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What Causes Acne
Things You Can Do To Help

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Have you found yourself asking the question - what causes acne? Is it in my genes? Does milk cause acne? Or is it my hormones? If it is my hormone, then what hormone causes acne? What can I do about it?

Well, what causes acne are factors that you have very little or no control over. But reducing stress levels, avoiding the use of heavy and oily make ups, as well as an eye on what you eat and some basic skin care tip may help reduce the severity of acne or zits.

Nearly 90 percent of teenagers have acne. While a few of them will "grow out of" this skin condition in a few years, up to half will continue to suffer with acne into adulthood and up to 1 in a 100 men will still have acne at age 40 and 5 in 100 women carries this condition into their forties.

That most people develop significant acne in their teenage years, it clearly indicates that something different must be happening at that time.

As teenagers start maturing into adolescent, they start producing sex hormones. Androgens are the main hormones produced at this stage. These hormones causes a number of things to happen together, leading to changes in the hair follicles of the skin that ultimately leads to acne.

The four main process medically shown to lead to the development and formation of acne are:

  1. In response to the normal increase in the level of androgens in puberty, the sebaceous glands increases the production of sebum significantly. These sebaceous glands are found at the base of each hair follicle in our skin, and they produce sebum - an oily material that help keep our skin lubricated and supple.  Any excess sebum produced would normally flow through the pores in our skin to the surface. But something else happens, as well as the excessive sebum production, that leads to the formation of acne.

  2. Also in response to the normal increased levels of androgens at puberty , the skin produces a very high amount of skin flakes or keratin. These keratin blocks the pores in the skin where the sebum would normally be expelled. If the blockade occurs at the level of the skin, it causes a bump in the skin called whiteheads or open comedones. If the blockade occurs below the level of the skin, it leads to blackheads or closed comedones.

  3. Once the sebum is trapped inside the skin pores and tension builds up inside the pores, this is what actually causes the acne. The trapped sebum becomes a "soup" for a normal skin bacteria called Proprionibacterium acnes to multiply in very large numbers, causing an infection. This leads to skin inflammation.

  4. The inflammation may then lead to formation of pustules and redness and in severe cases, scarring.

So, if you are looking for what causes acne, in simple terms, it is the plugging of our skin pore by excessive keratin production, by increased amount of sebum produced, both in response to androgens produced at puberty.

If this blockade then gets infected, it causes an even worse out with acne. It is important to recognize these four factors in the successful management of acne.

How Knowledge Of What Causes Acne Can Help You In The Treatment Of This Condition

For the purpose of clarity, and in the spirit of "repetition for emphasis", we shall now list again, and then discuss the four main causes of acne and relate how a knowledge of each of these steps can help us in the appropriate treatment of this condition. They are:

  • Hormone Induced Overproduction of Sebum
  • Comedone formation from hyperkeratinization and 1 above
  • Colonization of the clog of sebium and keratin by the skin bacteria called Propionibacterium acnes and sometimes, another related skin bacteria called Propionibacterium granulosum leading to inflammation and
  • Scar formation following severe inflammation and disjointed healing.

Over Production of Sebum

Application of the knowledge of what causes acne at this level involves the use of regular face wash.

Even here, there is need to exercise caution. You must not over wash your face. Use of various cleansers and washes like Castile hand or liquid soap or even pure glycerin hand soap a few times in a day (ideally no more than twice daily) and with sparing amount of these agents has been advocated in some studies to be useful way of overcoming and reducing excessive sebum clog.

Comedone Formation

As mentioned above, another important factor apart from excessive sebum production, that causes the blockade of the skin pores and which in turn is what causes acne is the accumulation of keratin, causing comedones - whiteheads and blackheads.

Use of "peeling agents" like retinoids, benzoyl peroxide, and azelaic acid is the mainstay of treatment of non-inflammatory acne.

These agents helps to clear away the excessive keratin and help open the pores again.

Bacterial Colonization

A third and one of the very important "what causes acne" is the colonization of the clogged pores by bacteria. Two forms of bacteria has been implicated; the Propionibacterium acnes, and to a lesser degree, the Propionibacterium granulosum. The body responds to the presence of these bacteria by releasing chemicals that in turn leads to the inflammatory reaction observed in some acne.

This is again where a sound knowledge of what causes acne is needed to succeed in instituting the right treatment. Antibiotic preparations like Clindamycin are only useful where inflammation is noticed in the acne - redness and sometimes pus formation. A topical antibiotic cream or oral antibiotic can be used at this stage.

Antibiotics are useless if there is no evidence of inflammation as in non-inflammatory acne - grade one acne.

Acne Scar

This is the final stage in the natural history of acne - the formation of scars. What causes scar in acne is the body's attempt to heal after the injury caused by the offending bacterial colonization.

Scars are difficult to treat and require the use or "peeling agents like roaccutane and laser in some cases. Though it must be said that roaccutane does not treat already existing scar, but only prevents the formation of new scars.

Can you see how a sound knowledge of what causes acne ties in nicely with picking the right treatment agent for acne? That is what we hope to emphasize all through this site... and thus help improve the treatment of this depressing skin condition.

Now that we know what causes acne, let's look at things that could make acne worse and what can be done about them.

Things That Make Acne Worse

The following are things that can trigger or worsen acne, and if such "causes of acne" are identified and excluded or minimized, then the impact of any of the four processes described above can be mitigated. These "causes of acne" include:

  1. Puberty: There is nothing you can do about this.

  2. Stress - expectations (like before a big event like a wedding), severe emotional distress, before interviews and examinations

  3. Use of anabolic steroids as in body builders

  4. Certain food items - there is increasing body of evidence to show that they type of food you eat can worsen or make you acne better.  Some have found that items like milk and diary products, groundnut (peanuts), kelp, and pork worsens their acne. You should make a diary of what you eat over a period of time and see whether you can identify the food that causes acne for you. And avoid such.

  5. During or just before your menstrual period in some women

  6. Certain cosmetic agents e.g use of too oily body cream causing the so called pomade acne

  7. Withdrawal of hormonal treatment (especially testosterone)

  8. Certain medications

  9. Weather - some find their acne worse in winter and improves in summer

  10. Continuous facial irritation as in a violinist (they tend to develop chin acne more

  11. Male infants

  12. Tumour of the adrenal gland and polycystic ovarian syndrome - called PCOS for short. Those with PCOS are women, grow facial or unusual pubic area hair, have little or no menstrual flow, may be obese, and develop acne more than others.

  13. Genetic predisposition as in those with PAPA syndrome

This list is by no means exhaustive, but reflects the list of things that could contribute to or worsen acne.


  • Acne vulgaris BMJ 2013; 346 doi: (Published 8 May 2013) Cite this as: BMJ 2013;346:f2634

What Do You Think Makes Your Acne Worse?

Some have found certain things that make their acne worse... and can even point to a suspected cause of their acne. Have you noticed a pattern yourself? Certain foods? Creams? Or before major events? Share it! Just add your contribution below:

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