What's Causing my Acne?
Acne Vulgaris is one of the most common skin conditions and it typically starts at puberty, however it can continue into your adult years. It is a complex condition, and along with genetics, it can develop from 4 major factors:
Plugged follicles with epidermal hyper proliferation (poor exfoliation)
Too much sebum production (excess oil)
Colonization of bacteria Cutibacterium acnes
Inflammation
Acne is best treated with an inside and outside approach! There are so many factors that can trigger acne, so it’s best to tackle only a couple at once. What is happening on the inside can influence your skin health, and it can impact the 4 major factors listed above.
So what else could be going on?
Hormones
Hormonal acne is acne that happens due to hormonal fluctuations. This can happen at different stages of your life (puberty, pregnancy and menopause) or it can happen because of your period. Often, hormonal acne can be due to an excess of androgens (for example testosterone), which can lead to an increase in sebum production and inflammation! Androgens are produced by ovaries, testicles and the adrenal glands.
Genetics
Genetics also play a huge role in adult acne! Genetics can impact androgen production as well as how sensitive you can be to androgens that are in your body. Having a family history of acne will give you an idea of how important it is to have a plan in place so you can manage it long term.
Stress
The skin is also sensitive to psychological stress. Stress can impact hormones, inflammatory cytokines (inflammation) and the sebaceous glands (produces oil). Acne can also be a stressor in itself! Some people will cope by excessively picking or scratching their acne; also called acne excoriee, which can greatly be improved with CBT (cognitive behavioural therapy).
Sleep
It is also interesting to note that there is a relationship between sleep quality and acne severity! The relationship isn’t totally understood, however sleep is super important in restoring the body. Those who don’t sleep well usually desire high glycemic foods to get through the day, and may feel it’s harder to manage stress. This is a very interesting topic and I imagine there will be more articles diving into this relationship in the future.
Medications / Supplements / Skin Care
There are some medications and supplements that make acne worse. A common medication trigger I see in the clinic is the progestin IUD. The progestin IUD is believed to be localized and therefore have less systemic effects, however 6 to 36% of IUD users report a worsening of their acne. High doses of certain B vitamins can also contribute to acne flare ups. Just as things you consume can trigger acne, things you put on your skin can also be a trigger. It’s always important to look at your cosmetics, cleansers, etc. to see if there are pore clogging ingredients in your products, for example: cocoa butter, coconut oil, algae extract, and flaxseed oil.
Smoking
Nicotine can increase sebum production and smoking can also influence inflammation!
Sun exposure
Hands up if you’ve heard that the sun will make your acne better. I personally grew up thinking that getting some rays would clear up my breakouts, but later found out that UV rays can cause more inflammation and sebum (oil) production through melanocytes (the cells that produce pigment). I don’t want you to be afraid of enjoying the sun, as Vitamin D status is also important in acne prevention, but know that laying in the sun isn’t going to clear up your skin!
Nutrition
Diet can influence P. acnes colonization, inflammation and sebum production. Consumption of high glycemic foods and certain dairy products can increase insulin and IGF1(insulin growth factor), which can have an impact on androgens / sebum production. A holistic acne treatment will include a discussion around nutrition, however a comprehensive treatment plan will also touch on other factors as well! It seems like social media sometimes vilifies certain foods or creates this “perfect diet” for people experiencing acne, but acne is more complicated than the idea that one food is the only thing triggering acne.
Fungus
Pityrosporum folliculitis a.k.a. malassezia folliculitis is an acne like breakout that’s often accompanied by itchiness that flares up in areas with with a lot of sebaceous activity. This includes the t-zone, shoulders, chest and back. It can often be misdiagnosed as acne vulgaris and people with Malassezia folliculitis find that regular acne treatments don’t help.
Gut Microbiome
The gut microbiome is the community of microorganisms that live through your digestive tract and people with acne may have a different gut microbiome profile than those who do not have acne. The gut microbiome is also connected to inflammation, but does this mean everyone should be taking a probiotic? Not necessarily! There is some research suggesting probiotics can benefit acne while you take them, however a more sustainable long term plan should focus on eating behaviours and foods that benefit the gut microbiome!
Acne is a genetic condition which is best treated by a multifaceted approach. Flare ups will happen so it’s best to have someone on your team who can acknowledge the complexities of the condition and who can help you pinpoint what factor may be impacting you the most.
There are so many different ways to treat acne and it can start to feel really overwhelming when you are looking at recommendations on social media or google! It can take a little bit of a trial and error to figure out what works for you, but if you’re finding yourself overwhelmed with information and that what you’re doing isn’t working, then I would be more than happy to discuss this over an appointment (booking link below)!
References:
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DermNet (2020) Malassezia folliculitis. Retrieved from: https://dermnetnz.org/topics/malassezia-folliculitis
Lullo, J. J., Ethington, E., Arshanapalli, A., Reserva, J., Jiang, A., Adams, W., Graziano, S., & Tung, R. (2018). Incidence of androgenic dermatologic side effects following placement of a levonorgestrel intrauterine device for menorrhagia: A survey-based study. Journal of the American Academy of Dermatology, 79(2), 364–365
Mashayekhi Goyonlo, V., Sardabi, M. S., Tavalaei, A. M., Khoshnevisan, Z., & Razmara, M. (2020). Cognitive behavioral therapy as an adjuvant therapy in acne excoriée: A randomized controlled clinical trial. The Journal of Dermatological Treatment, 1–7.
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