The development of acne is multi-factorial with a number of causes and exacerbating factors contributing to the onset and persistence of the condition. These include:
- Gut health and the microbiome – microbial residents of the gastrointestinal tract are now recognised as having wide ranging effects. Links with depression and anxiety, immune issue and skin conditions have been shown. Current thinking proposes that alterations in the microflora of the intestine brought about by factors such as stress, poor diet, allergies and some medications lead to local and systemic inflammation. This in turn promotes skin inflammation and microbial overgrowth.
- Bacteria – A bacteria species Propionibacterium acnes (P. acnes) is commonly found in the pores of the skin. Under normal circumstances P. acnes is in balance with the skin environment however when stimulated by factors such as excess sebum and pore congestion the environment is ideal for bacterial growth. Overgrowth of P. acnes triggers an inflammatory response, leading to pustules.
- Sex Hormones – High androgen production is one of the key reasons acne tends to flare up at puberty or with the menstrual cycle. Androgens stimulate the production of sebum in the skin’s oil glands. Oil glands that are blocked by dead skin cells build up sebum creating swelling. Sebum production can also be stimulated by sweat and humidity.
- Cosmetics and medications – Contact with oily substances such as mineral oil, rich creams or make up and petroleum based products can trigger or exacerbate acne. Cosmetics can also cause skin irritation which may flare-up acne. Certain medication such as stero ids can also stimulate acne production.
- Stress – There is some indication that stress can exacerbate acne by disrupting hormone levels and suppressing the immune system.
- Dietary Factors – There are a number of links between diet and acne. Diets high in trans fats, simple carbohydrates and sugars promote inflammation in the body, which aggravates acne. A high glycemic index (GI) diet is also associated with insulin resistance and increased production of androgens.
- Insulin levels – High insulin levels occur when the cells that usually take glucose up from the blood become resistant to its effects. The pancreas responds by producing more insulin creating a cycle that can lead to an increase in acne, as well as weight gain and hormone imbalances.
- Nutritional Deficiencies – Zinc, Essential Fatty Acids and vitamin A are important skin nutrients. Deficiencies in any one of these can lead to skin problems. Skin that is dry and inflamed or congested with whiteheads or blackheads may be deficient in EFAs. Skin deficient in zinc can scar very easily which is often the case in chronic acne. Adequate levels of zinc in the skin will help with skin repair and reduce ongoing scarring. Acne and rough or thick skin are also possible signs of a vitamin A deficiency. A visit to your naturopath will help identify low levels of any nutrients.