Acne is a chronic inflammatory condition of the skin that involves pilosebacious units. Sebaceous glands are a part of normal anatomy found at the base of hair follicles, they produce sebum which provides a waterproof barrier keeping hydration in and the external environment out. Sebum is composed of a mixture of lipids (fats) that when produced in excess can lead to acne.

Acne can be multifactorial including increased proliferation of skin cells, excess sebum production, inflammation, and/or involvement of the bacteria Propionibacterium acnes. There are some conditions, such as PCOS, that provoke acne due to hormonal imbalance and altered insulin production.

Keratinocytes (cells) within the follicles can begin to over-proliferate causing increased buildup of cells within the follicle and leading to clogged pores. This leads to downstream affects of built up sebum, debris, and bacteria. When dead skin cells are sloughed off at a slower rate, usually due to dry skin, it can compound the problem.

Androgens stimulate the sebum glands, significantly increasing sebum production. When over-stimulated this creates an inflammatory process which leads to clogged pores and a buildup of debris. Testosterone, Dihydrotestosterone (DHT), and DHEAS are examples of androgenic hormones, and although largely considered ‘male-hormones’, balance of these hormones is equally important in both men and women. DHT is your active-testosterone hormone and is a common target of therapy for both acne and hair loss.

Acne can often be caused by or aggravated by underlying inflammation in the gut. The gut microbiome is a key regulator of the gut-skin axis, influencing keratinization and immune response in the skin. Another culprit of acne is a Standard American Diet (SAD), in which a vast majority of the diet is composed of foods high on the glycemic index scale. This causes an increase in Insulin and Insulin-like Growth Factor (IGF-1) that consequently stimulates sebaceous glands and promotes keratinization. In addition to high glycemic foods, some individuals may have food sensitivities which invoke an immune response that can manifest with many different symptoms including acne.

Propionibacterium acnes compounds the inflammatory response by up-regulating cytokines and altering sebum composition. This provokes an immune response, triggering inflamed, red pimples.

When all these elements in the production of acne interplay with one another, treatment can become prolonged and frustrating. That is why it’s important to approach treatment of acne by addressing the whole person and get to the root cause. Choosing the appropriate treatment leads to optimal results and enhances patient satisfaction.

Some treatments such as Salicylic acid and Benzoyl peroxide are used topically for their antimicrobial properties and to decrease inflammation. Topical applications are usually the first line treatment because it can deliver potent results to the local area. There are systemic treatment options which are usually taken orally, and although very effective it is important to remember these treatments have higher side effect risk profiles. Oral antibiotics and Isotretinoin are examples of systemic treatments. Food allergy panels can identify problematic foods for individuals, creating a personalized guide to avoid inflammatory foods. Hormone testing may also be necessary to identify hormone imbalances that are acne-promoting.

Although in most cases acne is self-limiting, prolonged or severe acne can leave pigmentation changes and scar formation. Microneedling with PRP is a safe and effective way to correct texture, tone, and color (read more).