What Causes Acne

Acne is actually a super complicated skin disease. Why and how an acne lesion forms is not totally understood but we do believe there are three main ‘pathogenic’ or ‘disease-causing’ factors involved which all seem to lead to the same thing: Skin Barrier Dysfunction…

  1. Follicular hyperkeratinisation – which means that there are too many overly sticky skin cells sitting in the hair follicles on the skin. How this happens (why the cells are too sticky and don’t shed out of the hair follicle like they should) is still up for debate but it may have to do with a defective stratum corneum barrier function which leads to the follicle getting plugged.

  2. Hormonal stimulation of sebaceous glands – this one is fairly straightforward. Androgen hormones cause, for one reason or another, the oil glands attached to the hair follicle to get larger and produce more oil. This leads to acne potentially because it is a feeding ground for P.acnes bacteria (Which lives off fatty acids on the skin) but also potentially because the increased oil output dilutes the amount of certain epidermal lipids that are essential components of the stratum corneum barrier – again leading to barrier dysfunction. 

  3. Inflammation in response to P.acnes – lots of oil leads to a great environment for acnes bacteria to thrive and stimulate inflammation in the skin

But what does this all mean for you, if you suffer from acne? If barrier dysfunction is primary problem in causing acne, then first and foremost working hard to protect your skin barrier is the key. How can you do this? Stay away from harsh scrubs or washing your face with washcloths. Be gentle to your skin. Perhaps stay away from lots of irritating and drying peels and masks (like sheet masks). Be weary of facials and acid peels, as well as using toners with alcohol in them. Soaps and lots of cleansing also mess up the skin barrier. Disrupting the skin pH affects the skin barrier. Picking at the skin, sunshine exposure, scratching – all these things may affect your delicate skin barrier. Minimise the products you use, focus your acne treatment on a prescription retinoid, be gentle and give it time. 

Natalia Spierings