What causes acne? What are the types of acne?

Understanding Acne: Causes, Types, and Treatments

Acne is caused by a complex interaction of factors, with genetics and hormones playing the primary roles. These factors can increase the size of the skin’s oil glands, leading to excess sebum (oil) production, clogged pores, and ultimately, acne. Here’s an in-depth look at how acne develops and the best ways to treat it.

Causes of Acne

1. Increased Sebum Production

   • Sebum, the oil produced by sebaceous glands, keeps skin hydrated but can trigger acne when overproduced.

   • Acne-prone skin often has excess sebum with high squalene levels and low linoleic acid, which increases inflammation through lipid peroxidation, contributing to pimples and acne lesions.

2. Clogging of Skin Pores

   • Inside pores, skin cells may stick together, creating a bottleneck that traps oil, leading to blocked follicles and an ideal environment for bacteria.

   • Low levels of linoleic acid in sebum and reduced skin ceramides can contribute to pore-clogging.

3. Acne-Causing Bacteria

   • Cutibacterium acnes (formerly Propionibacterium acnes) bacteria reside in follicles and contribute to inflammation in acne-prone individuals.

   • However, acne is not an infection and cannot spread through contact.

4. Inflammation

   • Inflammatory responses around sebaceous glands can be triggered by hormones and bacteria, resulting in visible pimples and lesions.

5. Hormones

   • Androgens, such as testosterone, bind to oil glands, increasing oil production and inflammation.

   • Hormonal fluctuations, particularly around menstrual cycles in women, often worsen acne.

6. Diet and Acne

   • High-glycemic foods (sugary or refined carbs) increase blood sugar, causing insulin-like growth factor-1 (IGF-1) to activate oil glands and trigger inflammation.

   • Dairy, especially skim milk, and whey protein have been associated with acne, whereas yogurt and cheese have not.

7. Stress and Acne

   • Stress-induced cortisol levels stimulate oil production and inflammation, exacerbating acne.

8. Environmental Factors

   • Pollution, humidity, and UV radiation can worsen acne by clogging pores, increasing oil production, and causing inflammation.

Types of Acne Lesions

1. Whiteheads: Clogged oil glands covered by a thin skin layer, appearing as white spots.
2. Blackheads: Open pores clogged with sebum and dead skin, oxidizing to give a black appearance.
3. Papules: Small, inflamed, and sensitive pimples.
4. Pustules: Red pimples containing pus, with a yellowish center.
5. Nodules: Hard, painful lumps beneath the skin, common in severe acne.
6. Cysts: Large, inflamed lesions that can cause scarring, typical of cystic acne.
   

Types of Acne

• Non-inflammatory Acne: Characterized by whiteheads and blackheads.
• Inflammatory Acne: Includes papules, pustules, nodules, and cysts.
• Acne Grades:
  • Mild: Fewer than 20 comedones or 15 lesions.
  • Moderate: 20–100 comedones or 15–50 inflamed lesions.
  • Severe: More than 50 papules or cysts with at least 2–5 cysts.
  • Cystic Acne: Severe form with multiple deep cysts.
  • Acne Fulminans: Rapidly progressing acne on the chest/back with joint pain and fever, more common in young males.
  • Acne Mechanica: Triggered by friction and pressure, seen in athletes or with prolonged mask use (maskne).
  • Acne Conglobata: The most severe cystic acne form with interconnected cysts under the skin.

The Role of Bacteria in Acne

The third stage of acne involves the growth of C. acnes bacteria within follicles. These bacteria metabolize sebum into fatty acids, which irritate the follicular wall, triggering inflammation and promoting tissue destruction.

How Red, Painful Pimples Develop

In severe acne, inflammatory mediators in the sebaceous glands activate immune responses, leading to swelling, redness, and pain. This inflammation causes the glands to enlarge, sometimes rupturing and forming different acne lesions.

Best Acne Treatments by Type

Effective acne treatment should be customized based on acne type, severity, skin type, and other factors. Personalized treatments, like those offered by MDacne, analyze your skin and tailor medications for maximum results, avoiding one-size-fits-all approaches that may be ineffective.

Key Ingredients for Acne Treatment:

• Benzoyl Peroxide: One of the most effective anti-acne ingredients recommended by dermatologists.
• Salicylic Acid: An exfoliant that unclogs pores and reduces inflammation.
• Niacinamide: A skin-soothing ingredient with anti-inflammatory effects.
• Retinoids: Vitamin A derivatives that improve cell turnover and prevent clogged pores.

Oral Medications:

• Antibiotics: Minocycline, doxycycline, and erythromycin reduce bacterial growth and inflammation.
• Isotretinoin (Accutane): For severe cases, isotretinoin reduces oil production and prevents severe cystic acne.
• Hormonal Treatments (for women): Spironolactone, oral contraceptives, and DIM supplements help regulate hormone-related acne.

Treating Acne Scars and Dark Spots

Once active acne is managed, post-acne signs like dark spots and scarring can be addressed. For dark spots, products with hydroquinone or arbutin, retinoids, and oil-free sunscreen are effective. Treating deep scars often requires in-office procedures, such as microneedling or laser therapy.

Understanding how acne develops and which factors contribute can make it easier to manage and treat. By using the right ingredients and understanding the types and causes of acne, you can find the treatment that’s best suited to your skin type.

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