Pimples, spots, acne; whatever you call them, they’re infuriating. As an acne sufferer, I wanted to get to the root of the problem (pardon the pun). Many things can cause spots and I think it’s useful to understand each of them, and what science is doing to help those of us who are affected.
Acne has been an ongoing issue for me since I was 13. Like many, I had hoped by my 20’s my hormones were done messing about and it would all be over. This has not been the case. After antibiotics, contraceptive pills, face creams, steroids and many tears, I still get flare ups. On a really bad day, no matter what others say, I can feel like leaving the house is near impossible (and I’m not alone). Acne is one of the most common disorders worldwide, with 80% of us expected to suffer with it in some form, at some point.
Medically, acne is an inflammatory disease of the skin caused by changes in the structure of the skin (i.e. where a hair follicle and sebaceous gland are). It is most common during puberty, and is seen more in Western societies who are genetically more prone to it. Numerous instances can cause a spot to appear. However, the fundamental outcome is the excessive secretion of oils (sebum) from the sebaceous gland, combined with dead skin which in turn blocks the hair follicle. The oils build up beneath the blocked pore where skin bacteria (called Propionibacterium acnes, and which usually keep skin healthy), can multiply uncontrollably. Our skin responds by inflaming and producing a visible spot (i.e. lesion). There is no one-thing-fixes-all way to prevent acne; there’s no cure, and most drugs that treat it have not changed for decades.
A 2018 study found that from a group of 26,722 people, the acne sufferers shared genetic mutations. These regions of our genome are responsible for controlling hair growth, and follicle formation. It is comforting to know my oily disposition is genetic rather than due to cleanliness. These findings suggest that targeting medication to fight follicle development/maintenance would be complementary to current treatments, which focus on inflammation and bacterial reduction. A duel approach would help to prevent the condition and also treat symptoms.
For those who suffer acne through to later life, it is likely due to genetic factors, contributing to oily feeling skin, and the acne that comes with it. (I’m still hoping my oily skin makes me look 40 when I’m 80 though!). Teenage acne is thought to be caused by hormonal imbalance, mainly increased levels of testosterone. This is the case for both boys and girls. The sebaceous glands are sensitive to hormones, especially testosterone which is hypothesised to increase sebum production. 80% of adult acne occurs in women though, and is heavily linked to hormonal changes throughout our lifetime, our menstrual cycle, pregnancy or as a side effect of polycystic ovary syndrome. Although not listed on the NHS website, I find stress, alcohol, and really fatty foods can cause a break out – e.g. a domino’s pizza makes my skin crawl, almost literally. Much more research is required to identify true links with such causes.
As I said before, many treatments have not changed for decades. Current research is focusing on the removal of P. acnes bacteria in the skin. However, this bacteria is present for everyone, and in similar amounts (i.e. if you have acne you have roughly the same amount as someone who does not). However, I don’t believe killing naturally occurring bacteria is the final answer. What about lasers? Two potential treatments are intradermal radiofrequency treatment (RT) and intense pulsed light (IPL). When tested on rabbits, IPL was found to modify the immune system (i.e. an immunomodulatory effect), whilst RF treatment reduced acne volume markedly. RF uses high-frequency radio waves to heat the skin, whilst IPL uses many wavelengths of light in short pulses. Such a combination of treatments could treat the condition and help counter antibiotic resistance. These procedures still require a lot of research and proper human trials, although they are available in some form, from certain beauty shops… There is also the potential for an acne vaccine. Read more about this HERE.
To those who do not suffer from acne, we envy you. By no means is my acne the worst case, but that doesn’t stop me from feeling as though I cannot leave the house on a very bad day. It can be exhausting, especially when you have tried everything. I have come to terms with the fact that I am an adult with acne, and take comfort from my skin care routine, avoiding makeup and generally looking after my skin as well as I can. However, instead of writing it off as inevitable for many, scientists are researching genetic causes and thus, eventually designing drugs to fight the “root” of the condition.