3 Causes of Acne

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As one of the longest Miami Beach based med spas offering acne treatments, it is our pleasure to offer you the following information about the causes (and options to treat) of acne.

Despite what many think, acne is not just a ‘teen’ skin disorder. While acne does usually begin in adolescence (usually more severe in males) and does usually subside in late adolescence, acne can affect adults as well (adult onset of acne can affect men and women into their 40s). We’ll cover more about teen and adult acne in the next few pages. Let’s go over the basics of acne, as this information is pertinent to every acne sufferer, no matter what age.

First, let’s go over the causes of acne:

  • Genetics: Acne is caused mainly by inflammation of the pores (more to follow) due to the over production of sebum (oil), bacteria accumulation and dead skin cells trapping within the pores. Just as certain health issues are genetically linked between families, so is acne. For example, those of Spanish ancestry have a certain gene which makes them prone to cystic acne.
  • Stress: There is a link between severe acne and anxiety, stress and anger, which at higher levels, cause more breakouts. The main culprit is cortisol, a hormone often referred to as the stress hormone. Cortisol is released by by the adrenal glands in response to stressful situations. Cortisol can cause excessive sebum production and increased inflammation, both of which contribute to acne. Stress also delays how quickly your skin is able to heal itself, so if you have painful acne breakouts and are under severe stress, your skin will not clear itself as quickly.
  • Hormones: This is such an important section, we urge you to read this thoroughly! The amount of sebum (oil) that is produced is regulated by your hormones. Higher levels of testosterone (the male hormone, although found in females in small amounts) generally contribute to higher levels of sebum (oil) production which results in acne breakouts. This is commonly experienced in teens (both males and females), and in females before their periods. Some women, starting in their teens, suffer from polycystic ovarian syndrome (PCOS), which causes an imbalance of the sex hormones, which may cause weight gain, excess hair growth, infertility, and acne.

Acne begins when a hair follicle produces cells that stick together so tightly that they cannot be shed. These cells mix with other skin materials, such as pigment and bacteria, and stick to one another, forming a plug. Acne is an inflammatory, papulopustular skin eruption stemming from the sebaceous (oil) glands on the face, neck, shoulders, and upper back. The etiology of acne is unknown. However, the simplest explanation is that the bacterial breakdown of sebum into fatty acids, wax esters and triglycerides (fats) mix with other skin materials, such as pigment and bacteria, forming into a plug or plugs. Breakouts occur due to millions of bacteria harboring in as many as 5,000 sebaceous glands per square inch of facial skin.

These blockages/plugs of the pores may cause any of the following:

  • Papules- small, solid, raised lesions less than (1) centimeter in diameter.
      • Pustules- elevated, circumscribed lesions that contain pus. This pus (made up of leukocytes, aka white blood cells) may or may not contain bacteria. Pus may be of various colors, with yellow, white, green or red. Some pustules become abscesses- which appear as red, swollen, and are often tender.
      • Comedones (aka blackheads) – are usually flat shaped. The black color is because the whiteheads rose a bit through the pore, being exposed to light, and oxidized. (Think about this way, when you peel a banana, if you don’t eat it right away it turns brown in color. That’s called oxidation. That is exactly the same thing that happens with whiteheads which turn into blackheads). Blackheads are commonly seen on the face, back, chest and shoulders.
      • Nodules- usually larger than papules, larger than (1) centimeter.
      • Cysts- sacs that contain fluid or semisolid pus. Sebaceous cysts form in the hair follicles and can grow quite large. [PLEASE NOTE: If you squeeze these cysts with your fingers, they may become infected and this could pose a health risk which will require antibiotics and/or other medical treatment/s].

[The above definitions were taken in part from the book Advanced Professional Skin Care, Medical Edition, written by Peter T. Pugliese, MD].

The sebaceous gland continues to produce sebum (oil). As the follicle releases its contents into the surrounding tissue, inflammation occurs (as you can see in the above diagrams). This is why the surface around the pimple is reddened and swollen. Leukocytes, known as white blood cells, enter the tissue, forming as pus. The above types of blemishes (i.e. papules, pustules, comedones, nodules and cysts) may or may not occur at the same time. The severity of acne is directly correlated to the sebum secretion rate.

The reason that acne is more prevalent in young men is because their bodies tend to produce higher levels of testosterone to promote growth which tends to over stimulate the oil glands resulting in over production of oil which is one of the major causes of acne. [An important note: when shaving, men should do so carefully as to avoid nicking their breakouts].


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