Educational Series: All About Acne

by | 8 May 2023

If you’re dealing with acne, know that you’re not alone.

Acne is an incredibly common skin barrier disorder that occurs not just among teenagers but adults too. It can have a negative effect on your self-confidence and leave not only visible scarring but psychological scarring too. Many individuals experience acne throughout their lives as it is a skin barrier disorder that can manifest due to numerous factors. 

Acne affects many different cells and systems that involve texture, colour and secretion of skin i.e., sebum (oil). For example, the keratinocyte and corneocyte (cells of the epidermis, the outermost layer of the skin), change the surface texture of the skin by either making it smooth, soft and compact, or congested, rough and texturised. Down in the dermis (underneath the epidermis), the fibroblast (your collagen-producing cell), causes the formation of scar tissue which can alter the outward appearance of the skin in the presence of inflammation, infection and from excoriation (picking at lesions).

 

Acneic Skin

 

Acne is connected to the inflammatory processes that change the colour of the skin, as well as the endocrine system (hormones), which stimulates the production of sebum from the sebaceous glands. It’s important to note that there is always a hormonal component involved in all forms of acne, the most commonly known is the increase in circulating androgens such as testosterone, at the onset of puberty. However, age, menopause, adrenal stress, nutrition, medication and genetics also influence the endocrine system which may contribute to acne.

Acne is a multifaceted skin barrier disorder affecting the follicles within the skin; whereby the initial events in the development of an acne lesion are abnormal cell-turnover (exfoliation), as well as incomplete corneocyte compaction (textural issues such as congestion). Both instances contribute to the formation of closed and open comedones (whiteheads and blackheads).

Oily Acne 

Circulating androgens stimulate the production of sebum within the sebaceous glands causing the skin to become oily and congested. A series of events create an environment for the bacteria, Cutibacterium acnes (C.acnes), to grow and multiply (not good!). The C.acnes bacteria is responsible for creating acne, and although mainly commensal and part of the skin’s microbiome, it may have a propensity in certain circumstances to become pathogenic and perpetuate the local inflammatory response causing the acne to worsen.

Dry Acne

Not all acne will be oily, in fact, there is such a thing called “dry acne.” This is where the surface of the skin can become increasingly dry when the individual has a genetic predisposition to having a “lipid-dry” skin type, or they have been using products that strip their skin; damaging the pH of the acid mantle, causing impaired enzyme activity, and forcing the sebaceous glands to overcompensate sebum in an attempt to help rebuild the first three lines of skin barrier defence.

 

Acne treated with dermaviduals

 

Hormonal factors that contribute to acne

Let’s take a look at the four main hormonal factors that contribute to the disorder of acne, followed by other contributing factors that may support you when it comes to investigating the underlying cause of your acne…

Impaired Acid Mantle

The acid mantle is an invisible protective film composed of oil and water that is home to an ecosystem of bacteria. An impaired acid mantle occurs with daily stripping, harsh cleaners, toners, exfoliants and treatment modalities that are said to remove “dead skin cells” (by the way, so not true!). Removal of the acid mantle results in dryness, poor wound healing, as well as raises the risk of scarring due to the skin being unprotected.

Poor Corneocyte Compaction & Desquamation

Occurs when there is a build-up of corneocytes (skin cells) on the surface and within follicles, which may cause the formation of open or closed comedones to occur. Instead of undergoing normal skin cell turnover, the progressive accumulation of corneocytes leads to further blockages and textual skin issues such as congestion.

Cutibacterium Acnes (C.acnes)

C.acnes is both a commensal and opportunistic bacteria that is linked to the development of acne depending on the strains associated. Yes, not all C.acnes bacteria are bad! C.acnes resides within the acid mantle, follicles and sebaceous glands. When there is an elevated production of sebum by hyperactive sebaceous glands and/or blockages of the follicle, this can cause the opportunistic C.acnes bacteria to grow and multiply; creating an environment of inflammation causing the acne to worsen in its appearance.

Refined Carbohydrates (glucose)

Refined carbohydrates are quickly absorbed into the bloodstream which in turn causes a resurgence in blood sugar levels. When blood sugars rise, insulin levels also rise to help shuttle the blood sugars out of the bloodstream and into your cells, and high levels of insulin are an aggravating factor for those with acne. One study found those who frequently consume added sugars had a 30% greater risk of developing acne, while those who regularly consumed pastries and cakes had a 20% greater risk of developing the skin disorder. This increased risk may be explained by the effects carbohydrates have on blood sugar and insulin levels.

How does insulin work?

Due to our overwhelmingly Western diet, we are eating far too much glucose and this is having a detrimental effect on our skin. In regards to hormones, insulin makes androgen hormones more active and increases insulin-like growth factor 1 (1GF-1). This growth factor increases the rate at which a chemical reaction occurs, thus contributing to acne by making cells grow more quickly and boosting sebum production!

Other contributing factors include:
  • Hormonal imbalances such as testosterone and oestrogen
  • Essential fatty acid deficiency (EFAD)
  • Changes in sebum composition (thick and viscous)
  • Excess sebum
  • Impaired skin barrier defence
  • Inflammation of the innate/adaptive immune systems
  • Changes in the skin surface microbiome (damaged pH of the acid mantle)
  • Steroids (oral & topical)
  • Acidic food groups
  • Nutritional deficiencies
  • Excessive alcohol consumption
  • Poor quality skincare, make-up and haircare products

So, what can be applied topically to support the acneic skin?

  1. Cleanse with mild cleansers that will not strip the acid mantle, or cause redness or tight stinging sensations. We recommend the use of a dermaviduals cleanser that can be individually customised for your skin type and conditions by one of our Practising Corneotherapists.
  2. Daily protection should begin with the application of healing actives to each individual blemish or area affected. These healing actives should contain anti-inflammatory and bacterial agents such as Azelaic Acid, Provitamin B5, Niacinamide B3 and Zinc, as well as Vitamins A, C, and E to help regenerate the connective tissue.
  3. SPF is part of daily protection, and it is well known that UVA exposure can cause a great deal of damage to the dermis, causing premature ageing and compounding scar tissue. Under no circumstances should any type of acne be deliberately exposed to UVR with no sun protection, as you will worsen existing post-inflammatory erythema and scar tissue. We recommend the use of the dermaviduals Suncream SPF 15 as it is a lightweight, non-greasy and broad-spectrum formulation that replenishes and protects the skin from solar radiation. Always work in synergy with antioxidants underneath your sun protection for a full system of defence and to prolong the effects of your suncream.
  4. In-clinic facial treatments are highly beneficial, as our dermaviduals facial treatments are custom-tailored to your skin’s needs and concerns. Your practising Corneotherapist will assess your skin and decide on the appropriate topical actives and masks to help repair, replenish and regenerate your skin barrier.
  5. When it comes to makeup, do not buy cheap foundation (cheap usually means harsh chemicals) to cover your acne, it is always worth investing a bit more to get the right products. We recommend the dermaviduals deco foundation as it is a skin-mimicking formulation that has anti-inflammatory, antioxidant and antibacterial properties. It works with the skin and not against it, unlike other foundations that generally dry the skin out and/or promote comedone formation.

Working in conjunction with a naturopath who specialises in the endocrine system and gut dysbiosis is highly encouraged, as there is always a hormonal component involved when it comes to the acneic skin.

There are many underlying causes and triggers as to why an individual is presenting with acne, and the truth of the matter is, there could be multiple causes of acne and also many treatment options. The first step is finding your closest clinic and having a skin consultation with an educated skin treatment therapist. 

To find your local dermaviduals stockist and to get your personalised skincare prescription, check out our clinic finder.

Written by Kai Atkinson