Hi my skincare lovers, how is everyone doing today?
I’m so excited to be delving into this topic with you guys. I understand how acne can be such a difficult topic to talk about, we’ve all had to deal with the ups and downs and for many of us, it’s still an ongoing emotional journey.
Having problematic skin can be a burden to carry and can make anybody feel vulnerable or insecure. Over the past few years, it has been so great to see that the sigmatism around body image issues and confidence around physical appearances becoming the “norm” to talk about! Although, when it comes to sharing about problematic skin, there has been a very little amount of people that are often open and unfiltered about their personal experiences on social media platforms.
We’re also living in a time where skincare is talked about quite frequently, and most of the current beauty trends that you see online are catered around having “glowy skin” and “that natural no makeup, makeup look.” Of course, a common misconception that we sometimes often hear about is how people feel like they don’t have “good enough skin” to have that minimalist and sheer makeup look. It certainly makes me sad to hear this, as I feel like not only myself but so many other people can empathize with this.
So, I hope that with this entry I can enlighten and educate you all a bit about Acne Vulgaris so that we can work together to tackle it from its very roots!
What is Acne Vulgaris?
Acne Vulgaris is a common multifactorial inflammatory condition that affects the pilosebaceous unit (this includes your hair follicles and their accompanying sebaceous glands). It is often characterised by an eruption of papules, pustules, comedones and/or nodulocystic lesions that can be accompanied by a varying degree of scarring.
Did you know that acne is estimated to affect approximately 9.4% of the global population and is the 8th most prevalent condition in the world! Looking into the statistics I found that on average, 85% of adolescents from the ages between 12-19 suffer from acne to some degree. However, as most of you are probably aware, acne vulgaris can definitely still persist well into adulthood. In fact, studies have shown that in women ages 20-29 years there has been a prevalence rate of 50.9%.
What causes Acne Vulgaris?
Acne can typically appear on the face, chest, upper back, and shoulders. This is because these areas of skin have the most amount of sebaceous (oil) glands present. Have you ever wondered how a pimple is formed? Well, there are 4 main factors that are involved.
1. Increased/ altered sebum production due to Hormones
One of the main causes of acne is a surge in hormones called androgens (specifically testosterone in both men and women) that can cause sebaceous glands to enlarge and trigger an overproduction of sebum at the pilosebaceous hair follicle. These hormones often tend to be at their peak during puberty
2. An abnormal build-up of keratin and dead skin cells
This can lead to an excess amount of sebum becoming trapped within the hair follicle. It is unable to escape due to the follicular opening of the hair being too small, therefore, it is obstructed resulting in an abnormal gathering of desquamated corneocytes (dead skin cells) in the sebaceous follicle.
3. Overgrowth of C. acnes in the hair follicle
Gram-positive Bacteria (C. acnes) residing within the pores can infect the sebum filled follicle, hydrolysing the sebum into free fatty acids (FFAs). FFAs can then worsen the inflammation, and the inflammatory oedema can increase follicular obstruction.
When follicles become plugged, bacteria (C. acnes) can begin to grow inside the follicle causing inflammation, there is an increased blood flow to the area (vasodilation) and fluid leakage into the tissue around the hair follicle. This can lead to an erythematous papule, nodule, or cyst.
Other factors that can trigger acne:
- Genetics: The exact predisposition is unknown, however, the number, size and activity of sebaceous glands can be inherited.
- Lifestyle factors: Smoking and alcohol consumption can affect the way oxygen and nutrients are delivered to the skin. They are both oxidative stress-inducing toxins that provoke an inflammatory response and can slow down the body’s natural healing process.
- Diet: A high glycemic index (GI) diet including carbohydrates and refined sugar can cause a spike in insulin levels which can stimulate the secretion of androgens and cause an excess production of sebum. Some also find that dairy and milk products cause their acne to flare.
- Picking or squeezing: No matter how tempting it is, this is the worst thing you could do!! Picking or squeezing at acne lesions can introduce new bacteria or push it deeper into your skin. When this happens, it increases inflammation, which can lead to more-notice-able acne and scarring.
- Stress: This can increase levels of stress-related hormones such as cortisol, which can send sebaceous glands into overdrive causing acne to flare.
- Certain medications: Such as corticosteroids, anticonvulsants, antidepressants (lithium), androgenic steroids and medications containing bromines or iodines, can cause acne-like eruptions – *Make sure to speak to your GP first before ceasing any medications*
- Fluctuating hormone levels/ hormonal imbalances: Fluctuating hormones can play a role and is especially common in women. Factors that can contribute to this include menstruation and menopause. Women with Polycystic ovarian syndrome (PCOS) may also experience acne as a symptom of the condition, this is due to an overproduction of androgen. Other symptoms such as menstrual irregularities and hirsutism (excessive hair growth) may also be linked to acne vulgaris.
- Comedogenic cosmetics: Heavy creams, oils or moisturises can clog your pores and congest the skin leading to increased oil production that can exacerbate breakouts and cause further irritation. For example…
- Oils: Palm oil, coconut oil, Flaxseed oil, marula oil, moringa oil, soybean oil and wheat germ oil
- Lanolin’s: Lanolin, lanolin oil, acetylated lanolin, acetylated lanolin alcohol, PEG 16 lanolin (Solulan 16)
- Emollients and Emulsifier: Coca butter, coconut butter, oleth-3 phosphate, Laureth-4. *Some non-comedogenic emollients include petroleum and shea butter (non-irritating)
- Fatty acid:Lauric acid, wheat germ glyceride, stearic acid
Grade 1 (mild) – Mostly non-inflammatory acne (open and close comedones) with a few papules and pustules
Grade 2 (moderate) – Multiple comedones with occasional papule or pustule
Grade 3 (Moderately severe) – Many comedones present, papules, pustules along with occasionally inflamed nodules.
Grade 4 (Severe) – Severe nodulocystic acne with numerous large, painful, and inflamed pustules and nodules
What are the complications of Acne Vulgaris?
Post-inflammatory hyperpigmentation (PIH): Those dark hyperpigmented marks left behind after a pimple heals can be quite aggravating. When the skin’s barrier is disrupted PIH can occur as a response to cutaneous inflammation, this causes cells that produce melanin (melanocytes) to go into overdrive resulting in an overproduction of melanin. This tends to be rather persistent and longer-lasting for those with skin-of-colour (Fitzpatrick IV-VI).
Scaring: Acne can sometimes lead to unwanted scarring that can affect the quality of life, especially as a teen or young adult. These scars can present as thick fibrotic (hypertrophic or keloid) scars that are associated with excess collagen deposition, or they can present as depressed (atrophic) scars.
- Ice pick scars (less than 2mm): Narrow, deep and sharply demarcated tracts that taper to a point at the base and extend vertically to the deep dermis or subcutaneous tissue.
- Boxcar Scars (1.5-4mm): Look like round to oval depressions that are wider than ice-pick scars with sharply demarcated vertical edges.
- Rolling Scars (4-5mm): Are wider than ice-pick or boxcar scars and give the skin a rolling or uneven appearance. This is due to the abnormal fibrous tethering to the dermis or subcutaneous tissue.
I hope that I was able to provide you a bit of information about Acne Vulgaris. Healing is not always easy and takes time, so, remember to take it one step at a time. It’s not easy dealing with problematic skin, but I’m right here with all of you to help guide you through the best skin care advice! Stay tuned for more upcoming posts where we’ll talk more about specific products and ingredients that are recommended for your skin. Until next time –
*Please refer back to your doctor or dermatologist for your condition and medical advice if you are unaware of the risks, to prevent any side effects*