What Causes Acne?

In your quest to find the cure for your acne, you may be wondering "What Causes Acne?". That's a great question to have, because understanding where it comes from is the key to getting rid of it. Take away the causes and you remove the effect (i.e. the acne).

There is no complete pathogenesis on acne vulgaris. In other words, we don't know everything about how we get acne. We have some idea as to what causes acne by looking at what happens at the surface layers of the skin, but we don't have the whole picture.

From all of the research I have done, the following equation is the simplest explanation for what causes acne that I've been able to come up with:

As you can probably guess, one of the components of the acne equation is changeable while the other isn't (at least for now!).

Hormone irregularities is a huge topic that is what most of this web site is focused on. When your hormones are out of balance, you can develop a whole bunch of problems and acne is certainly one of them. The good news is that you can bring your body back into balance.

Genetic tendencies explains why some people have more problems with acne than others, and why some people never really have to deal with it at all. Do you know someone who has a really bad diet and yet has very clear skin? I've definitely met my share.

Don't be jealous, your acne is actually a good thing. It's your body telling you that something is wrong on the inside - it's like a feedback mechanism.

Plenty of Information Yet Plenty of Confusion

These two factors create huge confusion with people looking to find an acne cure. People have hormone imbalances for a variety of different reasons. So when you see someone explaining that simply taking vitamin X cleared there skin, you'll also see some people say it did nothing for them. It's hard to know who to believe.

On the flip side, you'll see people disagreeing with the causes of acne. The cause of hormone irregularities for one person may be their diet, while for someone else it might be because of the birth control pills they're taking. Some people might say that drinking milk gives them acne, while others say that's ridiculous because they drink milk and they don't get breakouts.

So please keep this big picture in mind while you do your own research for what causes acne. The acne equation will help connect all of the dots for you. For now, just accept that we don't have a complete understanding of the body so you will see conflicting advice from different people. Also try to be open minded while in search of your own cure for acne. Because the cure can be as individual as the person you have to be willing to thoroughly analyze your own lifestyle choices and become aware of what you are doing to yourself.

A Balanced View

With all the conflicting advice out there I try and take a balanced approach between the scientific knowledge we have on acne and a more holistic view (consideration of the whole body and environment). By combining the two points of view, the potential results are maximized - despite what causes acne.

Try and be open minded about both sides. I know that I used to be very empirical. Science was all there was and everything else was quackery. Are you like that too?

I've now begun to realize that science doesn't have all the answers, can be slow to adopt new ideas, and stubborn to let go of old ones.

The Diet Acne Connection

A classic example is whether or not foods you eat can cause acne. For the past several decades it has been a widely held belief that there is no link between food and acne. The belief was started by a couple scientific papers that are now more than 30 years old. Scientists have recently shown that there were flaws in the those studies. [1]

There are now many papers (listed below are only some) that show links between food and acne.

The problem is that many official sources of information still say there is no link between food and acne. Dermatology textbooks (and web sites) still most commonly use the old papers as their references, which only reinforces the out of date belief.

The public has embraced those old ideas, partly because they are easiest to accept and leave individuals feeling guilt free. "It's Not Your Fault" is an easy pill to swallow. But that's simply not true.

There are things you are probably doing that are making your acne worse.

Accept Multiple Sources of Information

Commonly accepted knowledge isn't the be all and end all. Sometimes you have to dig a little deeper to find the answers to questions you're looking for. Don't trust your information from only one source. Look for connections between multiple sources.

Don't even trust everything I write. :)

There are many acne causes and I don't necessarily have it all figured out either.

I'll share what scientists and doctors know about what causes acne, and then use holism to fill in the gaps and provide a high level picture.

So first of all, we'll start at the outer layers of the skin. We'll then work our way inwards throughout the body to get the best picture of what causes acne today.

What Causes Acne According to Science: In the Skin

So... what causes acne? Well you can almost think of the following as symptoms of acne, since the "cause/effect" chain of events goes back further even deeper within your body than this your skin. The information below is generally accepted as true, except for the couple sentences I have italicized - which are still debated:

• Excess Hormones and Hormone Sensitivity
Androgens like testosterone are a hormone. In puberty they trigger the sebaceous glands to enlarge, which is a natural part of the development process of the human body. What causes acne for most people is when the sebaceous glands are overstimulated with either too much androgens or the sebaceous glands are more sensitive than normal. This over-stimulation by hormones can occur not only by puberty, but the menstrual cycle, by taking performance enhancing drugs, and by eating dairy and other foods. [2]
• Extra Sebum
When the sebaceous glands are overstimulated they produce too much sebum. Sebum is a natural oil that is used to lubricate your skin and hair so it doesn't get too dry. The sebum travels up the hair follicle, and on its way it has a chance of clogging with dead skin cells from the follicle wall, and with skin bacteria. If a clog develops it can become acne. It has been shown that an increase in insulin response can increase sebum production. [1]
• Dead Skin Cells
Part of the skin rejuvenation process involves getting rid of the old and bringing in the new. The old dead skin has to be expelled and the speed of this is increased with the extra sebum flowing by. Unhealthy skin could potentially not shed as well as healthy skin, increasing the chances for plugs (i.e. acne) to develop.
• Bacteria
A chemical reaction can occur within a clogged pore that causes it to grow. The growth is caused by a form of bacteria called Propionibacterium acnes (P. acnes). This type of bacteria lives in our skin and is mostly harmless except for when it builds up in one area due to a clogged pore. The excess sebum and skin cells make it a perfect environment for p. acnes to grow.
• White Blood Cells
The white blood cells are sent to fight off the P. acnes bacteria that has now built up around the clog. They attack the "intruders" and this produces the inflammatory response. This is the redness, swelling, and pain you experience with your pimples.
• Water Retention
Too much water stored in the skin can cause it to swell. This swelling can pinch or decrease the size of the pore or hair follicle. Combined with all the other factors mentioned, more road blocks or plugs could develop because of the reduced space for the sebum and dead skin cells to flow out.

What Causes Acne According to Science: Going Deeper

Most of the following information is not as widely accepted, but I urge you to read on.

All of the information from above is all well and good, but we really need to dig deeper to get to some more underlying causes. How do the sebaceous glands get worked up to produce more sebum than normal? Why do some people get acne while others do not? If it were just hormones coupled the natural insulin resistance from puberty we wouldn't see so many adults with acne, and the trend is only getting worse.

• Diet
It has been shown that a low-glycemic-load diet can improve the acne on your skin. [3] This implies that a high-glycemic-load diet can make your acne worse. The short story of it is that high-glycemic load foods trigger a high insulin response, which can trigger your sebaceous glands to produce more sebum.

In addition, the release of insulin triggers further hormones to be released. These increase the rate at which skin cells regenerate AND cause the dead ones to break away in clumps, rather than one at a time. All of this is a sinister recipe for acne to form.


Graph of Blood Sugar Levels After Eating

Food allergies can also be what causes acne for certain people. Many are allergic to foods they aren't even aware of, and that's simply because they don't think anything of it until they become seriously ill. Getting tests done or eliminating certain foods via trial and error can isolate food allergies.

There are many tribes of people on the planet who still eat a very clean and natural diet, who also get no acne (even as teenagers!). There have been studies that have looked into why, to try and find the connection. [6]

It is my belief that the poor western diet is to blame and is what causes acne for most people.

• Extra Hormones
The hormone loaded dairy you eat can also stimulate the sebaceous glands, as there have been many studies showing a positive correlation between dairy intake and acne. [4] [5] The same goes for performance enhancing drugs that pump your body full of extra hormones.

If you don't believe that artificial hormones can affect your body like that, take note that certain kinds of contraceptive pills are commonly used to also treat acne. Many women get breakouts just before their periods, due to the fluctuating hormones and the contraceptive pill can help ease their cycle and their acne.

• Stress
Stress is actually bad for you in two ways, at least when it comes to what causes acne. Not only does it make your acne worse, but it also slows down the healing process. [7]

Stress causes the adrenal glands to increase production of testosterone, cortisol, and other hormones. These - yup, you guessed it - cause hormone irregularities. Cortisol also has a synergistic effect with glucagon to raise blood sugar levels. By now you probably know that this means... drumroll please... more acne.

• Irritation
• Skin picking
• touching your face
• popping zits
• rough shaving
• harsh cosmetics

...can all make your acne worse. This is because a follicle is very vulnerable when a clog has formed. If it is irritated as you scratch your skin, it can easily break.

If it breaks, white blood cells will rush in to protect your skin from the bacteria and an inflammation will develop. Leave your skin alone!

What Causes Acne According to a Holistic View

So why do the sebaceous glands get all worked up and produce more sebum?

Remember that you are what you eat. If garbage comes in, it must come out somehow. The body has many systems to cope with the unhealthy food that we put into our bodies, and the skin is one way of dealing with it.

The skin is the largest organ we have, and certainly one of the most amazing. It has a variety of functions, and can regenerate itself. It's pores act as a gateway for material to enter and exit, and the skin's natural state is one of balance.

Acne is just a sign that something is out of whack inside your body. Your body is trying to fix itself, and using the skin is one tool it has. The extra sebum your body is generating is just your body trying to push out all the toxins it can.

At a very high level, acne is an inflammatory disease. If you ingest toxins that provoke an inflammatory response, you may trigger acne to develop. Certain foods are more inflammatory than others, which can make your acne worse.

Try and minimize the toxin intake and your body will have an easier time dealing with it. Doing your best to minimize stress and skin irritation; and eating a healthy diet will keep your body in harmony with nature.

Working against your body, rather than with it, is what causes acne.

Sources for What Causes Acne?

[1] Cordain, L.
Implications for the role of diet in acne.
Semin Cutan Med Surg 2005;24:84-91.
http://www.thepaleodiet.com/articles/Final%20Acne%20Article.pdf

[2] F.Danby
Acne and milk, the diet myth, and beyond
Journal of the American Academy of Dermatology, Volume 52, Issue 2, Pages 360-362

[3] Smith, Robyn N, Mann, Neil J, Braue, Anna, Makelainen, Henna, Varigos, George A.
A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial
Am J Clin Nutr 2007 86: 107-115
http://www.ajcn.org/cgi/content/full/86/1/107

[4] C.Adebamowo, D.Spiegelman, F.Danby, A.Frazier, W.Willett, M.Holmes
High school dietary dairy intake and teenage acne
Journal of the American Academy of Dermatology, Volume 52, Issue 2, Pages 207-214

[5] C. Adebamowo, D. Spiegelman, C. Berkey, F. Danby, H. Rockett, G. Colditz, W. Willett, M. Holmes
Milk consumption and acne in teenaged boys
Journal of the American Academy of Dermatology, Volume 58, Issue 5, Pages 787-793

[6] Loren Cordain; Staffan Lindeberg; Magdalena Hurtado; Kim Hill; S. Boyd Eaton; Jennie Brand-Miller
Acne Vulgaris: A Disease of Western Civilization
Arch Dermatol. 2002;138(12):1584-1590.
http://archderm.ama-assn.org/cgi/reprint/138/12/1584

[7] Annie Chiu; Susan Y. Chon; Alexa B. Kimball
The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress
Arch Dermatol. 2003;139(7):897-900.
http://archderm.ama-assn.org/cgi/content/full/139/7/897#otherarticles

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