What causes acne and how to prevent new pimples?

Sadly, acne affects almost everybody at some point in life. Even though this skin disorder is not dangerous for our physical health, it often causes depression and affects one's self-esteem, social interactions and quality of life 6, 13. The problem is more serious than it might seem. For example, teenagers suffering from severe acne more often have suicidal thoughts and even suicidal attempts comparing to their acne-free schoolmates 14.

Statistics:

  • Acne affects 85% of adolescents 7
  • Only 20% of adolescents with acne seek help from medical professionals 5
  • 12% of women suffer from so-called ”adult acne” 7
  • Children whose parents suffered from acne develop the disease in 80% cases 3

 

What causes acne?
There are mainly three interrelated factors contributing to the development of acne 12:
1. Sebum overproduction
Sebum is a grease meant to lubricate our skin and hair. It is produced by sebaceous glands and then excreted to the skin surface via a hair follicle pore. At puberty sex hormones activate sebaceous glands, and sebum is produced faster than it can make its way out through pores.
2. Obstruction of hair follicle pores
Obstruction of a pore is caused by dead cells stuck inside a hair follicle. Normally cells lining the inside of a hair follicle are regularly replaced with new ones. Dead cells exfoliate and leave the hair follicle pore. Acne-prone skin produced excessive amounts of keratin (a structural protein of the skin). Keratin ”holds” dead cells together preventing their exfoliation to the cell surface. Since the hair follicle pore becomes smaller, it is more difficult for the produced sebum to come out. Overproduction of sebum at puberty exacerbates the problem. Excessive sebum and dead cells form a plug (whitehead comedo). Soon after, the plug oxidizes and turns grey (blackhead comedo). If the comedo affects nearby cells, it can trigger inflammatory reactions.
3. Bacteria
Overproduction of sebum attracts acne-causing bacteria (Propionibacterium acnes). They actively multiply and produce compounds causing inflammation. When bacteria invade deeper layers of the skin, blood white cells migrate to attack them. Dead blood white cells and bacteria form pus, and a painful pimple (or pustule) appears. When the pustule heals, it often leaves a long-lasting scar. 
 

Formation of acne

Formation of acne (click here to see a full-size image)

How to prevent acne?
As mentioned previously, acne appears for internal reasons. For example, sex hormones are the main cause of clogged pores and adolescent acne. Unfortunately, it means that fighting acne might be an extremely hard mission. However, nothing is impossible. Adjusting your daily habits is the first step in the battle against your pimples. These simple tips will definitely help your body to get rid of acne faster and also prevent new pimples and comedos to appear.

Hygiene and skincare
1. Avoid touching your face (especially inflamed skin!) unless you are sure your hands are clean 12.
2. No fringe! Hair touching your forehead can provoke the inflammation 12. Besides, the grease from your hair will add up to clogging the pores.
3. Keep your pillowcase and face towel clean 12.
4. Use proper cosmetics for acne-prone skin that suppress sebum production. Cosmetics should be free of comedogenic substances (such as lanolin, butyl stearate, oleic acid...) 7
5. Never forget to remove your make-up before going to bed.

make-up

6. Protect your skin from UV-light. Excessive sunlight increases formation of keratin that will worsen the acne 7.
7. Visit a beauty salon 3-4 times a year for a cleansing facial. The professional peeling will remove dead cells from the skin surface and then a cosmetologist will manually clean clogged pores. After-mask will help to reduce inflammation. However, choose a beauty salon and a cosmetologist properly since an amateur can bring an infection that will worsen your condition.
8. Do not pick at pimples – never! By doing so you might spread the infection. In addition, these acne lesions will take longer to heal and might leave unwanted scars3.

Life style
1. Try to cope with the stress. Anxiety and pressure of every day routines are important factors in worsening the acne4, 17, 18. Give yourself time to rest, relax and do things you like.
2. Sleep enough – 8 hours per night is a generally accepted norm, but it might be slightly more or less depending on the person 17.
3. Do not smoke!
Even though tobacco is not a primary cause of acne, it can trigger the disease if you have a predisposition 7. It has been shown that prevalence of acne is higher in active smokers, comparing to non-smokers (40% vs 25%). In addition, the more cigarettes is consumed per day, the more severe acne lesions are 15.

Nutrition
1. Include in your diet foods rich in omega-3 fatty acids – such as oily fish (salmon, herring, anchovies), hemp oil, and lingonberry 11. Omega-3 fatty acids have inflammatory properties and can moderate existing acne lesions and prevent the appearance of new ones 8.

salmon, source of omega-3 fatty acids
Omega-3 fatty acids present in salmon help reducing acne

​2. Good news for chocolate-lovers! Happy to announce that so far there was no convincing study showing that cocoa-products trigger acne. On the contrary, few scientific groups showed that pure chocolate and acne are not related 2, 8, 9, 10. However, it concerns only dark chocolate, as I will explain below.
3. Reduce your consumption of milk products. Many studies demonstrated that dairy-rich diets can stimulate the progression of acne and increase its severity 1. The reason is that milk contains components triggering the production of male hormones that activate sebaceous glands. The more sebum is produced, the higher risk for new pimples to appear. For the same reason, dark chocolate is a better choice than milk chocolate.

milk
Dairy products may trigger acne

3. Reduce the consumption of high-glycemic index food (such as white bread, white rice, cornflakes, and potatoes) 8, 16.

Do you want your pimples to go away faster? Try this homemade anti-acne oil blend Smile

Good luck!

References:

  1. Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005 Feb;52(2):207-14.
  2. Anderson PC. Foods as the cause of acne. Am Fam Physician 3(3):102-3 (1971 Mar).
  3. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013 Mar;168(3):474-85. doi: 10.1111/bjd.12149.
  4. Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003 Jul;139(7):897-900.
  5. Corey K.C., Cheng C.E., Irwin B., Kimball A.B. (2013) Self-reported help-seeking behaviors and treatment choices of adolescents regarding acne. Pediatr Dermatol.; 30:36–41.
  6. Dunn LK, O'Neill JL, Feldman SR. Acne in adolescents: quality of life, self-esteem, mood, and psychological disorders. Dermatol Online J. 2011 Jan 15;17(1):1.
  7. Fabrocini G, De Padova MP. Acne. From the book: Update in cosmetic dermatology. Springer Heidelberg New York Dordrecht London. 2013. p. 41-49.
  8. Ferdowsian HR, Levin S. Does diet really affect acne? Skin Therapy Lett. 2010 Mar;15(3):1-2, 5.
  9. Fulton JE, Jr., Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. Jama 210(11):2071-4 (1969 Dec 15).
  10. Grant JD, Anderson PC. Chocolate as a Cause of Acne: a Dissenting View. Mo Med 62:459-60 (1965 Jun).
  11. Kaur N, Chugh V, Gupta AK. Essential fatty acids as functional components of foods - a review. J Food Sci Technol. 2014 Oct;51(10):2289-303. doi: 10.1007/s13197-012-0677-0. Epub 2012 Mar 21.
  12. Mitsui T. Cosmetics and skin: acne. From the book: New cosmetic science. Elsevier Science, 1997.
  13. Pawin H, Chivot M, Beylot C, Faure M, Poli F, Revuz J, Dréno B. Living with acne. A study of adolescents' personal experiences. Dermatology. 2007;215(4):308-14.
  14. Purvis D, Robinson E, Merry S, et al. Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school students. J Paediatr Child Health 2006 Dec;42(12):793-6.
  15.  Schäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001 Jul;145(1):100-4.
  16. Truswell AS Glycaemic index of foods. Eur J Clin Nutr. 1992 Oct;46 Suppl 2:S91-101.
  17. Wei B, Pang Y, Zhu H, Qu L, Xiao T, Wei HC, Chen HD, He CD.The epidemiology of adolescent acne in North East China. J Eur Acad Dermatol Venereol. 2010 Aug;24(8):953-7. doi: 10.1111/j.1468-3083.2010.03590.x. Epub 2010 Mar 10.
  18. Yosipovitch G, Tang M, Dawn AG, Chen M, Goh CL, Huak Y, Seng LF. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-9.