What Causes Acne
No one factor causes acne. Acne happens when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty by elevated levels of male hormones. Sebum (oil) is a natural substance which lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature so that they are predisposed to clog the follicular openings or pores. The clogged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation.
Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt and do not reflect poor hygiene.
During adolescence sebaceous glands enlarge and produce more sebum under the influence of hormones, also called androgens. After about age 20, sebum production begins to decrease.
It's not known what causes the increased production of sebum that leads to acne. But a number of factors ? including hormones, bacteria, certain medications and heredity ? play a role.
Contrary to what some people think, greasy foods and chocolate have little effect on acne. Studies are ongoing to determine whether other dietary factors ? including high-starch foods, such as bread, bagels and chips, which increase blood sugar ? may play a role in acne.
Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder.
Here are some factors that don't usually play a role in acne:
Blockage of the skin pores
Oily skin occurs when an overactive oil gland enlarges and overproduces oil.Acne develops when some of the pores (through which oil normally flows from the oil gland to reach the skin surface) become blocked, resulting in trapping of oil within the skin pores.
The pores are blocked by skin cells that have been shed from the lining of the skin pore and have bunched together. The cause for this clogging is not known, but it is not due to poor hygiene. A blackhead or whitehead will develop from this skin pore blockage.
As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
Several factors can contribute to the cause of acne or make it worse.
Changing hormone levels in girls and women may cause a flare in their acne 2 to 7 days before their menstrual period starts. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne. Stress, particularly severe or prolonged emotional tension, may aggravate the disorder.
Inflamed skin is characterized by redness, swelling, warmth and discomfort. Inflammation of the skin occurs because the body's immune system is acting to rid itself of a foreign substance. In the case of acne, this substance is either bacteria or the irritating compounds they have produced.
These four factors contribute to blocked skin pores, which bulge outward to form:
- Blackheads. These form when the pores are clogged close to the surface of the skin. Because they are exposed to the skin surface, blackheads don't usually become inflamed. Blackheads are dark due to the presence of a dark pigment. This color is not the result of dirt in the pores.
- Whiteheads. These develop from a blockage deeper in a pore. Lacking a drainage path, the oil accumulates in the skin, causing small flesh-colored or white-colored bumps. Unlike blackheads, whiteheads are more likely to lead to the red inflammations known as pimples or zits.
- Pustules (also known as pimples or zits) occur when the walls of the blocked follicle ruptures. Oil, dead skin cells, and bacteria normally found on the skin surface get into the skin and irritate it, forming small areas of inflammation.
- Cysts are larger, red, inflamed areas deep in the skin that indicate a more extensive infection.
Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and pure chocolate in aggravating acne, these findings are very far from established.
Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid), which is used to treat bipolar disorder. Most cases of acne, however, are not drug related.
Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but research has shown that foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt.
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