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What Causes Acne?

Causes of Acne

Acne develops as a result of blockages in follicles, usually on the face or occasionally on the torso. The formation of a plug of keratin and sebum (a microcomedo) is the earliest change seen at the outbreak of acne. Enlargement of sebaceous glands and an increase in sebum production occurs with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). In these conditions the naturally occurring largely commensual bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.

Exactly why some people get acne and some do not is not fully understood. It is known to be partly hereditary. What we do know is:

Family/Genetic history

The tendency to develop acne apparently runs in families. For example, school-age children with acne tend to have other members of their family with acne. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions (visible acne symptoms).

Hormonal activity

Puberty causes an increase in male sex hormones called androgens causing the glands to get larger and make more sebum. Several other hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). In addition, acne-prone skin has been shown to be insulin resistant.

Bacteria in the pores

Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne.

Use of anabolic steroids

Any medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens can cause acne symptoms to worsen.

Exposure to certain chemical compounds

Acne is particularly linked to toxic exposure to dioxins, namely Chlorinated dioxins.


Most dermatologists are awaiting research confirming the link between diet and acne but some support the idea that acne sufferers should experiment with their diet, and refrain from consuming certain foods for their effects on the severity of acne


Seafood often contains high levels of iodine. Iodine is known to agitate existing acne worsening the symptoms, but there is probably not enough to cause an acne outbreak on its own. Be that as it may, people who are prone to acne may want to avoid excessive consumption of foods high in iodine.

High carbohydrates/High GI

There is some recent research suggesting that high sugar and carbohydrate laden foods negatively affect acne. The theory is that rapidly digested carbohydrate food such as white bread and refined sugars produces an overload in metabolic glucose that is rapidly converted into the types of fat that can build up in sebaceous glands. According to this hypothesis, the startling absence of acne in non-westernized societies could be explained by the low glycemic index of these cultures’ diets. Others have cited possible genetic reasons for there being no acne in these populations, but similar populations shifting to these diets do develop acne. Note also that the populations studied consumed little to no milk or other dairy products.

Vitamins A and E

Studies have shown that newly diagnosed acne patients tend to have lower levels of vitamin A circulating in their bloodstream than those that are acne free. In addition people with severe acne also tend to have lower blood levels of vitamin E.

While there are literally hundreds of possible causes for why we develop acne, we only know a few of them.

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