Though there is a hereditary tendency for acne eruptions, there are many factors that might contribute to the development of acne in normal individuals.
Who is at Risk of Developing Pimples?
Common acne risk factors include age, sex, occupation, hormonal imbalance, food habits, medications, outdoor activities and stress.
Age and Acne
Adolescence is of course the most common age for acne. The onset of puberty brings in hormonal changes which affects the sebaceous gland activity and other factors stimulating the acne development.
Acne and Gender
Though both sexes are equally affected, acne is more severe in males. Risk of acne complications like acne scars are consequently more in the males.
Hormone Disturbances Causing Acne
Androgenic hormones from the testes, ovaries and the adrenal cortex are mainly responsible for the sebaceous hyperactivity in acne. Hence any diseases of these organs, medications stimulating or increasing the secretions of these hormones or drugs having similar pharmacological effects can stimulate acne production in some individuals. It is common for women to get acne eruptions, usually of mild to moderate type, just before or during their menstrual periods. In pregnancy, some women experience worsening of their acne, while, in others, acne simply disappears during pregnancy.
Many patients with polycystic ovarian disease have moderate to severe types of acne along with unwanted hair growth. Low dose oral contraceptives are beneficial in treating acne in some female patients who show high levels of testosterone or Dehydroepiandrosterone (DHEA). Some combination pills which contain androgens could induce acne eruptions as well.
Virilization disorders where the male hormone levels are increased in females due to adrenal or ovarian growths are characterized by acne eruptions, abnormal hair growth (hirsuitism), voice changes, clitoral enlargement and increased libido.
Topical Applications Causing Acne
Acne is caused by the occlusion of the hair pores with plugs caused by thickened walls and action of the bacteria P.acnes on the oily sebum. It follows that anything irritating or further occluding the skin surface is bound to induce or aggravate acne. Oily cosmetic products like cold creams, moisturizers or oil based foundations can cause fresh acne eruptions and hence should be avoided by teens with acne prone skin.
Oil, gel or pomade applications on the face could cause acne bumps to appear on the forehead, scalp or behind the neck.
Topical steroids, especially the potent fluorinated classes of topical steroids are infamous for causing acneiform eruptions even in individuals without a previous history of acne.
Occluding and Irritating Agents as Acne Risk Factors
In addition to the occluding oily creams and oils, occluding synthetic dresses (body acne), helmets (forehead, scalp and neck acne), industrial oils (chloracne on hands and forearms), shoulder pads in players also induce acne eruptions. To be qualified as acne, the individual should have the tell tale comedones in nearby skin or face. Otherwise these should be called folliculitis, the inflammation of hair follicles. Most of the acneiform eruptions that are supposedly caused by chronic rubbing are not acne lesions, but folliculitis.
Acne Inducing Medications
Certain medications can induce acne like eruptions or exacerbate existing acne. The most common culprits are systemic and topical steroids, phenytoin, isoniazid, lithium, iodides and bromides.
In addition to the above, acne eruptions are worse in hot and humid conditions where sweating and increased sebum secretion can enhance the follicular occlusion and P.acnes proliferation. Acne has also been found to be increased under stressful conditions, probably through the hormonal stimulation of the sebaceous glands.
Related Articles
References
- Simpson NB & Cunliffe WJ. Disorders of the Sebaceous Glands in Rook’s Textbook of Dermatology. 2004; 7: 43.1-43.75.
- Sanjiv Jain. Acne Vulgaris in Fun with Dermatology. 1998; 1: 92-98. Jaypee Brothers Publications.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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