There are currently several factors to consider in the causes of acne:
- hormone-mediated sebum overproduction (skin overproduces oil and makes the oil more sticky than normal)
- follicular hyperkeratinization (dead skin cells stick together and clog the pores)
- chronic inflammation of the pilosebaceus unit (the skin releases more inflammation-related chemicals in people with acne)
- different types of p.acnes bacteria (which is why some skins do not react to antibacterial agents)
- Lipid peroxidation by free radicals (when sebum is oxidized, it becomes highly comedogenic)
Recent research shows that this last current factor – lipid peroxidation – actually helps to advance the acne process and can actually be the cause of the entire chain of events that cause acne. Research also shows that people with acne simply experience more oxidative stress than people without acne, both in their skin and in their bodies. It is still unclear whether higher oxidative stress is the result or the precursor to an acne-prone condition. It may be a bit of both, but regardless of that, oxidative stress is a factor that is extremely important in curing acne.
We used to think that follicle congestion (comedones) caused the colonization and growth of p.acnes bacteria, which then led to inflammation (pimples).
In recent years, it has been discovered that long before the microcomedon arises, there are several things going on in the skin that help create the perfect storm for the appearance of a pimple.
We don't know exactly why it happens, but for some reason there is an increased amount of pro-inflammatory factors around pores and sebaceous glands in people who are prone to acne. This means that even before sticky sebum and skin cells cause a plug, high amounts of flammable chemicals cause the sebum to oxidize in the pore. Lipid peroxidation of the sebum causes the sebum to change from an inhospitable environment for p.acnes to an environment where anaerobic bacteria such as p. Acne can survive and thrive. It also greatly increases the comedogenicity of the sebum.
It is now believed that inflammation and oxidative stress in the skin (pilosebaceous follicles) could create the conditions for all of the following factors that lead to acne.
Did you know that when antibiotics were heavily prescribed for acne sufferers, the theory was presented that antibiotics actually help cure acne because they act as antioxidants in the body? In fact, a recent study found that doxycycline, a common oral antibiotic used to treat acne, reduced acne at subantimicrobial doses by over 80% after 3 months in subjects with moderate facial acne.
How it works: Inflammation mediators cause the sebum to oxidize. Oxidized sebum then becomes hospitable to p.acnes; p.acnes begins to multiply. The p.acnes bacteria then generate free radicals, which further intensify both the existing oxidation and the existing inflammation, and a pimple develops.
This gives us some clues as to why zinc is so often (both internally and topically) associated with helping with acne – it is an important antioxidant co-factoring mineral.
In later blog posts I will hopefully go into what we can do holistically / internally to compensate for these above-average amounts of inflammation and oxidation in the body. However, for the skin, research has shown that certain antioxidants are key.
The antioxidant sodium ascorbyl phosphate (the stable form of vitamin C that we use in Illumina) showed superior efficacy over benzoyl peroxide in curing acne.
DMMC (Dimethylmethoxy Chromanol), a synthetic, extremely stable, strong and expensive antioxidant found in Potentci and also in AMBAR's Daily Antioxidant Primer, shows a great ability to prevent lipid peroxidation, which is the specific type of oxidation that is related to acne.
Other antioxidants that are currently under investigation and that have been shown to be effective against this specific acne trigger are vitamin E, green tea and zinc.
Snack: If you make sure that your skin care contains acne-compatible antioxidants, you may be able to control the cause of the acne lipid peroxidation of the sebum.