Contrary to common theories, eating chocolate or lack of hygiene do not cause acne. Most cases of acne occur in people who are under stress, experiencing hormonal changes or genetically predisposed to having acne. In every situation, the underlying causes of acne are a combination of excess oil, skin bacteria and clogged pores.
Excess Oil
Excess oil, or sebum, is the culprit behind most cases of acne. While people with dry skin may have breakouts, most chronic acne sufferers have combination or oily skin. Additionally, sebaceous glands in the skin produce excess oil during stress or during hormonal changes, which is when many people experience breakouts or worsening acne. Excess sebum exacerbates other factors that cause acne, such as bacteria and clogged pores. Both inflammatory and noninflammatory acne occur because of excess sebum. Treatments that target excess oil include benzoyl peroxide and the powerful prescription drug isotretinoin.
Skin Bacteria
Skin bacteria, known as P. acnes, naturally live on the skin, but a high population of this bacteria contributes to acne. In people with breakouts, this bacteria cause the inflammation associated with pimples because it mixes with excess sebum and travels deep into the pores. When the pores become clogged, bacteria become trapped in the pores and begin to multiply rapidly. The body's immune system attempts to fight off the bacteria, which causes redness and inflammation, resulting in a pimple. Treatments geared toward reducing the P. acnes population are often prescribed for people with inflammatory acne. These include antibiotics or skin creams, such as benzoyl peroxide.
Clogged Pores
Clogged pores occur when dead skin cells and excess oil mix and travel into the pores, forming sticky plugs. Most types of blemishes begin with clogged pores, and their varied appearance depends on other factors such as bacteria and how close the blemish is to the skin's surface. Blackheads and whiteheads, or comedones, are essentially clogged pores. According to the AcneNet website, whiteheads occur when the clogged pore is covered with a layer of dead skin cells and sebum, and blackheads occur when the clogged pore is visible. The black color is sebum that has changed color after being exposed to air. Inflammatory acne, such as pustules and nodules, occur when bacteria is trapped in the pore and cause the pore to rupture. Pustules occur at the skin's surface, and nodules occur deep in the skin. Retinoids, or topical vitamin A, are available by prescription and are particularly effective at preventing clogged pores and removing existing clogs.
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