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Acne Treatment & Care

Module 01

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1. Module 01: what is Acne

Table of Contents

1. Module 01: what is Acne ................................................................................................................... 1

1.1 Introduction ............................................................................................................................................... 2

1.2 What is acne? ............................................................................................................................................. 2

1.2.1 How does acne develop? .................................................................................................................. 2

1.2.2 Types of acne .................................................................................................................................... 3

1.2.3 Who gets acne? ................................................................................................................................. 4

1.3 Causes – Hormones .................................................................................................................................... 4

1.3.1 Testosterone and DHT ...................................................................................................................... 5

1.3.2 Periods .............................................................................................................................................. 5

1.3.3 Pregnancy .......................................................................................................................................... 5

1.3.4 Polycystic ovary syndrome ............................................................................................................... 6

1.3.5 Teenagers .......................................................................................................................................... 6

1.3.6 Birth control pills ............................................................................................................................... 6

1.4 Causes – Diet .............................................................................................................................................. 7

1.4.1 Cordain’s study ................................................................................................................................. 7

1.4.2 Mann’s study ..................................................................................................................................... 8

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1.1 Introduction

Welcome to your acne treatment course! In this first module, we’ll explore what acne is, how it is created

by the body, and the causes behind it. In the first section, you’ll learn about how acne develops, the types of

acne, and who most commonly suffers from it. Next, we’ll look at how hormones can cause acne, with

sections on testosterone and DHT, periods, pregnancy, PCOS, teenagers and birth control pills. The next

section is all about diet, showcasing two important studies that have indicated a strong link between diet

and acne. Following that, you’ll learn about various lifestyle habits that can contribute to acne, before the

module finishes up with a discussion about how genetics is relevant here.

1.1 What is acne?

1.2 Causes – Hormones

1.3 Causes – Diet

1.4 Causes – Lifestyle

1.5 Causes - Genetics

1.2 What is acne?

Acne is a disease which affects the oil glands in the skin. In this section, you’ll learn the science behind how

acne develops, and learn about who can get acne. This will serve as a preparation for you as this module

teaches you about a number of different causes of acne, showing you why people suffer from this condition.

1.2.1 How does acne develop?

There are small holes in your skin, which are known as pores. Pores are connected to oil glands underneath

your skin, via a follicle, a narrow channel. The oil glands produce sebum, and this sebum carried dead skin

cells to the surface of your skin through the follicle. In addition, a very thin hair grows through the follicle

and out of the skin.

The cells that form the walls of the follicle are called keratinocytes. These are the dead skin cells that, in

healthy skin, are pushed out of the skin by the growing hair inside the follicle.

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Sometimes, the hair, sebum and skin cells clump together in what is known as a plug. The bacteria in this

plug cause swelling, and when this plug breaks down, a blackhead or whitehead will form. Blackheads and

whiteheads are known as comedomes.

If the clogging is so severe that it causes the follicle wall to break under pressure, sebum leaks into nearby

tissue and forms a papule or pustule. This is how inflammatory acne develops.

This clogging can happen because there is 1. An excess growth of the skin cells, and/or 2. a condition

called hyper keratinization. Keratin binds the skin cells together, but when there is too much, the bonds

between the cells can’t break so they stick together and clog the follicle.

The oil glands where this can happen are mostly located in the face, chest, back, neck and shoulders.

1.2.2 Types of acne

There are different types of acne and pimples. People with acne may have one or more of these types

simultaneously, and one or more may be dominant.

Blackheads – pimples which rise to the skin’s surface and have a black appearance. It is important to note

that the black color does not come from dirt

Cysts – deep, painful pimples filled with pus, which can cause scarring

Nodules – pimples which are solid, large, painful, and deep inside the skin

Papules – small bumps which can be tender, pink in color

Pustules – pimples which are red at the closest point to the skin, and have pus on top

Whiteheads – pimples with pus, under the surface of the skin

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1.2.3 Who gets acne?

Acne is by far the most common skin disease, and people of all races and ages can suffer from

it. Both genders have acne, though suffer from it to different degrees at different life stages,

which we’ll explore further in this section.

Acne is the most common in people between the ages of 11 and 30, with 80% of all people in

this age group reporting acne outbreaks at some point. The most common ages for acne onset

are ages 10 to 13. Teenage acne generally lasts five to 10 years, subsiding in the late teens and

ending in the early 20s. At this age, teenage boys tend to have the most severe cases, though

the condition is present in both genders.

However, older people can also have acne. People in their 40s and 50s report outbreaks, and

20% of all acne cases occur in adults. Above the age of 30, women are more likely to suffer from

acne than men.

Though not nearly as well-known as teenage acne, there are two forms of the disease that occur

in young children. These are acne neonatorum, a pimply skin rash which affects babies but does

not leave any scarring, and acne infantum, which can be more severe and leave scarring. At this

age, boys are more likely to have acne than girls.

Some studies have found that traditional societies in remote locations do not suffer from acne

the way the developed world does. Further along in the module we will discuss this research

further and the potential reasons behind this.

1.3 Causes – Hormones

Hormones have a huge part to play in the production of acne.

In section 1.1.1 we covered two potential reasons for cells clogging the follicle, and thus causing acne. These

were 1. the production of too many skin cells, and 2. hyperkeratinization. Researchers suspect that

hormones are involved in keratin levels, and hormones are known the control the rate of skin cell growth.

In this section we’ll examine one of the main culprits in causing acne, testosterone, and look at many different

hormonal influences that can cause breakouts.

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1.3.1 Testosterone and DHT

Testosterone is a natural hormone that is found in the bodies of both men and women. The average adult

male has between 4 times to 75 times more testosterone than the average adult female. This hormone is

essential for sexual behavior, building protein, bone formation, the production of blood cells, liver function

and carbohydrate metabolism. In women, it is produced in the ovaries.

DHT (Dihydrotestosterone-alpha) is a natural steroid, produced in the gonads in men. (It is also present in

women, but to a much lesser extent). It is an androgen (male) hormone, and is responsible for the biological

characteristics of males, such as increased muscle mass, hair on the chest and a deep voice. 5% of free

testosterone is converted into DHT, by the 5-alpha enzyme. DHT is about five times more potent than

testosterone, and is considered a very potent androgen.

DHT can cause acne because it over stimulates the sebaceous glands, the same oil glands that cause your

skin to product more sebum. This can result in more acne as pores become clogged. This is not always the

cause of acne, but it can be, particularly in females.

1.3.2 Periods

Women can experience menstrual acne, which is a flare up on the skin that coincides with their period.

Generally, the acne will start to be more severe around seven to 10 days before the period begins, and will

subside when bleeding starts. Around 63% of women who are acne-prone experience these flare ups,

according to a study in the Archives of Dermatology.

The reason for this is hormonal changes. In the first half of the cycle, estrogen is the main hormone, while

in the second half, progesterone is dominant. As the period approaches, the levels of both hormones fall

significantly. Testosterone stays at a constant level throughout the month, and when the other hormones

dip, it becomes dominant and makes the oil glands produce more sebum, which increases breakouts.

1.3.3 Pregnancy

Acne is very common during pregnancy. More than 50% of women develop some level of acne in pregnancy.

Some of these women will have had acne before pregnancy and find it gets worse, while others will have

never suffered from acne before. Women who have a history of acne or acne flares during menstruation are

more likely to suffer from acne during pregnancy.

Acne in pregnancy is mostly caused by the increased levels of hormones in the first trimester, which increases

the skin’s production of sebum.

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Specifically, it is the release of progesterone that causes breakouts around the sixth week of pregnancy. If

acne does not break out in the first trimester, it is unlikely to during the second or third trimesters.

1.3.4 Polycystic ovary syndrome

Polycystic Ovary Syndrome, also known as PCOS, is a condition caused by an imbalanced secretion of

hormones by the pituitary gland. This affects the ovaries. PCOS usually occurs when insulin levels or

luteinizing hormone levels are too high, which causes the ovaries to produce extra testosterone.

The consequences of this imbalance include weight gain, acne, and extra hair on the face and body. The acne

and extra hair are caused because the hair follicles and skin cells are very sensitive to even slight increases

in testosterone in the body.

1.3.5 Teenagers

Acne in teenagers begins because of a surge in hormone production.

During puberty, both girls and boys start to produce higher levels of androgen. These are the male sex

hormones, which include testosterone. The function of this hormone in boys is to stimulate the growth and

development of the testicles and penis, while in girls it is for maintaining bone and muscle strength. This

surge in testosterone sparks increased sebum production, causing breakouts.

1.3.6 Birth control pills

Though some women use birth control pills to control their acne, some women find that birth control actually

causes acne for them, or makes existing acne worse. Contraceptives which are injected, or IUDs (intrauterine

birth control devices) can also cause acne, because of the hormones they contain.

Birth control pills contain progestin (a synthetic form of the natural hormone progesterone), estrogen or a

mixture of both. The pill that most people use is estrogen dominant, while the ‘mini pill’ contains progestin.

When taking estrogen containing pills, acne is possible because low progesterone levels, coupled with

estrogen dominance, can cause acne. Some people, however, find their skin is cleared on these pills.

The mini pill, progesterone pills, and contraceptive implants can cause acne because of their high progestin

content, which boosts sebum production.

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1.4 Causes – Diet

The official stance of the medical profession and academia has been that there is no link between diet and

acne. This conclusion was based on a set of studies conducted in the 1970s, but now researchers and

scientists are coming forward to say that these studies were poorly designed and executed, and that there

is still much research to be done.

In this section, we’ll explore two studies which point to there being evidence of a link between diet and acne.

1.4.1 Cordain’s study

Scientist of health and exercise at Colorado State University, Loren Cordain PhD, conducted a study to find

out what the effect of diet was on the acne.

With an international team of researchers, he studied 1,200 in Papua New Guinea, and 115 in remote

Paraguay. This included 300 teens from Papua New Guinea and 15 in Paraguay. In two years of study, there

was not a single zit found. Cordain says that populations who eat all-natural foods do not suffer from acne.

Cordain believes this is down to diet, as the people in these studies eat only fruit, seafood, vegetables and

lean meats. They do not eat any processed or refined foods, and eat only what they grow, gather or hunt for

themselves.

Cordain and his researchers wanted to make sure the difference in acne prevalence was not due to genetics.

To test this, they studied South Americans and New Guineans living a westernized lifestyle, to check their

acne levels. It was found that people of these ethnicities do develop acne when they started eating an

American-style diet, which indicates that it is not genetics, but rather the diet.

But what is it about the American diet that causes acne?

Cordain noted that most of the American diet is based on high-glycemic foods, a group of foods which

includes staples such as white bread, cereals, milk, and russet potatoes. High glycemic foods lead to a spike

in blood sugar levels, which has been linked to increasing risk of cholesterol, obesity, diabetes and other

conditions. Cordain said that half of the intake of U.S. food is of high glycemic foods, and that 85% of the

grains in the western diet are highly glycemic and refined.

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Cordain says that foods with a high glycemic load cause acne because of the hormone responses in our

bodies. When we consume these foods, the levels of insulin and insulin-like growth factor, IGF-1, rise. In

response, more testosterone is produced, which leads to too much sebum being produced. This can lead to

acne.

This effect is particularly pronounced in teens because, Cordain says, “The teenaged years are a time of

natural insulin resistance. The teens are growth years; for tissues to grow, they become insulin resistant.”

Following on from his research, Dr Cordain created the Paleo diet for the treatment of acne, which we will

look further at in Module 4.

1.4.2 Mann’s study

Dr. Mann, an associate professor at Royal Melbourne Institute of Technology, has also pushed against the

assumption of there being no connection between diet and acne.

Mann and his research team conducted a study on 43 young men aged between 15 and 21 years. These men

were divided into two groups, each of which was given a different diet to follow for 12 weeks:

GROUP 1 was given a diet of low glycemic foods, including whole grain pasta and breads, lean meats,

legumes, low fat dairy, fish, and lots of vegetables and fruits.

While GROUP 2 was told to eat sugary drinks and snacks, white bread and potatoes.

After 12 weeks, the study of the young men’s acne showed some outstanding results. The boys in group 1

showed a 50% reduction in acne lesions, which is a better result than is usually seen when patients use

topical acne solutions. There were no new infections and no new lesions found.

The acne in group 2, however, was exacerbated by the diet they were following.

Mann said, “The results were astounding. And this is the first time there has ever been a proven connection

between diet and acne.”