A zit occurs when the tiny holes in your skin called pores get clogged by oil, dead skin cells, dirt or bacteria. If this happens a lot it might mean you have acne. 

Acne is a very common condition, with an estimated 85% of people between the ages of 12 and 24 experiencing some degree of symptoms, but it can happen in later years as well, particularly for women, who go through hormonal changes caused by menstruation. 

It’s not a life-threatening condition, however it can be painful and can cause emotional distress. By now, we have developed many effective treatments for acne so if you’re experiencing symptoms, the best course of action would be to make an appointment with a dermatologist. There are a lot of myths around acne and some home remedies or over-the-counter treatments actually make it worse. 

Symptoms

Acne is a chronic, inflammatory skin condition which results in spots or pimples almost anywhere on the body but the most common regions are the face, neck, chest, shoulders, back and upper arms. 

The mildest forms of acne cause pimples which appear white or black called comedones. The whiteheads are closed clogged pores and the blackheads ore open clogged pores – they may look as if it’s dirt because of the color, but in fact this is what happens when the sebum blocking the pores is exposed to oxygen. 

These are the most common symptoms of acne, but depending on the severity you may get:

  • Papules – skin lesions that look like small red bumps, the shade can vary and they can have distinct or indistinct borders. They’re often caused by an inflammation or infection of the hair follicles, can cluster together as a result of a rash and can also be a reaction to medication, in which case you should consult a doctor. 
  • Pustules – they look very similar to pimples but they’re usually bigger and cause pain when touched. They contain fluid or pus and can develop on any part of the body as a symptom of acne (most commonly) but they can also be caused by insect bites or indicate an allergy reaction to environmental factors/food.
  • Nodules – they look like lumps underneath the skin but they feel hard and painful when touched. Nodular acne is considered one of the more severe forms of acne. Don’t try to pick at or pop the nodules as this will lead to scarring. Likewise, over-the-counter remedies don’t work for nodules as the inflammation is formed in the deeper layers of the skin. Safest solution is to visit a clinic like Dermetics and get a proper diagnosis as nodules can be a symptom of several more serious conditions. 
  • Cysts – Cystic acne is a rarer and more severe form of acne. The cysts form in the deeper layers of the skin, much like nodules but nodules are harder and usually remain intact. Cysts, on the other hand, reach the surface of the skin and can burst spreading the infection and causing more breakouts. 

Cysts can also form in the skin as a result of ingrown hairs – hairs that grow down or sideways and become infected. They’re common for people who wax or shave.

When Should You See a Doctor?

You can use home remedies or over-the-counter treatments if you get whiteheads or blackheads from time to time, especially if you’re a teenager. It’s still better that you consult a dermatologist so you know you’re using the right products and you’re not damaging your skin. 

In case you have symptoms more consistent with severe forms of acne, like nodular or cystic acne, then it’s far more effective to get a prescription treatment from a dermatologist so you can minimize the risk of scarring. 

A sudden onset of severe acne in adults can signal a more serious underlying condition such as polycystic ovarian syndrome (PCOS).

Causes

Each pore in your skin is actually the opening of a hair follicle and contains a sebaceous gland which produces oil. This oil travels up the hair and onto the skin to keep it from getting dry. 

There are several things which can disrupt this process resulting in acne symptoms. 

  1. Your glands could be producing too much sebum which clogs the pores
  2. Your pores might get clogged by dead skin cells or dust
  3. A build of bacteria such as Propionibacterium acnes can cause inflammation or infection in the pores. Although the presence of this bacteria on the skin is normal, if it gets blocked in the pores with dead skin cells and sebum it causes infection and inflammation in the pores. When the pimple is popped, the fluid contaminates the surrounding pores. 
  4. Excess activity of androgen hormones which lead to increased sebum production in the glands

During puberty, testosterone in both men and women is converted into Dihydrotestosterone (DHT), a more powerful androgenic hormone which leads to increased body hair growth in both sexes and the development of the prostate and genitals in men. 

This hormone also binds to receptors located in the sebaceous glands and make them produce more sebum. Some of the pores or follicles will become stretched from the excess sebum and rupture which releases inflammatory chemicals into the skin. 

The balance between colonies of Propionibacterium acnes, Staphylococcus epidermidis and Malassezia furfur is also disrupted, leading to further inflammation and infection. 

In adults, hormone levels tend to level off which results in a reduction of acne symptoms but fluctuations such as the ones caused by menstrual cycles can cause breakouts. This is very common (70% of women). 

Risk Factors

  • One major factor is having parents that also had acne as the heritability factor account for 50 to 90% of the risk. 
  • Eating a lot of junk food, sweets and dairy products can cause insulin levels to spike which tends to make acne worse. 
  • Oil based cosmetics will likewise contribute to pore clogging resulting in pimples.
  • Stress or increased anxiety stimulates the production of hormones that will affect sebum production and consistency, and so will menstruation. 
  • Some medications like lithium, corticosteroids and anticonvulsants are linked to acne flare-ups.
Cite this article as:
Editorial Staff, "What Causes Acne?," in Medicalopedia, February 21, 2020, [Permalink: https://www.medicalopedia.org/8383/what-causes-acne/].