This month, we’re talking about Acne. We’ll be giving you information, products and services to help you better control acne and restore more healthy balance, function and appearance to this incredible organ.
There can be some confusion about what qualifies as acnes, so let’s start with a good understanding. Acne is a chronic inflammatory disorder of the skin marked by papules, pustules, open and closed comedones (blackheads and whiteheads), as well as cysts. Increased oil production is also often apparent.
Acne can also be grouped into two different classes, which just identifies how bad the acne is…
- Acne Simplex: Grades 1 and 2, have these things in common; a limited number of open and closed comedones, pustules and papules, but no “inflammatory lesions” or cysts. Acne simplex rarely (if ever), causes scarring and is usually confined to the face. Acne simplex also tends to be cyclical – it comes and goes – or is worse at times and then clears somewhat, but is never completely resolved.
- Acne Vulgaris – is just what it sounds like, more of everything. Grades 3 and 4 include all the types of lesions seen in the less severe acne simplex, but also includes cysts, inflamed and bacterial breakouts. Acne vulgaris is commonly seen on the back, chest and shoulders as well as the face, tends to get progressively worse, and often causes scarring.
The million-dollar question then is, what causes acne? The answer to this is different for every individual, but here are the four main causes:
- Inflammation: After 20 years in the clinical skincare field, I have come to see this as the underlying cause of acne, with all the other factors being mostly opportunistic or aggravating. The more severe the inflammation, the worse the acne tends to be. Identifying the cause or source of the inflammation is really the key, and we’ll give you some suggestions next week.
- Abnormal production of skin cells within the follicles (pores) causing obstruction or clogging. When our skin produces keratin and epithelial cells as it should, we get just the right amount of skin covering and protecting us from the outside world. But get not enough or too much (in this case), and the unfortunate side effect can be a pore-clogging, jam-up which sets the stage for even more problems.
- Increased sebum (oil) production because of increased androgen (male hormone) production: Testosterone and dihydrotestosterone (DHT) are not only produced in the adrenal glands and sex organs (gonads), but also within the follicles (pores) by androgen-metabolizing enzymes. This not only causes the skin to produce more oil, but can also cause the head of the follicle or pore to swell, making it very difficult for all the excess oil and skin cells to move out of the pore the way they should. Which sets the stage for the next problem:
- Over-growth of bacteria such as P. acnes, Staphylococcus and Corynebacterium. P.acnes in particular loves a low-oxygen environment and feeds on sebum, so you can see how, with too many skin cells clogging the works and too much oil present, the perfect storm can develop here. But let’s be clear, these bacterial species are native to human skin. The Human Microbiome Project proved this fact. So, getting rid of all bacteria in the skin in the “germ-warfare” kind of way we used to approach acne in the past is not only impossible, but not beneficial. What we do need to do is try to restore normal microbial balance of “good” and “bad” bacteria, without the over-growth the unfriendly kinds.
Next time, we’ll talk about some effective ways to help you control acne from the Outside in. So, stay with us, there’s hope!