face, the upper part of the chest, and the back. It is common in teenagers and normally tends to clear up after puberty, though the pimples can leave scars.
In the USA acne affects over half of all people in adolescence and early adulthood; in Australia around two thirds of all young people are affected. Acne tends to run in families, and for most people it tends to disappear or decrease substantially between the ages of 20-25. A few people have acne in their 30's, 40's and even older. The main effects of acne are psychological, as it usually appears during adolescence, when people already tend to be most socially insecure.
Acne can occur in inflammatory and non-inflammatory forms.
In older people acne is uncommon, and is sometimes confused with rosacea.
Symptoms of acne
- Pimples (pustules).
- Seborrhoea (areas of scaly red skin).
- Blackheads, whiteheads (comedones), pinheads (papules), nodules.
- Scarring (in more severe cases).
Causes of acne
- Acne is most common at puberty because the surge of hormones at this time stimulates the sebaceous (oil-producing glands) in the skin and makes them prone to blockages and infection. In adolescence, acne is usually caused by an increase in testosterone that occurs in both males and females at this time. The testosterone is associated with an enlargement of the sebaceous glands and an increase in sebum (waxy oil) production. Hair / sweat follicles / glands can also be blocked and infected.
- Several hormones have been linked to acne, including those that change around puberty and menstrual cycles. Taking pharmaceutical anabolic steroids (which mimic testosterone) can also cause acne.
- Cystic acne can occur when sweat collects in hair follicles and perspiration ducts, along with an infection and inflammatory reaction. The cysts or boils can appear on the groin, buttocks, armpits, and other areas, with lesions penetrating deeper than with common acne.
- In adult women, polycystic ovary syndrome may cause acne.
- In menopausal women, acne can occur as production of the natural anti-acne ovarian hormone estradiol decreases.
- Stress. Some research (1,2) has shown that stress can trigger acne. The psychological effects of acne can also cause stress for some people, so it can be self-perpetuating.
- Bacterial infection. A healthy skin contains and needs many different bacteria. In the case of acne, some bacteria take advantage of blocked follicles / glands and multiply. Propionibacterium acnes and staphylococcus epidermidis are usually in excess in acne cases.
- Sugar. A high sugar diet is associated with acne. (3,4)
- Milk. Dairy products can cause acne. (3,5) I suspect this applies to pasteurised dairy products rather than raw dairy products, but could not find any research to confirm this.
- Oily processed foods.
- Oil-based cosmetics.
- Lack of fresh vegetables and fruit.
Minor causes / triggers:
Remedies for acne
Different treatments for acne tackle the causes discussed above.
Do not touch the pimples or affected areas. It is easy to spread a bacterial infection. Be aware if you have the habit of touching your face absent-mindedly. Gently wash affected areas twice a day with lukewarm water and a mild soap. Keep your hair off your face.
- Apple cider vinegar. View visitors comments and experience for other natural home remedies.
- Antiseptics such as benzoyl peroxide may be used to clean the affected skin and reduce the bacteria. In more severe cases, antibiotics may be prescribed. Tea tree oil is a natural antibiotic and anti-inflammatory that has been used with some success, and is better than benzoyl peroxide and does not have the drying side-effect. (6,7,8)
- Hormones. For women, the hormones (estrogen / progesterone) may be used to treat acne. Sometimes hormonal contraceptives have a beneficial effect too.
- Retinoids (vitamin A look-alikes). Some doctors prescribe drugs such as retinol, tretinoin (Retin-A), adapalene (Differin),
and tazarotene (Tazorac), which tend to prevent follicle blockages when applied to the skin. However, they often tend to cause an
initial flare-up of acne, facial flushing, and significant irritation of the skin. They should only be used for a limited time,
and with excessive or longer use have severe side-effects.
Oral retinoids include Roaccutane, Accutane, Amnesteem, Sotret, Claravis and Clarus. They tend to reduce sebaceous secretion. However, they have severe side-effects, and must only be used for a limited time. Side-effects include liver damage, birth defects, nose bleeds, dry skin, hormonal disruption, chronic fatigue and mental disorders including depression.
- Anti-inflammatory. If the acne has an inflammatory component, then the anti-inflammatory diet and lifestyle described in my book will help.
- Herbs / plants. In addition to tea tree oil (above), some people have had success with aloe vera, neem, turmeric and papaya. (6)
1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, January 2006.
2. Yosipovitch G, Tang M, Dawn AG, Chen M, Goh CL, Huak Y, Seng LF. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-9. Article
3. Ferdowsian HR, Levin S. Does diet really affect acne? Skin Therapy Lett. 2010 Mar;15(3):1-2, 5. Article
4. Smith RN, Mann NJ, Braue A, Makelainen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007 Aug;57(2):247-56. Article
5. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol. 2009 Oct;18(10):833-41. Article
6. Mantle D, Gok MA, Lennard TW. Adverse and beneficial effects of plant extracts on skin and skin disorders. Adverse Drug React Toxicol Rev. 2001 Jun;20(2):89-103. Article
7. Koh KJ, Pearce AL, Marshman G, Finlay-Jones JJ, Hart PH. Tea tree oil reduces histamine-induced skin inflammation. Br J Dermatol. 2002 Dec;147(6):1212-7. Article
8. Khalil Z, Pearce AL, Satkunanathan N, Storer E, Finlay-Jones JJ, Hart PH. Regulation of wheal and flare by tea tree oil: complementary human and rodent studies. J Invest Dermatol. 2004 Oct;123(4):683-90. Article