Everything You Need to Know About Acne: Why We Get Acne & How To Treat It

Acne is one of the most prevalent skin conditions. With well-marked features, it can seldom be confused with any other eruption on the skin. But, despite its prevalence, a lot isn't known about how acne gets formed and the various reasons behind why we get pimples.

Before we get into everything you need to know (including how you can help treat/prevent acne), let’s start by first taking a look at how acne forms in our skin in the first place, and what this involves:

The Hair Follicles and Sebaceous Glands

Acne is a skin condition of our hair’s follicle - the sac-like structure within which a hair strand grows.

These 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) [1, 2].

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, scalp, back and chest) [3].

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 or puberty [1, 4, 5, 6, 7].

Having excessive levels of androgens triggers our sebaceous glands into overproducing sebum - to the extent that the sebum ends up clogging our follicles (commonly referred to as ‘clogged pores’) [1, 8]. 

Clogged Follicles and Dead Skin Cells

A clogged follicle is called a plug or a ‘comedone’. A comedone is what we generally see as a whitehead: a white bump underneath the skins’ surface. This can also be formed when excessive 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 [1, 9].

Oxidation of Melanin and Blackheads

When sebum continues to build up within a comedone, the resulting 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 of a blackhead has nothing to do with dirt; it’s simply a result of the oxidation 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 [1, 10].

Skin Dysbiosis and Inflammation

All humans have C.acnes (Cutibacterium acnes) on their skin. 

That’s the most abundant species of bacteria on our skin, particularly found in sebaceous areas, because it feeds on sebum. They release certain compounds that contribute to the acidic pH (~5) of our skin’s surface - this slightly acidic pH value is ideal for us to be able to prevent certain species of harmful bacteria from growing on our skin [11].

Within the species of C.acnes, there are also “good” and “bad” strains. Research has found that a higher diversity between these strains makes it less likely for us to develop acne.

When this diversity gets affected (through a process called ‘dysbiosis’, which means any disruption in our skin’s microbiome), the excessive growth of the ‘bad’ strains can lead to the formation of acne/pimples. 

This can happen because of various reasons like:

• Using cosmetic products that have an alkaline pH (above 8) or that contain alcohol
• Consuming alcohol or antibiotics
• Exposure to the sun’s UV rays
• Natural ageing

[12, 13, 14].

This is why rebalancing our skin microbiome’s natural equilibrium has now become one of the main ways in which acne is treated [15]. Which brings us to:

Things you can do to avoid and/or reduce acne

A decade worth of studies and clinical trials show that what we eat might play a role in whether we develop acne or not. The review of these studies suggested that foods like , fast food, chocolates, and a low intake of raw vegetables are associated with acne. On the other hand, good dietary habits (like frequently eating fruits, vegetables and fish) were shown to work against acne [16, 17].

Evidence suggests that limiting our consumption of refined sugar and high G.I. foods (foods that create a quick surge in blood sugar, triggering excess production of insulin) as much as possible could help with acne [18]. 

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 [19, 20].

Researchers have found that having low levels of zinc is associated with severe cases of acne [21]. Consuming foods rich in this mineral (like pumpkin seeds, quinoa, and seafood such as oysters and crab) can help reduce acne. This is also true for vitamins A, E and D, found in foods like carrots, mangoes and almonds [22, 23, 24, 25].

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 the sweat, bacteria and sebum that may have collected.

Don’t use strong soaps or rough scrub pads, since they alter the skin's pH and can lead to the dysbiosis of skin microbiome. The changes in the skin’s acidic environment, makes it more alkaline and creates dryness. To combat dryness, the skin's sebaceous glands go into overdrive and overproduce sebum, worsening existing issues [26].

Also, watch out for ingredients like ‘lanolin’, ‘petrolatum’ and vegetable oils before buying a cosmetic product: these are categorised as ‘comedogenic’. They clog our follicles and can form comedones. It’s best for people with acne-prone skin to opt for ‘non-comedogenic’ skin products [27, 28, 29].

There are a number of topical acne treatments that contain ingredients to help reduce sebum in the skin.

Salicylic acid: Often found in acne washes, this helps prevent our follicles from getting clogged. This correction reduces pore blockages, preventing breakouts - the reason why it works especially well for blackheads and whiteheads.

Sulfur and Resorcinol: These are usually found together in acne products. Resorcinol helps remove the buildup of dead skin cells, preventing comedones. Sulfur’s contribution to treating acne is still unclear, however, together these ingredients help reduce excess oil from the skin.

Tea tree oil: Its anti-inflammatory properties make it effective at reducing acne.

A growing body of evidence suggests that both using and consuming  probiotics (healthy microorganisms) may help prevent and treat skin conditions including eczema, acne, dry skin, and even UV-induced skin damage [29].

Consuming prebiotics also helps promote our numbers of healthy microorganisms, by feeding them and helping their numbers grow [30].

Consuming plenty of foods that contain prebiotics (like oats, onions, leeks, garlic, soy milk and legumes) as well as foods with probiotics (like yogurt or kefir) can  stimulate the growth of helpful skin bacteria and address acne. 

7. Managing Stress

Emotional stress triggers an increased release of the stress hormone called cortisol. Cortisol is key in causing stress acne breakouts as well.

When cortisol levels rise, they disrupt levels of hormones that regulate our sebum balance and result in clogged pores and acne [31].

Performing stress-relieving techniques, such as meditating, journaling, spending time in nature, exercising, setting work-life boundaries, or doing yoga can be helpful. 

While the information covered here can help you understand what may be causing your acne and address it accordingly, , there could be instances where that becomes difficult. Here, consulting a dermatologist or cosmetologist would be a good idea.

Apart from medications, a professional expert may also advise you to get specialised  treatments in the form of  procedures like photodynamic therapy, chemical peels, and dermabrasion. These are especially helpful in treating severe acne and prevent scarring, and work by removing the damaged skin and reducing the skin’s sebum production.

Conclusion

Acne is one of the most common skin conditions - it’s completely natural (as you’ve read!) and nothing to be ashamed of. We hope this blog helped you understand it a little better.

If you have any questions, please comment below and we’ll make sure to answer them!