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Home Articles The four factors that contribute to acne

What causes acne?

In this article we explore the four major pathogenic contributors to acne

Into this article I have distilled the pertinent information about the 4 pathophysiological factors that interact together to cause your acne.

1. Excess sebum production. Basically, your sweat glands are making too much oil.

2. Bacterial colonization of the pilosebaceous duct. The bacteria that are usually involved in acne are known as P. Acnes. These bacteria are on everybody's skin. In acne, these bacteria are plentiful, and multiply inside acne lesions causing red, swollen pimples.

3. Inflammation. Every angry-looking, red acne pustule or papule or nodule is an example of inflammation.

4. Abnormal keratinization within the hair follicle. There are skin cells (keratinocytes) that are growing and multiplying too quickly, and are unable to properly slough off and exit the pore. They end up clogging the pore, leading to trapped sebum and bacteria, leading to an inflated pore, leading to acne.

All four factors may play a role in your acne, but maybe not. Some people have very little inflammation. They might have comedonal acne, with closed comedones (bumps) and/or open comedones (blackheads). Most people have mixed acne, with a bit of all types at the same time.

When you think about different contributors to acne, consider which one of these pathogenic factors may be affected. For example, if you don't wash your face enough, you may be worsening #4, by not encouraging healthy skin care turnover. But if you wash your face too much, your skin may respond by over-producing sebum, contributing to #1. The right face wash can also affect #2, by discouraging proliferation of P. Acnes.

Every acne treatment affects one or more of these factors. The only treatment that affects all four simultaneously is isotretinoin (Accutane). Many of you know that Accutane is a medication that has many side effects, and for this reason is really reserved for the most severe, treatment-resistant acne.

If your acne care provider has prescribed oral antibiotics, that will help with #2 and #3. Low doses of antibiotics, typically 50mg of minocycline per day or less, will decrease inflammation but not affect bacterial colonization. Topical retinoids (Retin-A, Azelaic acid, Differin) affect #4 by promoting skin cell turnover. Benzoyl peroxide and topical sulfur are antibacterial and anti-inflammatory.

As you can see, acne is an imbalance that has multiple contributors and various methods of treatment. Depending on your type of acne, different treatment approaches may be more or less effective. Your provider at Bellevue Acne Clinic will collaborate with you to devise a treatment plan to fight your acne.