The Mechanisms Behind Acne

Acne is the most common of all skin complaints, it can affect anyone at any age but is most common in teenagers and young adults. It’s estimated 80-95% of adolescents will experience acne at some point, with those older than 25 40-50% have some degree of facial acne. Sufferers often loose confidence, feel embarrassed or ashamed of their skin.

The precise mechanisms of acne are still not fully understood, our individual genetic makeup can influence how our body responds to daily stimuli. We are all individuals and therefore what triggers acne in one person will not be the same for another. However we do know that along with our individual genetics and indeed as part of those genetics, acne is characterised by a complex interaction of various hormones, bacteria and inflammation.

Laurel has described acne as, ‘burdened skin making up for burdened organs or systems elsewhere in the body’. The skin is an organ, and along with the liver and kidneys plays an important role in detoxification and elimination. Supporting the livers ability to detoxify is important when addressing acne. When the liver becomes overwhelmed (burdened) internally the skin then becomes burdened as it takes on more responsibility for elimination.

The influence that stress has on acne shouldn’t be ignored. Doctors have hypothesised that the chemical changes induced by stress may alter the normal intestinal microflora. This can increase intestinal permeability contributing to increased inflammation which in turn can increase sebum production. It can become a vicious cycle with acne becoming worse due to stress and and our stress increasing because of the acne.
There are several aspects of the diet that contribute to the development and progression of acne, both from a preventative perspective and a therapeutic one.
Lets take a slightly closer look at some of these mechanisms driving acne. Each of these topics could have full blog all of their own, but for the moment I’ll try to keep it brief!

Hormones, Bacteria and Inflammation

Hormones play a role in stimulating the cells lining the pores that produce keratin, and in the production of sebum. Overproduction of keratin and or sebum can cause the pores to become blocked. When the pores become blocked bacterium within the pores can overgrow releasing enzymes that will promote inflammation. Excess androgens (including testosterone) cause the sebaceous glands to become enlarged and produce more sebum.

People with acne tend to have lower levels of a protein called, sex hormone binding globulin (SHBG), that would normally bind to testosterone for removal. So testosterone is not removed and an excess can develop. In addition those with acne show a higher amount of an enzyme, 5-alpha-reductase, that converts testosterone to the more potent, dihydrotestosterone (DHT), causing even more pore enlargement and sebum production.

Recent studies have examined the role of the hormone, insulin-like growth factor (IGF-1) in the development of acne. IGF-1 promotes cell growth and is naturally higher during puberty. Elevated levels of IGF-1, also lead to increased sebum production and over production of the cells in the sebaceous follicles.


Detoxification, Digestion and Elimination

Acne clients often find it odd that some of the first questions I ask when discussing acne, involves their digestive and liver health, what can that have to do with the condition of their acne? Well quite a lot as it happens.

For the body to efficiently remove waste and toxins we need every organ and the systems that those organs are apart of to work efficiently. The cells of our body create waste products every day – metabolic waste. In addition to this we have waste from digestion, environmental toxins that we pick up through our daily lives, in the food we eat, the water we drink the pollution in the atmosphere etc. Our body has to process and eliminate all of this.

An unburdened body would do this with ease, but there are very few people who don’t carry some level of burden affecting the livers ability to metabolise and process, the kidneys ability to filter and purify, an efficient lymphatic system to pump waste from the tissues.

The intestinal microflora have the ability to influence not only systemic inflammation, but oxidative stress, glycemic control (more on that later), tissue lipid content (more on that latter too) and even mood (stress!). So these tiny little bacteria pack a huge punch, maintaining balance and diversity of our intestinal microflora is crucial for all aspects of health, including acne.

When the balance is disrupted a state of dysbiosis develops, and can contribute to the development or further progression of acne. Conventional treatment for acne often includes an oral antibiotic and initially this will often improve acne but unfortunately antibiotics kill of our own intestinal microbiota.

Diet

There are several dietary factors that play a role in the development and progression of acne, both from a preventative perspective and a therapeutic one.

Carbohydrate and Refined Sugar

As far back as the 1940’s, acne has been referred to as ‘diabetes of the skin’, when studies suggested impaired skin glucose tolerance, insulin insensitivity or both were implicated in the development of acne. Insulin is used by the body to convert glucose into energy, but excess insulin in the blood stream can cause an increase in IGF-1 and increase the conversion of testosterone to DHT (those hormone again!).
Diets high in refined carbohydrates and sugars increase the level of insulin in the body, so by avoiding these foods we can help to balance glycemic control and minimise the increase of both IGF-1 and DHT.
Fats
Fats and oils are a necessary part of our diet, they are part of the lipid family and lipids are crucial for health, they are required for cell membranes, production of steroid hormones, brain health, they provide us with fat soluble vitamins A, D, E and K. Fats are not created equal though!
Some fats increase inflammation within the body while others can reduce it. Trans-fats and hydrogenated fats found in margarine and processed foods and oxidised fats from fried foods are all known to increase inflammation within the sebaceous glands. Where as omega 3 fats are known to decrease inflammation.
Protein
Proteins are the building blocks of our cells, they form collagen and elastin, essential for skin health and ageing. When it comes to acne the amount of protein and the sources we get it from can have significant effect on the progression of acne. Animal protein contains more pro inflammatory fats compared to plant source of protein, considering reducing animal protein and increasing plant sources can be a positive change as regards acne. Changing to organic meat can also be helpful as non- organic meat often contains synthetic hormones which can up-regulate the production of IGF-1.