Module 1: Understanding acne

 

1.2 Causes – Hormones

Hormones have a huge part to play in the production of acne.

In section 1.1.1 we covered two potential reasons for cells clogging the follicle, and thus causing acne. These were 1. the production of too many skin cells, and 2. hyperkeratinization. Researchers suspect that hormones are involved in keratin levels, and hormones are known the control the rate of skin cell growth.

In this section we’ll examine one of the main culprits in causing acne, testosterone, and look at many different hormonal influences that can cause breakouts.

1.2.1 Testosterone and DHT

Testosterone is a natural hormone that is found in the bodies of both men and women. The average adult male has between 4 times to 75 times more testosterone than the average adult female. This hormone is essential for sexual behavior, building protein, bone formation, the production of blood cells, liver function and carbohydrate metabolism. In women, it is produced in the ovaries.

DHT (Dihydrotestosterone-alpha) is a natural steroid, produced in the gonads in men. (It is also present in women, but to a much lesser extent). It is an androgen (male) hormone, and is responsible for the biological characteristics of males, such as increased muscle mass, hair on the chest and a deep voice. 5% of free testosterone is converted into DHT, by the 5-alpha enzyme. DHT is about five times more potent than testosterone, and is considered a very potent androgen.

DHT can cause acne because it over stimulates the sebaceous glands, the same oil glands that cause your skin to product more sebum. This can result in more acne as pores become clogged. This is not always the cause of acne, but it can be, particularly in females.

1.2.2 Periods

Women can experience menstrual acne, which is a flare up on the skin that coincides with their period. Generally, the acne will start to be more severe around seven to 10 days before the period begins, and will subside when bleeding starts. Around 63% of women who are acne-prone experience these flare ups, according to a study in the Archives of Dermatology.

The reason for this is hormonal changes. In the first half of the cycle, estrogen is the main hormone, while in the second half, progesterone is dominant. As the period approaches, the levels of both hormones fall significantly. Testosterone stays at a constant level throughout the month, and when the other hormones dip, it becomes dominant and makes the oil glands produce more sebum, which increases breakouts.

Module 1: Understanding acne

 Welcome to your acne treatment course! In this first module, we’ll explore what acne is, how it is created by the body, and the causes behind it. In the first section, you’ll learn about how acne develops, the types of acne, and who most commonly suffers from it. Next, we’ll look at how hormones can cause acne, with sections on testosterone and DHT, periods, pregnancy, PCOS, teenagers and birth control pills. The next section is all about diet, showcasing two important studies that have indicated a strong link between diet and acne. Following that, you’ll learn about various lifestyle habits that can contribute to acne, before the module finishes up with a discussion about how genetics is relevant here.

1.1 What is acne?

1.2 Causes – Hormones

1.3 Causes – Diet

1.4 Causes – Lifestyle

1.5 Causes - Genetics

1.1 What is acne?

Acne is a disease which affects the oil glands in the skin. In this section, you’ll learn the science behind how acne develops, and learn about who can get acne. This will serve as a preparation for you as this module teaches you about a number of different causes of acne, showing you why people suffer from this condition.

1.1.1 How does acne develop?

There are small holes in your skin, which are known as pores. Pores are connected to oil glands underneath your skin, via a follicle, a narrow channel. The oil glands produce sebum, and this sebum carried dead skin cells to the surface of your skin through the follicle. In addition, a very thin hair grows through the follicle and out of the skin.

The cells that form the walls of the follicle are called keratinocytes. These are the dead skin cells that, in healthy skin, are pushed out of the skin by the growing hair inside the follicle.

Sometimes, the hair, sebum and skin cells clump together in what is known as a plug. The bacteria in this plug cause swelling, and when this plug breaks down, a blackhead or whitehead will form. Blackheads and whiteheads are known as comedomes. If the clogging is so severe that it causes the follicle wall to break under pressure, sebum leaks into nearby tissue and forms a papule or pustule. This is how inflammatory acne develops.

This clogging can happen because there is 1. an excess growth of the skin cells, and/or 2. a condition called hyperkeratinization. Keratin binds the skin cells together, but when there is too much, the bonds between the cells can’t break so they stick together and clog the follicle.

The oil glands where this can happen are mostly located in the face, chest, back, neck and shoulders.

1.1.2 Types of acne

There are different types of acne and pimples. People with acne may have one or more of these types simultaneously, and one or more may be dominant.

• Blackheads – pimples which rise to the skin’s surface and have a black appearance. It is important to note that the black color does not come from dirt
• Cysts – deep, painful pimples filled with pus, which can cause scarring
• Nodules – pimples which are solid, large, painful, and deep inside the skin
• Papules – small bumps which can be tender, pink in color
• Pustules – pimples which are red at the closest point to the skin, and have pus on top
• Whiteheads – pimples with pus, under the surface of the skin
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• 1.1.3 Who gets acne?

  Acne is by far the most common skin disease, and people of all races and ages can suffer from it. Both genders have acne, though suffer from it to different degrees at different life stages, which we’ll explore further in this section.

  Acne is the most common in people between the ages of 11 and 30, with 80% of all people in this age group reporting acne outbreaks at some point. The most common ages for acne onset are ages 10 to 13. Teenage acne generally lasts five to 10 years, subsiding in the late teens and ending in the early 20s. At this age, teenage boys tend to have the most severe cases, though the condition is present in both genders.

  However, older people can also have acne. People in their 40s and 50s report outbreaks, and 20% of all acne cases occur in adults. Above the age of 30, women are more likely to suffer from acne than men.

  

  Though not nearly as well-known as teenage acne, there are two forms of the disease that occur in young children. These are acne neonatorum, a pimply skin rash which affects babies but does not leave any scarring, and acne infantum, which can be more severe and leave scarring. At this age, boys are more likely to have acne than girls.

  Some studies have found that traditional societies in remote locations do not suffer from acne the way the developed world does. Further along in the module we will discuss this research further and the potential reasons behind this.