Acne is the most prevalent skin condition, with well-marked features; it can seldom be confused with any other eruption on the skin. Despite its prevalence, it can be difficult to treat- primarily because of the number of factors that can be involved in the formation of a pimple.
Here’s a look at what they are and how acne forms in our skin.
The Hair Follicles and Sebaceous Glands
Acne is a skin condition of our hair’s follicle- that’s a sac-like structure within which a hair strand grows.
The follicles receive an oily substance, called sebum, from our sebaceous glands. Sebum serves many purposes: it nourishes and coats our skin and hair with fats, antioxidants and other nutrients (like vitamin E).
Too much sebum, though, is the main culprit behind the formation of a pimple. That’s also why acne is mostly found in areas that have a higher concentration of sebaceous glands (the face, neck, back, chest and shoulders).
Excess Sebum Production
Our endocrine (hormonal) system is tightly regulated. Any changes in the functioning of one hormone can set off a cascade of events that affect other hormones as well.
When there’s an imbalance in our hormones, it can lead to an overproduction of androgens, the male sex hormones. This can be caused by many factors: emotional stress, PCOS, pregnancy and puberty are just some examples.
Having excess levels of androgens triggers the sebaceous glands into overproducing sebum- to the extent that the sebum ends up clogging our follicles (commonly referred to as ‘clogged pores’).
Clogged Follicles & Dead Skin Cells
A clogged follicle is called a plug or a ‘comedone’. This can also be formed when excess sebum mixes with dead skin cells.
Normally, our skin cells are in a constant state of death and renewal. The dead cells die off and rise to the surface to shed, while newer cells are made in the deeper layers. The result: fresh, renewed skin about every month or so.
However, excess sebum sticks to dead skin cells and prevents them from rising to the outer layer. The dead skin cells get trapped inside the follicle, creating a comedone.
A comedone is what we generally see as a whitehead: a white bump underneath the skins’ surface.
When sebum continues to build up within a comedone, the pressure creates an opening in the surface. A blackhead is formed when, because of this opening, the oxygen in the air reacts with the skin’s melanin. The dark colour has nothing to do with dirt; it’s simply a result of the oxidisation of melanin.
Both blackheads and whiteheads are considered as mild forms of acne. This can advance into moderate or severe acne when the condition worsens.
The By-products of Bacteria and Inflammation
All humans have propionibacterium acnes (P. acnes) on their skin- it’s the most abundant bacterium on our skin- particularly in the sebaceous areas, because it feeds on sebum.
When it’s in reasonable numbers, it’s actually quite helpful. It helps produce the acid mantle: a fine, slightly acidic film on the surface of human skin that acts as a barrier to other potentially harmful bacteria, viruses and various contaminants.
However, the presence of excess sebum and the dead skin cells in clogged follicles serve as an energy source and suitable environment for their growth. They then start to populate out of proportion.
As they continue to feed on sebum, they release by-products that the body recognises as foreign invaders. This triggers our innate immune system into creating inflammation in the area, recruiting white blood cells and releasing other enzymes and free radicals at the site.
This makes the area painful and swollen, ultimately leading to the red, tender bump we know as a pimple. The severity of this may vary based on the individual’s immune response to the bacteria; the stronger the reaction, the greater the swelling.
Steps to Avoid/Manage Acne
1. Eating Low G.I. Foods
Certain foods are high in carbohydrates, which are immediately broken down to glucose in the body and create a sudden rise in our blood sugar. These foods are called high G.I. (glycemic index) foods.
Research has shown that both high G.I. foods (like rice, potato, white bread, pasta, sugar) and trans fats (found in fried foods and bakery products) stimulate the production of hormones, ultimately triggering excessive sebum secretion and inflammation – which can worsen our response to the by-products of P.acnes. Consuming low G.I. foods like whole grains, legumes, whole fruits and vegetables can prevent and improve acne as per studies.
2. Consuming Omega-3 Fats
The sebum of acne patients tends to lack healthy fats; you can think of it as lower-quality sebum, which is believed to play a role in worsening acne.
Consuming foods rich in omega-3 fats (like fish, flaxseeds, walnuts, avocado, chia seeds etc.) will help keep our sebum production healthy. These fats even help restore the balance of omega-3 in the body, reducing inflammation and possibly improving acne.
3. Getting Plenty of Micronutrients
Researchers have found that having low levels of zinc is associated with severer cases of acne. Consuming foods rich in this mineral (like pumpkin seeds, quinoa, and seafood such as oysters and crab) may reduce acne. This is also true for vitamins A, E and D (which can be consumed through foods like carrots, mangoes and almonds).
4. Adapting Your Skincare Routine
The first rule of thumb when you have acne is to avoid rubbing or touching your pimples. Squeezing, pinching or picking at them can lead to scars or dark blotches.
Gently wash your face with a mild cleanser twice a day, as well as after a heavy workout, to wash off away the sweat, bacteria and sebum that may have collected.
Don’t use strong soaps or rough scrub pads, since they disrupt the acid mantle layer; they reduce its acidic environment, making it more alkaline and creating dryness. To make up for this, the sebaceous glands can go into overdrive and overproduce sebum, worsening existing issues.
Also, look out for ingredients like ‘lanolin’, ‘petrolatum’ and vegetable oils before buying a cosmetic product: these are categorised as ‘comedogenic’ because they clog our follicles and can form comedones. It’s best for people with acne-prone skin to opt for ‘non-comedogenic’ skin products.
5. OTC medications
There are a number over-the-counter acne medications that contain ingredients to help kill bacteria or reduce sebum in the skin.
Benzoyl peroxide: present in many acne creams and gels, this is used to remove sebum from existing pimples and can even prevent new ones by killing acne-causing bacteria.
Sulphur: also kills acne-causing bacteria.
Resorcinol: a less common ingredient that’s used to remove dead skin cells, and prevent them from sticking to sebum.
Salicylic acid: often contained found in acne washes, this helps prevent our follicles from getting clogged.
Tea tree oil: has anti-inflammatory properties, which makes it effective at reducing acne.
While it’s best to consult a dermatologist or cosmetologist for prescription medicines or treatments, this is an overview of the most common ones that are recommended.
Women with hormonal acne are often treated with birth control pills or ‘spironolactone’, to regulate their hormones and decrease sebum production. ‘Isotretinoin’ is a vitamin-A-based medication that’s used to treat certain cases of severe nodular acne. It can cause serious side effects, and it’s only used when other treatments have failed.
A dermatologist or cosmetologist may even recommend additional procedures like photodynamic therapy, chemical peels and dermabrasion, to treat severe acne and prevent scarring. These work by removing the damaged skin and reducing sebum production.
Tuchayi, S. M., Makrantonaki, E., Ganceviciene, R., Dessinioti, C., Feldman, S. R., &Zouboulis, C. C. (2015). Acne vulgaris. Nature Reviews Disease Primers, 1, 15029.
Tabasum, H., Ahmad, T., Anjum, F., & Rehman, H. (2013). The Historic Panorama of Acne Vulgaris. International Journal of Advanced Ayurveda, Yoga, Unani, Siddha and Homeopathy, 2(1), pp-99.