Acne: Causes and Solutions

Of all the skin conditions that lead consumers to seek treatment, acne is, by far, the most common. A chronic, inflammatory disease of the pilosebaceous units (hair follicles and their sebaceous gland), acne affects between 40 and 50 million people in the U.S. alone.1
Today, countless products and therapies exist to treat acne, the largest sector of which is topical treatments – both prescription and over-the-counter. Yet, few products succeed at eliminating acne. This is because most exist to address acne symptoms rather than the multiple causes of the disease. Unless each of these factors is addressed, acne symptoms will reoccur. 

The Four Main Causes of Acne

For those who suffer from acne, the skin’s natural rhythm of oil production and sloughing of dead skin cells is not in balance, as it is for those with healthy skin. Four principle factors have been identified:

1. Follicular keratinization – Acne sufferers tend to have abnormally “sticky” skin cells. Because of this, dead skin cells do not slough or shed as they should and instead plug the hair follicle. This leads to a build-up of oil.
2. Excess sebum production – Many acne sufferers have overactive sebaceous glands. This causes the production of greater quantities of sebum than is common.
3. Colonization of Propionibacterium acnes (P. acnes) – The skin environment of some individuals tends to be more hospitable to P. acnes, the bacteria that cause acne lesions.
4. Inflammation – Each of the three scenarios above may cause inflammation. When inflammation occurs, the acne condition worsens and may lead to scarring.

While these factors can individually contribute to the development of acne, most often they work together. The most common scenario is this: The overactive production of oil and presence of abnormally “sticky” cells cause the hair follicle to plug, thus promoting the growth of P. acnes. The obstructed follicle, engorged with sebum and dead skin cells, becomes visible at the surface of the skin in the form of a white papule (whitehead). If the follicle continues to dilate, the plug becomes further exposed and, due to the oxidation of its contents, the papule appears a dark color (blackhead). At this point, the follicle becomes the ideal environment for bacteria. As the bacteria release proteins (enzymes), inflammation occurs as characterized by a reddened appearance at the skin’s surface. The sebum is then converted to free fatty acids that attract white blood cells to the area and further the inflammation. This is when pustules begin to form.