You might be covered in pimples all the time, or maybe you just woke up with a few breakouts overnight and are scratching your head as to why.

Acne is a widespread skin condition that affects people of all ages and backgrounds. You might be searching for the one trigger for your acne; but I’m here to tell you there can be more than one. And, understanding a little more about your condition can help in being able to link what these unique drivers might be for yourself.

What Is Acne?

Acne is a common skin condition characterized by the formation of pimples, blackheads, whiteheads, and often, inflamed red bumps on the skin (we call these papules when they don’t come to a head, and pustules where they’re cystic and pus-filled). It typically appears on the face, neck, chest, back, and shoulders; anywhere where there is a concentration of sebaceous glands. Acne can be physically and emotionally distressing, impacting one's self-esteem and overall quality of life.

Acne is a massive umbrella term for pimples and breakouts, but there are many different definitions of acne; from acne vulgaris to acne mechanica. Understanding your particular presentation and having a correct diagnosis is important in understanding what steps will assist in treating it.

For example, if you have acne mechanica (caused by irritation to the hair follicles by mechanical friction like clothes) then working on your hormones isn’t going to help. Removing tight clothes or whatever is irritating the hair follicle in that area will help. Conversely, if you have hormonal acne and you’re expecting results from cutting out every food you love, you won’t get that result until you actually work on the hormone driver.

We pride ourselves on our expert knowledge in acne, and understanding what sort of acne you are suffering with (which is often more than one kind!).

Depending on what kind of acne you have, the development may be a little different, but overall the basics of how acne forms is the same in most cases.

How does acne develop?

The development of acne is a complex process involving multiple factors, including genetics, hormones, diet, lifestyle, and skin care practices. Let's break down the key components of how acne develops:

1. Excess Sebum Production

- Sebum is an oily substance produced by the sebaceous glands in the skin. Under normal circumstances, sebum helps keep the skin moisturized and supple.

- In individuals prone to acne, there can be an overproduction of sebum due to genetic factors or hormonal fluctuations. The size of your sebaceous glands is one genetic component that can make you more prone to acne (but also to ageing a little better than those with dry skin!).

2. Clogged Pores

- The excess sebum mixes with dead skin cells, leading to the clogging of hair follicles or pores. Comedogenic ingredients in skincare items or make ups can also be a contributing factor to the clogging of pores.

- This creates an ideal environment for the growth of acne-causing bacteria, primarily Cutibacterium acnes (previously known as P. acnes).

3. Bacterial Infection

- Cutibacterium acnes is a bacterium that thrives in the clogged follicles and multiplies rapidly, causing inflammation and irritation within the follicle. Bacterial infection can be promoted on the skin by simple things like not washing make up brushes, pillow cases and your PHONE regularly. Whilst I don’t condone the idea that acne is simply caused by not having a good enough skin hygiene practise, if you have acne than these things can certainly make it worse. Also, having skin needling done too early can spread the bacterial infection to different areas of the skin.

- The body's immune response to the bacterial infection results in redness, swelling, and the formation of pus-filled pimples.

How do hormones cause acne?

- Hormones play a significant role in acne development. Androgens, such as testosterone, can stimulate the sebaceous glands to produce more sebum. Androgens aren’t just limited to our reproductive hormones like testosterone; stress hormones such as DHEA-S and androstenedione can also be contributors to driving excess sebum production.

- Hormonal fluctuations, which can occur during puberty, menstruation, pregnancy, or stress, can exacerbate acne. In the clinic, we always begin our hormonal investigations with pathology so that we have a clear understanding of your production of testosterone in comparison to estrogen, as well as what your reproductive hormones are doing. We often find follicle stimulating hormone (FSH) and luitenising hormone (LH) to be out of whack and contributing to breakouts in the middle of the cycle or leading up to the period. Having a clear understanding of your baseline hormones is imperative to understanding how to effectively treat the condition.

What else can cause acne?

- Inflammation is a hallmark of acne. As the body attempts to fight off the bacterial infection, it triggers an inflammatory response that worsens the appearance of acne lesions. Inflammation is also a big part of hyperpigmentation which can occur following a breakout, which is why an area where you’ve had a breakout may remain red or different in colour than the rest of your skin. Understanding your internal levels of oxidative stress and inflammation are an important part of being able to help reduce inflammation from the inside out. We find most often the gut is a major contributor to systemic inflammation, which is why we ask so many questions about your diet and gut health in our consultation process.

- Poor dietary choices, high-glycemic diets, and dairy consumption have been linked to acne in some individuals. Whilst cutting out dairy isn’t my first piece of advice, as it’s quite generalised, it can help to reduce inflammation in some people’s presentation. I think the more important thing to focus on is the amount of sugar and alcohol in the diet. Sugar (especially refined sugars) can drive insulin imbalances, and insulin problems can drive excess sebum production, as well as inflammatory changes within the ovaries which is a major driver of PCOS which almost always has not been investigated in people suffering with acne. If you have constant breakouts, and if you notice breakouts 1-2 days following increases in sugar or alcohol, then you may benefit from focusing a little more on a low GI diet to help control insulin. This is also something we test for specifically in the consultation process, and why we direct dietary support around low GI diets for people where is highly relevant.

- Additionally, stress, inadequate sleep, and certain medications can influence acne development. Stress hormones themselves can sometimes be 100% responsible for acne presentation. Lack of sleep continues to drive the stress cycle, creating more havoc with stress hormone imbalances. Sleep is also an imperative part of healing for the body, especially the skin. You’ll notice the difference in your complexion when you’ve had good sleep versus poor sleep! Lifestyle elements like this are important to consider in treatment so that all aspects contributing to your acne can be encompassed and corrected so you can kick the pimples for good!

Where to from here?

As a naturopath specializing in skin health and healing, understanding the origins and development of acne is crucial for effective treatment and guidance. While the factors contributing to acne are multifaceted, personalized approaches that consider genetics, hormones, diet, and lifestyle can help address the root causes of acne and promote clear, healthy skin for the long term. That’s what we do best here.

If you’re looking for personalised help on your path to clear skin, let us help guide the way for you, girl!

Our Naturopath, Emily-Rose, is a specialist in acne and, as a Corneotherapist, also has a deep understanding of topical ingredients to run towards and run from. This is something we love helping people with in their acne journey; covering all bases, giving you the answers as to why you’re experiencing the problem, and giving you solutions to assist (including topical recommendations and guidance).

Ready to get started on your path to clear skin from within?