ACNE

 PART I: Cause

           Do zits give you fits? Chances are, yes. Acne is the most common skin problem affecting three out of every four teenagers to some degree. And an imperfect complexion is not limited to this age group; many in their twenties and thirties also suffer with this condition. The problem is an expensive one, with millions of dollars spent each year on over-the-counter preparations as well as prescription drugs. For many, acne consists of nothing more than an occasional pimple or blemish on the face, back, or chest. A few are less fortunate and develop extensive, persistent eruptions resulting in permanent pits and scars. The psychological effects may be devastating, and acne has been linked to depression and suicidal thoughts.

                    Acne depends on the presence of sebaceous (oil) glands found within the dermis of the skin. These specialized structures are most numerous on the face but are also present on the back, chest, and upper arms. At puberty the glands undergo rapid enlargement because of hormonal stimulation. As the glands grow in size, they become more active, manufacturing a mixture of oils that in excessive amounts gives rise to the so-called oily complexion. The gland openings (pores) may become clogged, causing the oil, or sebum, to back up and stagnate. Bacteria growing in the sebum break this substance down into a number of irritating compounds that lead to the formation of blackheads, whiteheads, and those unsightly mountains and craters affectionately called zits.

        There are several different types of acne lesions. These include comedones (whiteheads and blackheads), papules, pustules, cysts, and scars. Comedones are of two varieties: open and closed. A closed comedone, called a whitehead, arises when a pore becomes clogged with oil and the sebum creates a tiny white covering over the entrance. When the opening remains unobstructed, the oil is oxidized by the air and turns black. This open type of comedone is called a blackhead.

        A papule is a solid, elevated lesion of the skin. Papules range in hue from flesh-colored to bright red. Red papules are those pimples still undergoing inflammation.

        A pustule is a pimple filled with fluid, or pus. This substance is composed of dead cells and bacteria. When a pustule becomes larger and deeper, it is then termed a cyst. Tender, inflamed red pustules and cysts may result in scars, which is why these two types represent the most severe forms of acne.

        What then is the cause of acne? Why is it that some people escape this condition entirely, while others are plagued with blemishes, zits, and blackheads year after year?

        Acne appears to be the result of a number of factors; there is no single cause. Certainly a major factor is heredity. If one of your parents had acne, you run an increased risk of acquiring this condition.

        Another contributing factor to the development of acne is the activity of certain hormones within the body. For many, acne first becomes a problem at puberty. During this period, testosterone, the male sex hormone, is formed not only by the male sex organs, but also in small quantities by the ovaries in young women. Testosterone causes marked growth of the sebaceous glands and, in susceptible persons, may trigger or worsen acne.

        Some women develop one or two pimples each month shortly before their menstrual periods. Others may flare when placed on certain birth control pills. In both cases, the resultant acne is due to changes in the body’s hormone levels. Polycystic ovary syndrome is characterized by irregular periods, excess facial hair, and scalp hair thinning. Abnormal hormone levels in women so afflicted results in persistent acne.

        Another factor that contributes to acne is the bacteria that live within the sebaceous glands breaking the skin’s natural oils down into irritating by-products. These bacteria and the substances they produce play a key role in the inflammatory lesions of acne.

        An increasing number of American women are developing acne not at puberty or in adolescence but during their twenties. This phenomenon has been attributed in part to the prolonged use of cosmetics. Certain moisturizers, creams, and cover-ups may contribute to pore plugging and consequently lead to comedones and papules.

        Emotional upsets and stress also tend to worsen existing acne. Many high school and college students experience marked flare-ups during their exam periods.

        Certain factors once thought to play a significant role in the cause and perpetuation of acne are now considered quite unimportant. No evidence exists that lack of regular washing leads to a worsening of acne. By the same token, acne does not appear to be improved by incessant cleansing. Washing two or three times daily is all that is usually needed to remove excess oil and germs on the skin’s surface.

        Lingering controversy surrounding acne involves the role of diet. A diet high in fats and oils does not make the skin oilier; greasy skin is not caused by greasy foods. A scientific study conducted years ago was unable to demonstrate that feeding individuals with acne huge quantities of chocolate led to increased pimple formation. However, more recently, a link has been postulated between breakouts and high-glycemic-load diets that are rich in processed carbohydrates. Acne severity decreased in volunteers maintained on low-carbohydrate diets, but these diets also promoted weight loss, which alone may have triggered changes in body hormones that diminished the number of breakouts.

        Speaking of hormones, yes, the role of milk in acne causation is also controversial. Again, a recent study found a positive association between milk intake and acne. Since the majority of milk comes from pregnant cows, a tenable hypothesis holds that hormones in milk have a stimulatory effect on the oil glands of those that drink it.

DermDOX Centers for Dermatology

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