What Causes Acne?

It's so "vulgar" to get affected with acne vulgaris. People will keep looking at you as if they are trying to examine some of your "character" traits. Some people will even throw jokes at you by comparing you with some fruit which is on the verge of getting ripe. And the marks! They will make you carry a small mirror with you all the time wherever you go and whatever you do! Looking at the red bumps and their remains in the form of scars over and over in the mirror may become a habit with most of us. The obvious question will strike us - "Why me?" So why does acne show up its unsightly heads? Here are the "Why-s":

1. Overactive Oil Glands: Oil glands, also known as sebaceous glands, are located deep in the skin. These glands are connected to a tiny canal called a follicle that contains a hair. The oil produced by these glands, also known as sebum, flows to the surface of the skin through these canals (skin pore) to lubricate the hair follicles and the surrounding skin. The oil glands are stimulated to produce oil by hormones, specifically the male hormones called androgens. During times of stress or puberty, the oil glands become overactive in response to the hormonal changes, hence causing acne.
2. Stress: Stress can have many physiological effects on our body, including changes in our hormones that may theoretically lead to acne. In some cases, stress may actually be caused by the acne lesions, not the other way around! If the acne is being treated effectively, stress is not likely to have much impact on the majority of people. Medical studies have demonstrated that stress can provoke acne lesions. That is because stress can impact a series of biological functions that include food digestion and immune function.
3. Bacterial Attacks: A bacterium, known as Propionibacterium acnes (P. acnes), is a normal inhabitant of the skin. For growth purpose it uses sebum as a nutrient and increases in the follicles during puberty. People with acne have more Propionibacterium acnes in their follicles than people without acne. The bacteria also causes the formation of free fatty acids. These are irritants which increase the inflammatory process in the follicle.
4. Genetics: Facial oiliness is another factor to be pre-conditioned for acne. The genetic makeup of a person partly affects the degree of oiliness that an individual experiences.
5. Blockage of Skin Pores: Acne develops when some of the skin pores (through which oil/sebum normally flows from the oil gland to reach the skin surface) become blocked, resulting in trapping of sebum within the skin pores. The process of obstructing follicles is called comedogenesis, and the resulting type of acne is called comedones. This blockage is often caused by poor hygiene. When the pores get blocked, they may lead to the following skin conditions:
   • Blackheads: Blackheads are formed when pores become clogged to the surface of the skin. Since they are at the surface, blackheads are not usually inflamed. There is a dark pigment present in them and this gives blackheads their characteristic dark color.
   • Whiteheads: These develop from a deeper blockage. The oil accumulates on the skin because they can't find a drainage outlet and hence causes small flesh colored or white colored bumps. Unlike blackheads, whiteheads are more likely to lead to the red inflammations known as pimples or zits.
6. Inflammation: Redness, itching, swelling, warmth and discomfort are the characteristics of inflamed skin. The body's immune system acts to get rid of the foreign substance that has attacked the skin. This is when the inflammation is caused. In case of acne, this substance is either bacteria or the irritating compounds that they have produced. Inflammation may lead to:
   • Pustules: When there is a rupture on the walls of the blocked follicles, pustules occur. These are also known as pimples or zits. Oil, dead skin cells and bacteria, normally found on the skin surface get into the skin and irritate it, forming small areas of inflammation.
   • Cysts: These cysts form deep inside the skin and are red inflamed areas which usually denote skin infections.
   • Papules: Papules, also known as pimples, are the most common form of acne. Papules are inflamed acne lesions which appear as small, reddish bumps on the skin without any head and do not contain pus. Their size ranges from approximately 6 millimeters in diameter to nearly invisible.
   • Nodules: Nodules are solid, raised bumps in or under the skin that are wider than 10 millimeters.
7. Hormonal Effects: Hormonal acne not only affects teenagers but also adults. The onset of acne is triggered by the production of hormones called androgens. Androgen production stimulates sebaceous glands and causes them to get enlarged. People who develop hormonal acne have over stimulated sebaceous glands. 
8. Cosmetics: Women and men alike, in their teens, twenties and even early thirties, are potential candidates for cosmetic acne.The skin's pores have a tough time dealing with the skin's own oil sebum, so rubbing in more irritating oils that are bought from outside, is one of the worst things you can do. While some people have skins capable of withstanding the damaging effects of cosmetics, an estimated 30% of all cosmetic users have skins which are acne prone.
9. Diet: Some foods like dairy products such as cheese, milk, yogurt, cream, processed foods, refined foods like bread, deep fried foods like chips and wafers, spicy foods, caffeine and alcohol have also been linked to acne. However, experts have not found a link between the diet and acne.
10. Birth Control Pills: Oral contraceptives, or birth control pills, have been used to treat acne in some women as the estrogen in them helps balance the natural levels of male hormones (androgen), thereby minimizing your skin's oil production. However, not every birth control pill will help with acne. Most pills available in the market contain both estrogen and progestin (synthetic progesterone), which are added to prevent the undesirable side effects of unopposed estrogen. Progestins can act either as androgens (that is, they can act like male hormones) or as anti-androgens (which means that they block male hormones); some progestins are essentially neutral and do neither! Therefore, the best birth control pills for acne management are anti-androgenic (contain progestins with less androgenic activity such as norgestimate, norethindrone, desogestrel, ethynodiol, or levonorgestrel), while the others can aggravate the condition.
11. Anatomy of Hair Follicles: The hair follicle is a small, tube-like opening in the skin through which hair and sebum reach the skin's surface. In acne prone skin, sebum and dead skin cells easily become trapped within the follicle. This accumulation of cellular debris and sebaceous matter forms a hard plug that obstructs the pore opening. Hence, this results in small bumps and acne.

Knowing the causes of acne or hiding your face from your guests will not allow you to make the situation better. You need to act upon the causes! And let those "curious" eyes know that the cause is not always very "vulgar"!