In patients who develop acne, abnormally high levels of sebum secretion
are usually found. This seems to be due to an increased sensitivity of the
sebaceous glands to normal levels of testosterone.
Blockage of the hair duct: - Blockage of the hair ducts is due to an
abnormality of the cells lining the duct. In normal skin these cells
continually grow and die and are shed into the duct and thus onto the
surface of the skin. In patients with acne, the cells react abnormally to
testosterone and become "sticky’ and instead of being shed,
progressively block the duct- rather like a kettle becoming furred up.
This leads to a partial obstruction of sebum flow from the sebaceous
glands with pooling of sebum in the hair ducts. The oil solidifies and
this, with the plug in the duct which becomes pigmented, gives rise to
blackheads and whiteheads which are the non-inflammatory spots of acne.
Inflammation: - The cause of inflammation and pus formation in acne is
still poorly understood. It is thought that periodically the partial
blockages of the hair ducts become complete. This leads to an acute
build-up of oil in the hair duct which is broken down by bacteria present
with the production of inflammatory chemicals. These penetrate into the
skin and cause the redness and swelling which heralds the new spot. At
this time there can be itching or tenderness at the site. Pus cells are
then recruited into the area and eventually a pustule develops. In the
natural evolution of the spot, the pus eventually ruptures onto the
surface of the skin and the spot settles down. If the inflammation is
present deep in the hair duct, or if the spot is squeezed too early, the
pus can rupture into the skin which will cause even more inflammation and
potentially more scarring.
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Is acne
hereditary?
Acne is not an inherited disease in
the medical sense of the word. However, acne is more common in children of
parents who have had or still have acne. Looking at it the other way, if
you look at parents of children with acne, more of them have acne or have
had acne than parents of children who do not have acne. If you look at
twins, you will usually see acne in both twins if they are identical while
the incidence of acne affecting both non-identical twins is much less.
There is no way of predicting whether or not the child of a patient
with severe acne will develop acne or if the child does, how severe it
will be.
Is acne hormonal?: - Although the abnormality in the skin is caused by
the effect of the hormone testosterone, the levels of this hormone in
patients with acne is generally normal.
Testosterone is the male sex hormone and is present in both men and
women. In women its main effects are counteracted by the female hormones.
Men with acne usually have normal levels of testosterone in the blood.
Women with acne may have slight abnormalities in the levels of
testosterone but these do not influence treatment and there is no reason
to measure hormone levels in these patients.
There is a condition called the polycystic ovary syndrome, in which
women may be overweight, develop excessive body and facial hair, have
irregular periods and may suffer from infertility. Some of these patients
do develop acne, and this seems to be related to an abnormality of hormone
levels in these patients.
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What
affects it -
fact and fiction
Does diet affect acne?: - No direct link has been found between acne
and diet. It is a myth that chocolate and fried foods make acne worse.
However a good balanced diet will improve your general well-being and this
will be reflected in the condition of your skin.
Does sex affect acne?: - No. Although the sex hormone testosterone is
the primary cause of acne you do not develop spots because you have too
much of this hormone or are over-sexed. Masturbation and whether you have sex or not has no effect on
acne and certainly does not cause it.
Is acne caused by dirt?: - No. The black of blackheads is due to the
pigment or colouring of the plug of "sticky" cells blocking the
hair duct. In fact most people with acne wash more frequently than those
without the condition to try to clear away the excess oil produced by
their skin. But over-washing can actually make acne worse by drying the
skin and making it sore. Normal regular washing with mild soap twice a day
is all that is needed. If you have a combination skin, non-oily
moisturiser on dry patches will not make the acne worse.
Does acne become worse before periods?: - Yes. Many women notice that
their acne gets worse two to seven days before their period starts. This
is probably due to changes in their hormone levels at this stage in the
menstrual cycle.
Will pregnancy improve acne?: - Yes and no. Some women’s acne
virtually disappears but often recurs at the end of pregnancy while, for
others, pregnancy heralds the reactivation of acne or the worsening of an
existing condition.
Does sweating affect acne?: - Yes. Up to 15 per cent of sufferers find
their acne flares up when they have been sweating a lot. This is probably
due to water swelling the partial hair duct obstruction causing a complete
blockage and therefore inflammation.
Do humid atmospheres make acne worse?: - Yes. Going on holiday to a
very humid climate or working in an environment such as a kitchen or steam
room can cause acne to flare up in the same way as sweating does. This is
due to hydration and swelling of the ductal blockages, which precipitate
the inflammatory phase of acne.
Can medicines make acne worse?: - Yes. Many medicines may do this, most
commonly corticosteroids and anti-epilepsy drugs. If you think that
medicines you are taking have made your acne worse, you should speak to
your doctor. Never stop medication without medical advice.
Can cosmetics make acne worse?: - Some cosmetics, particularly those in
USA and the ethnic Indian make-ups may induce blackhead formation in the
skin.
Certain hair oils or pomades, particularly those used to "defrizz"
very curly hair may induce blackheads and whiteheads along the hair
margin. These should be avoided by those with a tendency towards
developing acne.
In the same way, some people react to suntan oils with a worsening of
acne. Always test suntan oils on a small area of the chest first to make
sure you do not react to them.
Can clothes affect acne?: - Continual pressure from headbands, tight
bra straps and collars may cause spots in those areas of skin. The reason
for this is unclear but may be related to localisation of sweat in those
areas.
Can my work exacerbate my acne?: - Yes. Coming into contact with
cutting and mineral oils can cause acne-like spots on the arms and legs
and make existing acne worse where the oil comes in contact with the skin.
