Acne: Pathogenesis & Causes

Acne is a chronic, inflammatory skin disorder that develops around the pilosebaceous units (compromising hair follicles, hair shaft, and sebaceous gland) and commonly affects the face, chest, upper back and arms. Acne is mostly hormonally driven (excess androgen or cortisol) and inflammation occurs as a by-product of imbalanced hormones.

Acne commonly occurs in adolescents & young adults although it can also occur spontaneously in the older adult. Whilst genetics & hormones play an integral role in the pathogenesis of acne, nutritional & lifestyle factors are also implicated in its pathogenesis.

The top nutritional & lifestyle causes of acne are as follows:

1. Change in hormones

2. Androgens (endogenous or exogenous) play a large part in the pathogenesis of acne. Testosterone and 5-alpha reductase production disturbs the skin barrier function and elicits an inflammatory response resulting in excess keratin production. Androgens are elevated in conditions such as PCOS, which you can read more about here.

3. Stress

   Stress activates the hypothalamic-pituitary-adrenal axis and sympathetic nervous system secreting various inflammatory cytokines and aggravating acne. For strategies to manage stress, read my previous post on the top 25 ways to manage stress. 

4. An inflammatory diet

   An inflammatory diet (such as a Standard American Diet (“SAD” diet)) increases oxidative stress and sebum production. Excess sebum blocks pores and allows the growth of bacteria on the skin resulting in inflammation and the development of a pimple. Individuals with acne will have up to 59% more sebum compared to individuals without acne.

5. A sedentary lifestyle

   The lymphatic system is responsible for carrying waste material and toxins throughout the body. A poor lymphatic system will result in diminished filtration and accumulation of waste material and toxins. The body will then remove the waste products through the skin.

6. A diet high in sugar & dairy

   Sugar is rapidly digested and spike insulin levels in the blood which drives androgen production increase sebum production and blocks the sebaceous glands. Dairy increases insulin-like growth factor levels which trigger acne.

7. Gut dysbiosis

   Gut dysbiosis (an ‘imbalanced’ gut) and enhanced intestinal permeability (“leaky gut”) allow toxic metabolites and endotoxins to enter the digestive system which then promotes an inflammatory cascade, and stimulates excessive sebum production and proliferation of P. acnes.

8. Nutritional deficiencies

   Several studies have found decreased serum levels of antioxidants (Vitamins A, C, and E, and selenium) and glutathione in acne patients.

If you would like further assistance with acne and managing your skin symptoms, reach out for a consult here and/or send me an email at judy.c.nutrition@gmail.com

REFERENCES

Brando-Neto, J., Madureira, G., Mendonca, B., Bloise, W., & Castro, A. (1995). Endocrine Interaction Between Zinc and Prolactin: An Interpretative Review. Biological Trace Element Research, 49, 139-149.

Masterson, K. (2018). Acne Basics. Journal Of The Dermatology Nurses’ Association, 10, S2-S10. doi: 10.1097/jdn.0000000000000361

 Pappas, A., Johnsen, S., Liu, J., & Eisinger, M. (2009). Sebum analysis of individuals with and without acne. Dermato-Endocrinology, 1(3), 157-161. doi: 10.4161/derm.1.3.8473

Toyoda, M., & Morohashi, M. (2001). Pathogenesis of acne. Medical Electron Microscopy, 34(1), 29-40. doi: 10.1007/s007950100002