Scientists Say They Know Why Some People Get Acne, And The Clue Lies Where You’d Least Expect It

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Although acne is widely associated with going through puberty, the skin condition can strike anyone. And for some time, the reason why some people are prone to spots while others boast completely clear skin has been a bit of a mystery. Now, however, a new study may shed some light on the phenomenon. Yes, in 2016 scientists identified a link between acne and a perhaps unexpected part of the body.

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In particular, while experts once thought that acne was caused by inflammation, it turns out that a seemingly unrelated feature may contribute to the condition, too. And thanks to this breakthrough, there may be a whole new range of medical possibilities for those who experience acne.

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As the research’s findings help us further understand the skin condition, you see, they may pave the way for an entirely new set of potential treatments. And considering the psychological effects that acne often has on sufferers, finding better ways in which to eradicate spots completely could even save lives.

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And acne is very common, with a 2018 King’s College London report on the breakthrough explaining that 80 percent of individuals experience the condition between the ages of 11 and 30. Yet even though acne can affect people well into adulthood, it is often associated with teenagers.

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After all, girls typically develop acne from 14 to 17 years of age, while boys generally suffer from the condition from 16 to 19. Regardless of when spots rear their ugly heads, however, the condition usually ebbs and flows for years until it finally fades. Yet while acne is mostly gone halfway or so through the sufferer’s 20s, that’s not always the case.

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In a small percentage of people, you see, symptoms persist past puberty; according to the U.K.’s National Health Service (NHS), one percent of men and five percent of women sport acne beyond the age of 25. Nevertheless, there are reasons why blemishes are most typically seen on teenagers.

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Specifically, teenage acne seems to be caused by a shift in the sufferer’s hormones, with this process then making an individual’s skin inflamed, irritated and occasionally tender on contact. In addition, acne produces more oil, leading to the most visual reaction: spot clusters. And while an acne patient’s face is the most frequently afflicted area, pimples can occur on the back and chest as well.

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Practically everyone with acne gets facial spots, according to the NHS, while over 50 percent of people experience outbreaks on their backs. By contrast, however, the NHS claims that only 15 percent or so of acne sufferers see the condition on their chests. And there isn’t just one type of spot, either; in fact, experts have identified six different varieties.

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Among these six types of acne are papules, which appear to resemble tiny red lumps. These can be sensitive and cause pain to the sufferer. And the second kind, pustules, bear some resemblance to papules but with one exception: they have white heads. That’s because they contain pus, from which they derive their name.

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Then there are two varieties of spot distinguishable by and named for their tops: blackheads and whiteheads. Yet blackheads’ moniker may not be entirely accurate, as the pimples that fall under this category can have either dark or yellow centers. Whiteheads, on the other hand, don’t just differ in color to blackheads; unlike their counterparts, they don’t pop under pressure.

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However, the last two kinds of acne pimple – nodules and cysts – are perhaps the most severe of all. Nodules are large and sore spots that grow below the skin’s surface. Cysts, meanwhile, are formed from pus that builds up into pockets, and these blemishes may ultimately leave permanent scars on the sufferer’s skin.

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So what can you do if you have acne? Well, although there’s currently no cure as such, you can nevertheless manage the condition through some simple techniques. Resist the temptation to squeeze your spots, first and foremost, as it won’t make them better, and you may even end up marking your skin for good.

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Likewise, although acne makes skin oily, washing too often can aggravate the condition. Instead, only cleanse any irritated sections a couple of times a day with mild products. It’s also wise to stick with tepid water, as extreme temperatures will just exacerbate symptoms. Washing your hair on a frequent basis will help, too.

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And while using makeup to cover up acne may sound like a good idea, choose your products carefully. You see, some cosmetics can block skin pores, and this naturally won’t help your complexion. For the best outcome, then, try non-comedogenic makeup that creates fewer obstructions – but be sure to wash it all off before bedtime.

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Alternatively, pharmacists can advise you on topical treatments and other over-the-counter acne solutions. Make sure that you see a doctor if lotions and creams don’t work, however, or if you get acne on your back or chest. In these cases, you may be prescribed therapies that prevent potential scarring from cysts or nodules.

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In addition, doctors typically treat more serious cases of acne with prescription medicines such as antibiotics. And when such drugs are used in conjunction with creams – most commonly benzoyl peroxide – the combination often yields results after a few months. This approach both combats the cause of acne and helps soothe inflamed areas of the skin.

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Plus, as acne is linked to hormone changes, women may experience more severe bouts of spots during their periods. Fortunately, if you’re female, other treatment options are available to you. Taking a contraceptive pill that contains both estrogen and progestogen may help, for instance.

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But what causes acne in the first place? Well, principally, outbreaks are the result of bacteria on the skin’s surface triggering inflammation. Yet while this explanation doesn’t actually explain why bouts of pimples affect some people and not others, in 2016 researchers discovered the answer to that very conundrum.

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Yes, a team at the University of California, San Diego has in fact identified a cause of acne. Specifically, it’s all to do with our follicles – small pockets in the skin from which hair sprouts. And each follicle has corresponding glands that create oil – or sebum – to lubricate hair and prevent skin from becoming overly dry.

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However, problems may occur when follicles trap Cutibacterium acnes bacteria that reacts negatively to the environment. In these instances, the sebaceous glands may go into overdrive and create more lubrication than usual. After that, the extra sebum may in turn combine with dead skin to plug the follicles and trap the bacteria inside.

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That build-up under the skin then makes follicles protrude outward, creating acne spots. Open follicles contain trapped hair pigments that give blackheads their color; whiteheads, on the other hand, are closed follicles that push at the skin’s surface. And the four other kinds of spots we mentioned earlier occur when bacteria spreads and creates more severe acne.

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Yes, bacteria-infected follicles can then become pustules, papules and the potentially scarring cysts and nodules. But what causes all of this in the first place? Well, experts believe that testosterone is at least partly responsible. The hormone is usually present in both males and females – albeit in different quantities – and is thought to cause excess sebum production.

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There is, however, also evidence of a genetic component to the condition, meaning acne could be hereditary. For instance, having parents who have suffered from acne – whether as teenagers or later on in life – increases a child’s risk of pimples. And if acne runs on both sides of the family, then a youngster is more likely to develop harsher symptoms earlier on.

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Regardless of how acne develops, though, it doesn’t just have a physical effect on sufferers. Indeed, its presence can demoralize people so much that they lose self-confidence and fall into depression. In some cases, acne even plays a role in self-harm and suicide – making the need for effective treatment even more important.

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Unfortunately, though, acne medication may be either slow to work or possess unwanted side effects. For example, the drug co-cyprindiol has a small but significant risk of causing breast cancer in later life. It also carries an increased likelihood of developing blood clots among other more minor symptoms.

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And there are also potential drawbacks to isotretinoin, which is marketed under the brand name Roaccutane. This treatment can result, for example, in bloody urine, swings in blood-sugar levels and, in rare cases, liver or pancreatic problems. In addition, isotretinoin is unsuitable for pregnant women as its use may result in birth defects.

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Nor are these specific medications the only ones to have potential side effects. Yet owing to new information that has been gleaned about acne, the ways in which doctors treat the condition may yet change in the future. You see, experts have discovered 15 separate genetic indicators that may act as the key to tackling such skin complaints.

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To be specific, researchers now believe that some of these new gene locations – or loci – are responsible for a mutation that changes the shape of hair follicles. And as certain kinds of follicles are more susceptible to trapping bacteria than others, they may well contribute to the development of acne.

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Professor Jonathan Barker, who works at the National Institute for Health Research (NIHR) at Britain’s Guy’s and St Thomas’ Biomedical Research Centre, headed up one of the teams of researchers who came up with these findings. And Barker and his colleagues worked alongside the King’s College London’s Genomic Medicine Group – led by Professor Michael Simpson – to study the DNA of 26,722 acne sufferers. In 2018 the journal Nature Communications would also publish an article detailing the fruits of the scientists’ efforts.

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And, amazingly, 12 of the 15 loci identified during the study haven’t been associated with acne before. Both Simpson and Barker are, therefore, understandably passionate about the implications. “We are really excited to have found so many regions of the genome that are involved in acne,” Simpson is quoted as saying in a 2018 article on the NIHR website. It seems, too, that one of those regions is also associated with ectodermal dysplasias.

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Ectodermal dysplasias, or ED, are a collection of rare genetic disorders that lead to atypical development of certain aspects of the body; they can affect nails and teeth or prevent sweating, for example, or result in thinner hair on the body or head. And since ED occurs when two WNT10A genes mutate, an individual with only one of those genes is immune to acne.

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“It was surprising that so many of the variants appear to influence the structure and function of the hair follicle,” Simpson added on the NIHR website. “It may be that the genetic variation influences the shape of these hair follicles and makes them more prone to bacteria and inflammation, which are characteristic of acne.”

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“In the last 20 to 30 years, there have been few advances in the way we treat acne,” Barker also explained in the NIHR article. “And the current main treatment has a number of significant side effects.” But how could these new developments affect the ways in which we combat acne in the future?

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Well, Barker continued, “Applying these genetic approaches to acne has never been done before, and it’s a significant leap forward. When you have insight into the genetic basis of a condition, you can develop much more effective treatments.” There may yet be a glimmer of hope, then, to those living with acne’s effects.

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If nothing else, new treatments could improve the standard of life for people suffering from severe acne. And considering the debilitating psychological effects that the condition may bring on, that’s a welcome advancement. “For people with acne, it’s so important to have more treatments available,” Barker explained.

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The dermatologist went on, “We need to treat people earlier and more effectively so that they don’t get scars, which last even after the condition has come and gone.” It must be said, though, that other research teams have looked into the causes of acne. And in 2018 another study found a possible link between the skin complaint and collagen.

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Collagen is the body’s most common protein, and it’s abundant in ligaments, tendons and – most importantly – skin. And scientists at Singapore’s Agency for Science, Technology and Research (A*STAR) have theorized that without proper collagen digestion, cells can’t move into sebaceous glands properly. If this happens to be the case, then, a blockage may occur – thus increasing the likelihood of acne.

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The A*STAR researchers believe that this improper digestion explains why sufferers of the collagen-limiting disorder Winchester’s Syndrome sometimes develop severe subdermal acne. “Once stimulated, a few factors could lead to acne causing comedone [spot] formation,” research director Maurice van Steensel, who authored the A*STAR Acne and Sebaceous Gland Program paper, explained to Medical Xpress in March 2019.

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Van Steensel continued, “[The factors include] problems with the movement of these cells into the new gland, excessive growth signaling or defects in the way gland cells develop.” Finding a solution to acne is even more imperative for Asian communities, though, as darker skin tones produce more collagen and may therefore be more prone to acne and scarring.

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“The psychological burden of acne is high,” Van Steensel concluded. “It frequently impairs the self-esteem of affected individuals as it negatively impacts their employability and ability to maintain romantic relationships. Acne is difficult to conceal and can leave life-long scars, so I think it qualifies as a very serious condition.” Thanks to research on the subject, though, experts will hopefully find a cure one day.

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