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Acne overview

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Acne is characterised by comedones (blackheads and whiteheads) and pustules (puss filled spots). Acne is usually found on the face, neck back and chest. Acne usually starts during puberty and stops during the late teens but it can continue into adulthood.

Acne is caused by hair follicles becoming blocked which leads to a buildup of oil and sebum. What are usually harmless bacteria within the skin can contaminate and infect the plugged follicles and cause cystic acne and pustules. 

Common symptoms of acne

Red spots

Blackheads and whiteheads

Large tender spots or cycts

Oily skin

What happens to the skin

Our follicles (pores) are lined with cells called keratinocytes. Acne prone skin produces keratinocytes faster than usual which causes the follicle walls to become thicker to the point where the pore eventually gets blocked.

As part of the natural process of the skin sebum and dead skin cells enter the pores. Rather than being able to move through and out out of the skin it stays within the blocked follicle. As more sebum and dead cells enter the follicle it starts to expand and turns into a comedo (blackhead or whitehead).

As a result of the follicle wall getting thicker red blood cells can no longer reach the follicle which reduces the oxygen being able to be delivered to it. The low oxygen environment is then prime for the bacteria to multiply.

What causes acne

There are a number of things that can cause acne and cases will be unique to each individual. Below we cover the most common causes.

Deficiency in linoleic acid

There is a correlation between sebum production and amount of LA. The lower the levels of LA the more sebum is produced. A lack of LA causes more free radicals to be released by white blood cells when they come into contact with bacteria which can trigger or worsen acne. Reduced levels of LA also causes the skin follicle barrier to be weaker and more prone to rupture allowing the bacteria to spread.


There haven’t been many studies done that looked at the links of stress and acne but correlations have been found. Stress increases the amount of neurotransmitter substance P which triggers an inflammatory response in skin cells leading to increased sebum production. Stress is known to affect gut health. Stress increases the amount of DHEA hormone released which as we discussed above stimulates skin cell growth and sebum production.

Oxidative stress

Studies have shown that people with acne prone skin have higher levels of oxidative stress. There is also a clear correlation between the severity of the acne and the level of oxidative stress.


Hormones levels affect sebum production, growth rate of keratinocytes and regulate inflammation. Studies have shown that insulin and amino acid availability regulate how sensitive the skin is to androgens. So it is not actually the level of androgens within the body but how the skin reacts to it.

How to look after acne

With acne prone skin it is important to minimise the possibility of infection and irritation. This will help reduce the number of flare ups and help the skin recover.

  • Do not scrub the skin or burst the pimples as this may cause further infection.
  • Avoid popping the pimples as this can cause further infection and scarring.
  • Avoid touching the face as this may cause further infection.
  • If acne is on the body wear loose clothing so that the skin can breathe.
  • Shave carefully, if possible use an electric razor.
  • Avoid the sun as this may worsen the acne.

Skincare for acne

It is important that your skincare for acne routine supports the skin's recovery and avoids products that can irritate the acne. Whitehead and blackhead treatment is also important to consider. 

  • Wash your face no more than twice a day as it may irritate your skin.
  • Do not exfoliate as scrubbing the face can aggravate the skin and burst the pimples.
  • Use a moisturiser to keep the skin moisturised and help maintain the skin's barrier. Avoid alcohol based products as they can dry out the skin.
  • Clean your makeup brushes and sponges as these can build up bacteria. Summary

Hannah de Gruchy BSc(Hons)

About Author

Hannah de Gruchy is a freelancer writer who specialises in health and wellness. She has a keen interest in the biology of skin and loves using her words to help separate the real science of skincare from the pseudoscience of some skincare brands. Hannah has a degree in Human Biology and many years’ experience working in laboratories around London. Using this experience, Hannah enjoys turning complex science into interesting, engaging and easy to digest pieces to read. In her spare time, Hannah runs, practices yoga and loves cooking plant based foods.

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