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Acne – Mechanisms & Myths
16 October 2019
If you have Acne, it can be a disheartening experience. Many of us are suffering the emotional and physical effects of this confidence destroying condition. In fact, there are 633 million of us affected worldwide, making it the 8th most common disease globally. So, although this skin disorder can make us feel isolated and lonely, you are not alone.
Particularly affected are teenagers and young adults, with an alarming 80 to 90 percent having experienced this condition. However, acne is not just reserved for adolescents, adult acne is now more frequent and common than ever, with 40 to 55 percent of adults between 20 and 40 years of age diagnosed with low grade, persistent acne and oily skin.
Adult acne can actually begin suddenly and is not always as a result of the condition continuing on from puberty. Dealing with acne in adulthood makes the psychological effects even harder to deal with, often resulting in anxiety and depression for the sufferer.
So, given the significant impact of its effects the question is, what is the cause of acne and how can we treat this condition?
Firstly, in order to treat acne, you need to know what type of acne you have. As you may need to tailor your treatment approach according to its type and cause.
There are 4 grades of acne:
Mildest, blackheads, whiteheads or minor pimples.
Moderate acne, larger number of blackheads and whiteheads. Typically numerous papules and pustules, more frequent breakouts, inflammation present.
Moderate to severe, significant amount of inflammation in comparison to Grade II.
Nodules, Pustules or Papules may be present.
Most severe classification. Numerous nodules, cysts, and pustules. May also be a large amount of blackheads and whiteheads.
The first grade, the non-inflammatory type, can be treated using several different approaches and treatment modalities. Generally cosmeceutical skincare containing AHA’s and BHA’s, along with in clinic treatments such as microdermabrasion, peels or various types of laser treatments can be extremely effective in addressing this type of condition.
Grades II to IV are considered inflammatory acne. These must be treated holistically and from a causative perspective in order to address the condition in the most effective manner.
Firstly, we must understand that acne is a multifactorial condition, which means that there are many contributing causes and factors involved with the disease, lets explore some of these and some common misconceptions.
Widespread myths include that acne breakouts are solely caused by the P.acnes bacteria, or from having unclean skin. However, these factors are commonalities, they are not the causes.
In fact, every person in the world carries the P.acnes bacteria, it is a normal part of the skin’s microbiota and actually helps to defend the skin against more aggressive pathogens.
So, if everyone carries the P.acnes bacteria, then why do some people get acne, while others don’t? Especially as studies have shown that the concentrations of P.acnes do not differ between people with and without acne!
There is new research to suggest that inflammation, which was always thought to be a subsequent effect of blocked pores (comodogenesis) leading to acne, is actually a causative factor in the development of microcomedones and acne. Understanding this can help us to develop treatment plans that assist in reducing inflammation.
When addressing inflammation and acne there are several factors to consider, the main ones being:
Studies show that having a first-degree relative with acne increases the risk by four times. This is because our genes influence how many inflammatory chemicals there are in our skin, and the strength of their inflammatory response to bacteria.
Genes also influence the skins sensitivity to androgen hormones, especially DHT which is responsible for sebum over-production. While genetics do play a big role, there are things you can do to mitigate these factors and reduce the likelihood and occurrence of acne by reducing gene triggers.
Following are some factors which warrant consideration in the treatment of acne:
We must consider diet as a whole when it comes to addressing inflammation and acne, rather than focusing on a specific food. For example, foods which have a higher glycemic index, raise insulin levels, which stimulates a chemical called IGF-1. This can trigger inflammation and low-grade allergic type reactions in the body and skin which have a direct correlation to acne.
Research has shown that in some people foods such as gluten, dairy, sugar and certain grains can damage the lining of their intestines, causing leaky gut and inflammation. The best way to assess your diet is to see a nutritionist that specializes in controlling inflammation and treating acne.
There have been many studies on the correlation between gut health, hormonal imbalances, stress and disease in the body and skin.
For example there is strong research that links Small Intestinal Bacterial Overgrowth (SIBO) to acne.
A Korean study showed that certain strains of probiotics cleared inflammatory acne by 40% when compared to a placebo. While a U.S study that treated SIBO, also showed a clearance of acne rosacea in 71% of the patients involved.
Other factors that should be considered in the treatment of acne are lifestyle, stress, hormonal factors, pollution, liver stagnation and smoking. These elements can significantly contribute to inflammation both in the body and the skin.
There is a common myth that suggests that over-cleansing and stripping the skin of oils can treat and prevent acne, this could not be further from the truth. The reality is that over-cleansing with harsh chemicals and stripping the skin can lead to a significantly impaired lipid barrier. When the lipid barrier is impaired, toxins and allergens are able to penetrate the skins epidermis, leading to irritation and inflammation, which is, as previously stated a precursor and a contributing factor to acne.
In addition, the use of harsh chemicals can disrupt the skins microbiome, which is a protective barrier of bacteria and micro-organisms which protects your skin against invading pathogens, and pollutants. Once interrupted inflammation inevitably occurs.
Science is showing that the use of anti-inflammatory ingredients, combined with nourishing, rather than stripping cleansers and exfoliants can significantly reduce the inflammation which is associated with the development of acne, and other skin disorders.