Genetics
The mechanics of acne
are pretty much controlled by your genetics. So, don’t blame yourself for
having acne-prone skin. Genetics determine how your body’s immune system
responds to bacteria; one person may have only blackheads while another gets
explosive red and tender nodules. Genetics also play a role in how easily your
pores become plugged. For example, you may have inherited the ability to
overproduce dead skin cells, and then shed them in a way that clogs your pores.
Redness and pigmentation are functions of your skin color. The lighter your
skin, the more redness you are likely to see, while dark pigmentation hides the
red, inflammatory response. Darker skin clears with a brownish pink spot
(postinflammatory hyperpigmentation) that often remains for months or even
years. The bottom line is your genes are the underlying reason for your acne,
as well as what type of acne you have. Other factors, which we
will discuss later, are influencers.
And genetics are unpredictable. Even in identical twins, one person may get
tiny little pimples that last a week, while the other develops cysts that scar.
If both of your parents had significant acne, your risk for developing acne
also is very high. Because 85% of the population experiences breakouts at some
point in their lifetime, you won’t be alone.
Acne and Hormones
Hormones play a huge
role in acne. During puberty, everyone - boys and girls - starts to produce
masculinizing hormones called androgens. In women, the hormones include
testosterone, DHEA-sulfate and progesterone. In men, the hormones are
testosterone, dihydroxytestosterone and androstenedione. Androgen hormones
cause oil-producing glands to enlarge, stimulating oil production. When there’s
more oil and less shedding of dead skin cells, pores become clogged, and there
you have it - acne. That's why 80 to 85 percent of teens get acne.
Hormonal Acne – Women
The rate at which you
produce oil within the oil or sebaceous glands is affected by your hormonal
balance, which often fluctuates in both men and women throughout their lives.
Normal variations in women's
estrogen and androgen levels can cause acne. This explains why women often
experience it, not only in puberty, but later in life as well, especially the
week before their period. The increase in hormones during pregnancy and post
partum can also wreak havoc on a woman's skin. As the years go by, during
perimenopause and menopause, hormone levels become more erratic, often
triggering another bout of acne. Women with abnormally high levels of androgen
hormones, like those with polycystic ovarian syndrome, have a higher risk of
developing acne. Another hormone, cortisol, is released from the adrenal glands
during times of stress, often instigating the acne cycle too. To sum it up,
hormones explain why 30-40% of women experience some form of acne in adulthood.
Hormonal Acne – Men
Men's
hormone levels fluctuate too. Androgens are the male sex hormones that surge
during puberty. So it's no surprise that acne in teen males is more severe and
longer lasting than in females. Adult males produce about ten times as much
testosterone as women do. By adulthood, the oil production in most men
normalizes, making acne less of an issue with age. In fact, testosterone has
the benefit of increasing the skin thickness in men, explaining why they
wrinkle less with age.
Stress
Stress can trigger or worsen your acne because it
causes the body to release cortisol and androgens from your adrenal glands,
increasing oil production. Because women produce a greater percentage of their
androgens in the adrenal gland than men, women are more prone to stress related
breakouts. Some researchers believe adult acne
is on the rise because of the constant stress in our society. Stress can also
make your breakouts last longer. And as you well know, having acne adds to your
emotional stress, perpetuating the vicious acne cycle. We recommend lowering
stress levels with plenty of sleep, exercise and calming activities like
meditation and mindful breathing.
Environment and Habits
Outside factors like
pollution, exposure to oil and grease may clog pores and flare acne. Heat and
humidity, which increase oil production, are also well-documented acne
triggers.
The skin is the largest organ of the body. One of its main functions is to
protect us from noxious substances. Strong environmental pollutants can result
in a rare variation of acne called chloracne, which is characterized by acne
like eruptions of blackheads, whiteheads, cysts and pustules. Chloracne is
different from the more common acne vulgaris because it's not caused by
hormones or genetics.
Personal habits, including the types of products you use, also make a
significant difference. Shampoos, conditioners, pomades, hair gels and
hairspray may be
blocking pores, causing acne on the forehead and around the hairline. The wrong
moisturizers or makeup can also clog pores, creating blackheads and whiteheads.
Looking for “noncomedogenic” or “non-pore clogging” designations on a product
label is worthwhile. Additionally, oil from greasy hair may migrate to the
forehead and temples, triggering small breakouts along the hairline, along with
scalp acne. So if your hair is especially oily or flakey, consider shampooing
more frequently with a medicated product.
Acne is often flared by
friction from hats or athletic gear, which traps bacteria, increases sweating,
and inflames the skin. To avoid “stewing in your own sweat,” shower and clean
your equipment as soon as possible.
Small amounts of sun
exposure may seem to help your acne at first because the blue band of visible
light helps to sterilize the p. acnes bacteria and a tan masks redness. But
prolonged sun exposure increases the shedding of dead cells on the surface of
your skin, plugging your pores, eventually producing blackheads, whiteheads and
small pimples. Heavy sunblocks are occlusive and can increase the temperature
inside your hair follicles, creating small pimple-like bumps. These “sun bumps”
are not true acne but a medical condition called miliaria, which is especially
common on the torso during the hot, humid summer months. Avoidance of prolonged
sun exposure, along with daily use of a lightweight, noncomedogenic sunscreen
formulated for acne-prone skin, is best for protecting your skin and minimizing
breakouts.
Diet and Medications
While we don't believe
diet is the primary cause of acne there is more and more evidence linking
certain foods to acne, in some people it may play a contributing role. Carbohydrates
found in sugary, starchy, or processed foods have what is known as a high
glycemic index. These types of food spike your blood sugar level and eventually
create insulin resistance. When this occurs, your skin responds by releasing
thick, sticky oil into the pores, which results in breakouts.
Hormones and antibiotics in dairy and meats may also contribute to acne in some
people. Looking for “organic” or “hormone-free” foods may make a difference in
your skin. High iodine levels in people consuming lots of seafood, seaweed, or
iodized salt has also been reported to trigger breakouts.
As you can see, the link
between diet and acne is being actively investigated. What can you do in the
meantime? We suggest keeping a food diary. Because each of us responds
differently to foods, keeping track of what you eat for several weeks may help
you identify whether certain foods are flaring your skin. Your next step is to
eliminate that food. However, keep in mind, that because acne starts in your
pores weeks before a breakout appears on your skin, you will need to eliminate
a suspected food from your diet for at least 3-4 weeks. This is the best way to
determine whether or not your diet is contributing to your acne.
Drinking six to eight
glasses of water a day is healthy for you, but it won’t flush away acne.
There’s simply no proof that water can clean the skin from the inside out.
Also watch out for certain over-the-counter and
prescription medications that may have side effects that can alter your body’s
chemistry and hormones, leading to an acne outbreak. Lithium is one example.
Androgenic steroids, DHEA, progesterone-dominant forms of birth control, and
medications containing bromides or iodides also fall into this category. Make
sure to ask your doctor about any possible side effects of your prescription
meds because alternative medicines may be available.