What Is Acne?

Knowing what acne treatment is right for you can be difficult. Often the first stop when you develop acne is your NHS GP who can prescribe treatments for you; these are usually an antibiotic, a contraceptive pill, or topical creams.

Perhaps you’ve been down that route and haven’t found much success with these treatments and have found yourself Googling ‘Acne treatments near me’…  It’s at this point that we normally meet our clients on their journey. 

As a private skin clinic we can offer you alternative, clinically proven, acne treatments to what the NHS can offer you and have decades of experience treating people of all different ages, gender, and severity of acne. One of our priorities is educating our acne clients; as they say, knowledge is power. Once you understand what causes your acne, you’re better able to manage it. 

With that said, I’d like to share the various reasons why you’re getting acne in the first place, in the hope that it helps you.

What is Acne?

Acne is a skin condition that has no definitive cure, however it can be successfully managed to the point where it no longer bothers the individual. Acne does not discriminate against age, gender, or race; anyone can have it, at any time. 

Hair follicles are the culprit when it comes to acne; hair follicles consist of a shaft (where the hair sits), a sebaceous glad which produces oil, and a hair. This is often called a ‘pore’. Approximately every 28 days the skin cells lining the follicle shaft are shed and replaced by new ones. In someone with acne, keratin (a type of protein found in the skin cells) will be over-produced in the follicle making it harder for those skin cells to shed.

The cells that are having a hard time being shed get mixed up with the oil produced by the sebaceous glad and this can lead to a blockage. Sometimes we can cause the blockage ourselves with sweat that’s left on the skin, oily skincare products or make up; these things can enter the follicle and get trapped. The plug of skin cells, mixed with oil (and sometimes those external substances) is quite often how acne starts. 

Acne can come in various forms:

1. Blackheads. This is when the debris in the blocked follicle reacts with the air (oxidises) and turns black or brown in colour. Blackheads are often mistaken for enlarged pores.
2. Whiteheads. This is the same as a black head, only the opening of the pore is closed so the blockage looks white. There’s no inflammation with whiteheads.
3. Papules. This is the result of bacteria multiplying inside the blocked pore. The blockage grows and eventually tears the follicle wall causing your white blood cells to flood in to fight the bacteria. This results in inflammation and the white blood cells form a pocket of pus inside the pore. Note: we all have bacteria on our skin, this is not a result of being unclean. 
4. Pustules. Often mistakenly called whiteheads, pustules come along a couple of days after the papule when the pus comes to the surface.
5. Nodules. This is essentially a large papule.
6. Cysts. This is basically a large pustule. If you have nodules and/or cysts, I recommend seeking acne treatment sooner rather than later because they can severely damage the skin and cause acne scarring. 

What else can influence acne?

So now that we understand what acne is, we can start to breakdown what can cause all the above to happen.

1. Your DNA. When we see you at our skin clinic (St. Albans) we usually talk to you about your family history because your DNA is one of the main things that dictates how big and productive your oil glands are and how much keratin your skin makes. We often see that acne runs in families. 
2. Hormones. The hormones that contribute to acne are DHT and testosterone, which tend to appear during puberty. These hormones exit the blood and bind to hormone receptors in your skin; they then can increase your oil production which means your pores are more prone to blockages. Your DNA affects how your hormones are controlled too, thanks mum and dad!

During your menstrual cycle estrogen levels drop (generally around day 14 up until mensuration), leaving your testosterone levels higher in proportion and more freely able to bind to your skins hormone receptors and stimulating oil production, as in puberty. 

Acne is often experienced during pregnancy, typically the first three months, when progesterone is prevalent; this hormone has a similar impact to DHT and testosterone.

1. Bacteria. I mentioned the fact that we all have bacteria on our skin and is 100% not a sign that you’re unclean. We often see it more in those of use with acne simply because the conditions are ideal for it to thrive; it feeds on sebum and dead skin cells. The more a pore becomes blocked, the better the environment for them and they quickly multiply. 

The bacteria (called P. acnes) weaken the wall of the follicle allowing it to tear easily (see point 3 above under what is acne). The more bacteria found in the follicle, the more white blood cells are required to fight them off. 

1. Stress and diet. This is anecdotal evidence as they’ve not been confirmed in thorough clinical studies yet. However, anything that causes inflammation within your body, which stress can, can make acne worse. 

Some of us will notice that we’ll get a flare-up of our acne if we eat certain foods, whereas some of us won’t. Generally, sugary foods, dairy and carbs are the triggers reported; this is because they increase a hormone in your body which increases DHT and testosterone (see point 2 on hormones). 

1. Make-up, hair and skin products. Thick, oily products can end up inside your pores which create a blockage as described in what is acne? Commonly we see this in those whose hair touches the skin lots (especially if a product is on it), heavy foundation wearers, those who go to the gym and sweat without immediately showering (particularly if they have hair product on that runs onto their skin), and those who use heavy skin creams. My tips are to shower as soon as possible after working out, and use non-comedogenic skin products and makeup (comedone being another name for spots and blackheads) as they’re less likely to clog your pores if you can spend time without foundation on (difficult if you have a breakout I know) it may be beneficial. 
2. Medication and medical conditions. The most frequently seen condition associated with acne is PCOS. Those with PCOS have higher levels of testosterone (see point 2 above on hormones).
3. Some drugs can result in the increase (or development of) acne. Steroids can impact your DHT and testosterone levels (again, see point 2 above on hormones). Progesterone-based contraception can stimulate acne; progesterone is the hormone prevalent during pregnancy which has a similar impact as DHT and testosterone. 

Ok, good, that was a real crash course in acne and its causes hey! It’s important that we understand this though, because once you understand the causes it’s really the first step to taking control of your acne.

Jane Lewis, Skin to Love MD points out that: “Often our clients come to us after they’ve exhausted GP treatment options or if they want an alternative to medication. If this resonates, your first step is a skin consultation where we can assess your skin and discuss clinically proven acne treatments for you to consider. This is an educational session where we encourage you to go home and think about your skin treatment options, without pressure to book in”.

If you’d like a consultation, please contact us.

Disclaimer: This blog is not to be used for diagnostic purposes. We are all unique which means that our results, recovery and suitability for any type of treatment will vary. Always seek the advice of a professional should you have any health or cosmetic concerns or to discuss treatments specifically for you.