The aetiology of acne is multifactorial. Acne most commonly appears during puberty and is typically characterized by an excess production of sebum as well as the presence of comedones, pustules and papules. Some patients may also develop deep lesions and abscesses that can lead to scarring.
Acne is one of the most common skin conditions, namely amongst the top three skin conditions in the general population. It thus has a large impact on public healthcare systems worldwide (1,2). Epidemiologically speaking acne is a disease of puberty and is more common in developed countries.
Acne in adults
Acne often appears in men and is most likely linked to the presence of androgens.
In adult women it is typically related to the discontinuation of hormonal contraceptives, e.g. due to the desire to conceive, which statistically speaking happens later and later in the female population in the Western world.
Additional factors involved in the aetiology of acne
As a multifactorial dermatosis acne can be caused by an increased production of sebum, inflammatory mediators in the skin and colonization by a microbe called Propionibacterium acnes (3,4).
Studies have shown that a genetic predisposition may contribute to the development of acne. For example, women whose mothers have had acne have a higher probability to develop acne themselves. Furthermore, hormonal dysfunction such as an overproduction of androgens, immunological disorders, environmental factors and the use of incorrect cosmetics can lead to this disease (5).
It has also been shown that certain food products may be linked to the cause of acne. Several studies have been conducted. The findings of these studies suggest that food products with a high glycaemic index can worsen acne (6,7).
It has also been suggested that a causal relationship between acne and the consumption of red meat exists. A recent cross-sectional study conducted amongst adolescents in Nigeria showed a significantly higher prevalence of acne amongst students who reported a daily intake of fried beef (8). However, further studies have to be conducted in the Western world to be able to make an evidence based statement regarding the causal relationship in the Western population.
Regarding protective dietary factors recent studies show that a diet rich in omega 3 polyunsaturated fatty acids decreases the inflammation in acne lesions (9). Therefore a diet rich in vegetables and fish is recommended.
The treatment of acne also includes the diagnosis and treatment of syndromes associated with acne such as polycystic ovary syndrome (PCOS). Patients with PCOS classically present with acne as a sign of hyperandrogenism.
Recent studies have shown that women with PCOS have a higher level of bisphenol A in body fluids. This in turn may play a role in the pathogenesis hyperandrogenism and hyperinsulinemia in women with PCOS (10). The role of bisphenol A in the pathogenesis of acne, however, remains unclear.
Therapeutic strategies include both topical and systemic treatment of acne. Treatment should be started immediately after the diagnosis to prevent disease prolongation and scarring. An important aspect of the cosmetic treatment of seborrheic skin is the thorough yet gentle cleansing of the skin. Aggressive cleansing should be avoided as this may worsen the symptoms particularly the seborrhea associated with acne.
Well-suited formulations for the care of seborrheic skin are usually oil-in-water emulsions. To prevent acne caused by make-up products (also known as acne cosmetica) in individuals with seborrheic skin, water-in-oil emulsions and ointments should be avoided.
Factors to consider:
The correct choice of skin care products is essential. Not only the formulation but also the ingredients of skin care products play a crucial role. We suggest that the skin care products for the treatment of acne should include the following ingredients:
Zinc: Zinc has antioxidant, anti-inflammatory, anti-pigmentation and antimicrobial properties (11). It also acts as a natural sunscreen, thus decreasing the probability for developing post-inflammatory hyperpigmentation.
Purslane (also known as Portulaca oleracea): is known for its anti-inflammatory and moisturizing effect (12).
Albarellus ovinus: a fungal extract endemic to North America and Northern Europe. It decreases the erythema of the skin and causes a decrease in the microcirculation of the skin (13).
Panthenol (provitamin B5), tocopherol (vitamin E), niacinamide (vitamin B3): Many studies have shown the positive effects of these ingredients. In a large randomized controlled study involving over 200 participants with dark skin the daily use of a panthenol-containing lotion in combination with niacinamide and tocopherol acetate over the course of six weeks caused a significant reduction in skin pigmentation, improved uniformity of the skin tone and resulted in an overall improvement of the skin texture. (14,15).
read more about Panthenol read more about dark skin
Early treatment and diagnosis of acne plays an important role in the overall wellbeing of patients. Proper skin care has an anti-inflammatory and moisturizing effect and is crucial to avoid unnecessary irritation. If topical treatment strategies show no improvement, systemic treatment options should be discussed with the patient.
Do you want to learn more about the topical or systemic treatment options available for acne (as a cream or orally)? Listen to our free podcast on Spotify and iTunes!
- Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol 2013; 168: 474-85.
- Wolkenstein P, Grob JJ, Bastuji-Garin S, et al. French people and skin diseases: results of a survey using a representative sample. Arch Dermatol 2003; 139: 1614-9.
- Zouboulis CC. Acne vulgaris. Hautarzt 2014 65: 733–750.
- Michael Landthaler, Thomas Ruzicka, Walter Burgdorf, Gerd Plewig. Braun Falco’s Dermatology. Springer-Verlag, Berlin, Heidelberg 2011.
- Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerronia. Dermatology. 4th Edition. Elsevier.
- Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am AcadDermatol 2010; 63: 124-41.
- Cordain L, Lindeberg S, Hurtado M, et al. Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002; 138: 1584-90.
- Okoro EO, Ogunbiyi AO, George AO, Subulade MO. Association of diet with acne vulgaris among adolescents in Ibadan, southwest Nigeria.Int J Dermatol. 2016 Sep; 55(9): 982-8.
- Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. ClinCosmetInvestigDermatol. 2015 Jul 15; 8: 371-88.
- Rutkowska A, Rachon D.Bisphenol A (BPA) and its potential role in the pathogenesis of the polycystic ovary syndrome (PCOS).GynecolEndocrinol. 2014 Apr 30;(4):260-5.
- Abendrot M, Kalinowska-Lis U. Zinc-containing compounds for personal care applications. Int J Cosmet Sci. 2018 Aug; 40 (4): 319-327.
- Zhao H, Li S, Luo F, Tan Q, Li H, Zhou W. Portulacaoleracea L. aidscalcipotriol in reversing keratinocyte differentiation and skin barrier dysfunction in psoriasist hrough inhibition of the nuclearfactorκBsignalingpathway.ExpTher Med. 2015 Feb 9(2): 303-310.
- Hettwer S, Bänziger S, Suter B, Obermayer B.Grifolin derivatives fromAlbatrellusovinusas TRPV1 receptorblockersforcosmeticapplications.Int J CosmetSci. 2017 Aug 39(4): 379-385.
- Proksch E, de Bony R, Trapp S, Boudon S.Topicaluseofdexpanthenol: a 70th anniversaryarticle.J DermatologTreat. 2017 Dec 28 (8): 766-773.