What Causes Acne Breakouts?

Top 3 Factors that Cause Acne

What causes acne, really? We all know people who neglect their skin and rarely get a pimple. Others can diligently care for their skin and still fight against breakouts.

Why are some people prone to acne while others are not?

There are three major factors that contribute to acne development, and they have nothing to do with skin care or lack thereof. The result of these factors coming together is a formation of acne breakouts. All three factors must be present in order for acne to occur.

Overactive Sebaceous Glands

Trapped oil within the pore causes blockages and blemishes. Photo: Eric's Phtotgraphy / Getty Images

Sebaceous glands create sebum, or oil, needed to lubricate the skin's surface. Those who are prone to acne have oil glands that produce more sebum than is necessary.

Excess oil remains in the pore, blocking the sebaceous duct and creating a blockage within the follicle.  This blockage is called a comedo. 

Comedones (the plural of comedo) are the starting point, or building block, for all acne blemishes -- from the tiniest of blackheads to larger, inflamed papules and cystic acne.

Interestingly, there's some indication that the sebum of those who have acne may also be different in its makeup.  People with acne tend to have sebum with higher levels of squalene and wax esters than those without acne.  They also have lower levels of free fatty acids and linoleic acid, in their sebum.

It's theorized that this composition creates a more favorable environment for acne-causing bacteria.  Basically, it makes for a better home for the bacteria that are responsible for inflamed acne breakouts.

Abnormal Shedding of Skin Cells

Skin layers
Images: BSIP / UIG / Getty Images

The top layer of your skin, called the epidermis, constantly sheds dead skin cells through a process called desquamation. Consider this the natural way the skin exfoliates and renews itself.

The epidermis itself is made up of several layers.  New skin cells are created in the stratum germinativum, the deepest layer of the epidermis. 

These new cells slowly travel up through the epidermis until they reach the outermost layer, called the stratum corneum.  Once they reach the stratum corneum, the cells have flattened and dried out.  Essentially, the skin cells are "dead." 

These dead skin cells continually fall away from the stratum corneum, and are replaced by new cells pushing up from below.  This happens not just on your face, but over your entire body.

In acne prone skin this desquamation process goes awry, with four to five times more skin cells being produced than in normal skin.

There are also less Lamellar granules in the skin of people prone to acne. Lamellar granules are found within the cells of the stratum corneum. They are responsible for releasing enzymes that digest the substance that that holds cells together.

Simply speaking, acne prone skin produces more dead skin cells than is typical, and the skin cells are not being shed properly. Instead, the cells remain suck inside the follicle creating a comedo.

Proliferation of Bacteria

Propionibacteria acnes
Photo courtesy of the CDC

Propionibacteria acnes (P. acnes) are bacteria routinely found on most skin. In those with acne the P. acnes population grows out of control.

The plug of dead cells and oil within the pore creates an anaerobic environment: oxygen can't get into the pore. P. acnes thrive in this environment and their population grows.

The P. acnes digest the oil trapped within the pore, producing a fatty acid waste. This waste irritates the pore lining, causing redness and inflammation.

It is important to recognize that cleansing cannot wash P. acnes away. Its presence does not point to a lack of hygiene in any way.

So, although your skin may be prone to breakouts, you're not stuck with them.  There are plenty of treatments available that can help treat these major acne-causing factors, allowing your skin to clear up and heal.

If OTC acne products aren't working for you, give your dermatologist a call today.  With the right medications, you can be well on your way to clear skin.

Next Steps:

Acne Development: How Breakouts Form

The Main Types of Acne (and How to Treat Them)

Treating Acne at Your Life Stage

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