What causes acne?
The exact cause of acne is mostly unknown. The process by which a acne develops is highly intricate. Acne results from a change in the keratinization pattern in the hair follicle, with the keratinous material becoming more dense and blocking secretion of sebum. The lesions of acne (comedones) are the result of this abnormal keratinization and a complex interaction between hormones (androgens) and bacteria (Propionibacterium acnes) in the pilosebaceous units of
individuals with appropriate genetic back- grounds. Androgens (which are qualitatively, and quantitatively normal) stimulate sebaceous glands to produce larger amounts of sebum. Bacteria contain lipase that converts lipid into fatty acids. Both sebum and fatty acids cause a sterile inflammatory response in the pilosebaceous unit that results in hyperkeratinization of
the lining of the follicle with resultant plugging. The enlarged follicular lumen contains inspissated keratin and lipid debris (the whitehead). When the follicle has a portal of entry at the skin, the semisolid mass protrudes, forming a plug (the blackhead). The distended follicle walls may break, and the contents (sebum, lipid, fatty acids, keratin, etc.) may enter the dermis,
provoking a foreign-body response (papule, pustule, nodule). Rupture plus intense inflammation leads to scars.
Hormonal changes related to pregnancy or menstrual periods can also cause or contribute to acne. This is also the case with environmental irritants such as pollution, intense heat, humidity or cold.
Acne that appears after 25 to 30 years of age occurs for one of these reasons:
- Recurrence of acne that cleared up after adolescence.
- Flare-up of acne after a period of relative quiet-for example, during pregnancy.
- Occurs for the first time in a person who had never previously had acne.
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