Acne is a common and complex skin condition that affects people of all ages. Acne affects to a certain extent 85% of the population aged 11 to 30 years. Mild acne has been defined as up to 10 lesions, moderate acne between 11 and 25 lesions, and severe acne as more than 25 lesions. It is not a life threatening condition; However, it takes years and can cause physical and emotional scars. Nevertheless, acne may play a role in many endocrine disorders, including polycystic ovaries, Cushing’s syndrome, congenital adrenal hyperplasia, and acromegaly. Other non-endocrine diseases associated with acne include Apert syndrome, SAPHO syndrome, Behçet syndrome and PAPA syndrome. The general knowledge about the causes, the natural history and the treatment of acne is very low, not only in the general population, but also among medical students in the last year and even among GPs and nurses, where myths and misunderstandings are still in practice.
Acne is a disease of the sebaceous gland unit [PSU], which consists of sebaceous glands associated with the hair follicle. These sebaceous glands produce an oily substance called sebum, which normally opens to the skin through the opening of the follicles. The pathology of acne is caused by four key factors: excessive sebum production, hair follicle proliferation and constipation, Propionibacterium acnes (a normal anaerobic resident of the skin surface), colonization and inflammation. Acne begins with the formation of hardened sebum or the oily substance that is released through the sebaceous glands onto the skin. This will then be infiltrated by acne-infecting bacteria, which in turn cause the immune system to release white blood cells to block the attack of the bacteria. When this happens, dead white blood cells and bacteria accumulate in the hair follicles, mixed with skin remnants and dead skin particles. When the walls of this clogged follicle collapse, it all begins to spill out like sebum, bacteria, and shed skin cells, resulting in lesions and pimples, also known as pimples. Acne lesions essentially occur on the face, back, chest, neck and shoulders. Thus, acne is a term for clogged pores [blackheads and whiteheads], pustules and even deeper lumps [cysts and nodules] that occur in different parts of the body.
Acne vulgaris is a leading skin disorder regardless of skin color or age. Acne infantile is the term for acne that grows on newborn babies, on the other hand acne rosacea is related to middle-aged people. A recent practice study, conducted at the Skin of Color Center in New York City, found that acne is the most common diagnosis in black and white patients. As a form of skin disease, the good news is that acne is not transmissible.
Although the exact cause of acne is still unknown, there are three major factors: hormone, diet and environment. Some of the examples of these factors are listed here:
- Hormonal changes in adolescent girls and adult women: One of the main factors is the sudden onset of androgens, which occur more frequently during puberty and lead to increased sebum production. The use of birth control pills can also lead to outbreaks.
- Inheritance or genetics: Children tend to have acne from their parents and are often compromised by the use of drugs such as androgens and lithium.
- Environment: Irritants such as industrial pollution or natural factors such as high humidity, sun exposure, seasonal changes and climate can trigger an acne attack.
- Excessive secretion of oil after using skin products such as moisturizers and cosmetics and certain types of makeup can also cause an outbreak. Allergic reactions to components in cosmetic products can cause acne to break out.
- stress and anxiety. Stress can induce the release of certain bioactive molecules that can potentiate inflammatory factors that are released. It is reported that the skin and the mind are connected.
A difference in the prevalence of acne between non-westernized and fully modernized societies was noted and diet was suspected as the reason. This question regarding diet and acne is not a new topic and has been discussed for many years. It was reported that acne was absent in the Inuit (Eskimo) population when they still lived and ate in their traditional way. The prevalence of acne after their acculturation was similar to that in western societies. In some rural African.
Recently, an analysis of 1,200 Kitavan (Papua New Guinea Islanders) individuals, including 300 aged 15 to 25 years, and 115 Ache (Paraguayan hunter-gatherers) individuals including 15 aged 15 to 25, did not find any single case of acne of any class. The diet of Kitavan and Ache mainly contains traditional foods that are cultivated locally, so the absence of acne in these societies is due to environmental factors, mainly local diets that have a significantly lower glycemic index than the Western diet. This does not disregard the hypothesis that an alternative explanation for the low prevalence of acne in these non-westernized populations is the genetic susceptibility to acne, especially as people in these isolated regions live in close-knit and closed communities.
Despite the debate, many Western teenagers and their parents believe that food is a primary factor. A recent survey of adolescents found that as many as 62% to 72% felt that diet, despite the medical guidelines since the 1960s and 1970s, helped to reduce the importance of diet for acne, and that the condition was predominant attributed to genetic predisposition and hormonal influences. Recently, there was a reassessment of the diet and acne connection. The dietary components that have recently been re-evaluated for acne are dairy, high glycemic index foods, fat intake and fatty acid composition. Several studies have shown that higher milk intake is associated with acne risk. However, these studies suggest only a correlation but no causality and should be evaluated with caution. As the association with skim milk was stronger, it suggested that it was not the fat content in the milk that was the culprit. Researchers speculate that milk contains hormones and bioactive molecules such as androgens, progesterone and insulin growth factor-1 (IGF-1) or iodine, all of which can have an acne-stimulating effect. The effect can be stimulated via a genetic pathway involving the FoxO1 transcription factor. This suggests that acne is certainly a disease with a genetic background and other factors induced by environmental factors in industrialized countries due to growth factor-mediated effects on the genetics of acne. One study also links acne and cancer with the exogenous hormones in dairy products. Learn more about the effects of these hormones in our book “Is Your Food Killing You?” Chocolate, oily or fatty foods, and high-sugar foods have been repeatedly referred to as acne-causing or aggravating acne, but no convincing evidence for such a compound has been found.
There are many other environmental pollutants besides added hormones and bioactive molecules intentionally added to our foods that can cause acne. In rare cases, pollution can result in a variant of acne called chloracne. Environmental acne results from various chemical exposures and the eruption can be mild or severe. One such example is the Japanese yusho incident in which the ingestion of rice oil contaminated with polychlorinated biphenyls (PCBs), polychlorinated quarterphenylene, and 2,3,4,7,8-pentachlorodibenzofuran caused acne such as eruptions. Another similar incident occurred in Yucheng in Taiwan. In our book “Will Your Food Kill You?” We discuss in more detail how these environmental pollutants enter the food chain.
Most mild acne can be treated with over-the-counter medications. Standard acne therapeutics include oral antimicrobials, isotretinoin and hormonal agents. The main limitation of the current antibiotic treatment for acne is the increase in antibiotic resistance. Although isoretinoin therapy is very effective, it has many potential side effects. These include dry skin, lips and eyes, headache, diminished night vision and, less commonly, benign intracranial hypertension. It can also lead to an increase in liver enzymes and hypertriglyceridemia; The latter may possibly trigger acute pancreatitis. In addition, isotretinoin is a highly teratogenic agent, especially if it is used within the first trimester of pregnancy.
Vitamins have been linked to reduce the side effects of isotretinoin, although this effect is controversial. Synthetic vitamins are commonly used in cosmetics for the prevention and treatment of acne. It has been reported that in 100 patients with acne (compared to controls) systemic levels of vitamins A and E were lower overall; The lower the vitamins A and E, the heavier the acne. It is likely that blood levels of antioxidants are more easily consumed in acne patients because there is a greater demand to deal with free radicals that are produced by acne during skin stress. Various forms of Vitamin C (ascorbic acid) are used in lotions, creams, serums and patches. However, active L-ascorbic acid is such an excellent antioxidant that it is inherently unstable and turns brown when turned to air when oxidized to dehydroascorbic acid. Therefore, the shelf life of most formulations containing pure Vitamin C is short. Vitamin D metabolites may be important for growth regulation and various other cellular functions in sebaceous glands, making the sebaceous glands a promising target for vitamin D analogue therapy. Omega-3 fatty acid is another supplement to cosmetic products for the treatment of acne. An analysis of several cosmetic products containing omega-3 fatty acid supplements has not shown conclusive evidence that they help treat acne.
Hormone therapies used in acne include antiandrogens (androgen receptor blockers) and agents intended to reduce the endogenous production of androgens by the ovary or adrenal glands such as estrogens, oral combination contraceptives (OCs), low dose glucocorticoids or gonadotropin releasing hormone ( GnRH) agonists. The use of OCs for acne is controversial because of their possible side effects. If you know that you are not the only person who is infected with acne at any point in your life, a new understanding of acne will help emerging medicines show potential for the future.
While scientific research continues to be debated and reviewed, the best approach is to individualize a nutritional plan and focus on a healthy diet, as diet appears to indirectly play a role in the treatment of acne. Continue reading on acne research and help fight it.