Acne 411

What wouldn’t our teenage selves have given to have blemish-free, clear and healthy skin? Um, ask Brianna! Brianna had amazing skin all through her teenage years— only to experience nondulocystic acne in her early adult life (read more here).

Mary experienced more traditional, humiliating acne that plagues teenagers everywhere. Starting around middle school, blackheads and pimples became the norm, despite her daily face washing and no-makeup regime. Trial and error as well as the hormone regulation that comes with age eventually cleared her skin. So what is the key to overcoming acne? First you need to understand it.

What is Acne Vulgaris

Acne vulgaris, the medical term for common acne, is a chronic inflammatory disease affecting hair
follicles within the pores of the skin. Acne is most common during puberty and teenage years, affecting 85% of teens! However, it is also regularly seen in adulthood.1 Characterized by open or closed comedones and inflammatory lesions, acne vulgaris generally appears, but is not limited to, the skin of the face, neck, chest and back. This multifaceted disease has a complex pathology with a number of contributing factors. Our understanding of the causes of acne vulgaris are ever evolving, there are three common presentations of acne vulgaris, each is unique in appearance:

  • Non-inflammatory Acne (blackheads)
  • Inflammatory Acne (surface-level whiteheads and pimples)
  • Nodulocystic Acne (nodules and cysts deep within the skin)

Causes of AcneHairFollicle_mine_small1

Acne is caused when skin pores become blocked and inflamed. These blocked pores may become oxidized, causing black dots (blackheads). Or they can become inflamed as the aerobic bacteria that live in the pore, Propionibacterium acnes, begin to feed off the oil secretions. Aerobic bacteria do not need oxygen to thrive, so as the pore becomes blocked off to oxygen, these bacteria replicate and stimulate the immune cells. The resulting “pus” is made by the white blood cells of the immune system as they become mixed with the bacteria and oil sections of the pore. Skin pores can become blocked for various reasons. Leading causes are from the overproduction of sebum (oily fluid released by your pores), old skin cells, and cosmetic products. Additionally, hormonal changes from puberty, dietary changes, menstruation cycling or menopause can all cause acne symptoms to increase.

Acne and Science

In regards to chocolate, there is still no clear evidence as to whether it contributes to acne lesions or not. Neither is it clear if the antioxidant rich dark chocolate is favorable over milk chocolate. But what studies have found was that there is strong evidence that high-glycemic load diets are  a contributing factor. High-glycemic diets (diets high in refined sugar and grains) lead to an increase in insulin production, which in turn causes an increase in the amount of circulating androgens (hormones) that can build up in the cells around the follicle. The high insulin levels also cause an increase in the amount of sebum (oil) that is secreted from the glands within the pores of the skin. This direct pathway suggests that avoiding high-glycemic index diets can be beneficial to minimizing acne lesions.3

Dairy is another common contributor to acne. One possibility is the unique combination of androgens milk contains, due to the hormonal state of the pregnant cow. These pregnancy hormones stimulate the secretion of androgens that build-up in the hair follicles. These are the same androgens that are released during puberty! So, when a pubescent teen drinks milk, there is further androgen production which compounds the build-up within the hair follicle, forming acne lesions. The type of milk also influences acne. Skim milk, which contains far more sugars, was more likely to influence acne lesions over whole milk. This is likely for the same reason that high-glycemic diets encourage acne development.3

Stages of AcneTypes-of-Acne-Pimples-Acne-Stages-of-Acne

Comedo – scientific term for a basic acne lesion where the hair follicle has become clogged with oil (sebum) and dead skin cells. “Comedones” refer to multiple lesions. Open comedy refers to a blackhead, while a closed comedo refers to a white head.

NOTE ON LABELING: Comedogenic is a makeup that does cause comedones, whereas noncomedogenic refers to a product that will not trigger acne.3

Blackhead – open comedones. These are clogged hair follicles that are open at the surface and often appear dark due to oxidation and irregular light refraction.

Whitehead – closed comedones. They appear white because of the immune response to the trapped bacteria.

Papules – When a blackhead (open comedo) becomes inflamed, the clogged pore turns pink or red and can become a raised lesion on the skin.

Pustules – When a whitehead (closed comedo) becomes inflamed, the closed clogged pore appears as a bump with a white pus-filled center and a red ring encircling it.

Nodules – Firm nodules that are found deep within the layers of skin. They are often hard and can be very painful. These carry a high-risk of scaring.

Cysts – Similar to nodules, with the exception that they are filled with pus and fluid. They are also found deep within the skin, hard to the touch, and can be very painful. These also carry a high-risk of scaring.

Results of Acne

Acne can affect individuals emotionally. They may try to hide their difficulties, feel shame and embaressment, or loose self-confidence. These experiences can shape a young adults future, lead to a dependence on makeup and an irrational hatred of one’s own appearence. In addition to emotional scars, acne can cause both acute skin damage and permanent scarring. Picking and squeezing can cause the inflammation and infection to spread, but resisting the urge to pick is almost impossible. There are four main forms of acne scars, each is unique in shape:typesofacnescars

Icepick – narrow pitted scares that leave the skin looking like there are small pits left behind

Rolling – low grade depressions in the skin that cause the skin to have a rolled appearance

Boxcar – deep ditch or crater is left in the skin

Hypertrophic – a raised scar that can occasionally also be hyper-pigmented

The Good News!

By targeting the sources and contributing factors of acne, it is possible to decrease the likelihood of acne scars and decrease the frequency of breakouts!Look for our upcoming articles with topical and internal treatment solutions!


1 Zaenglein, Andrea L., MD, and Arun L. Pathy, MD. “Guidelines of Care for the Management of Acne Vulgaris.” Journal of the American Academy of Dermatology 74.5 (2016): 945-73. Journal of the American Academy of Dermatology. Web. 04 Sept. 2016.

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3 Kucharska, Alicja, Agnieszka Szmurło, and Beata Sińska. “Significance of Diet in Treated and Untreated Acne Vulgaris.” Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii. Termedia Publishing House, Apr. 2016. Web. 04 Sept. 2016.

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