Whiteheads, blackheads, papules, pustules, cysts. How do you know what type of acne you have and how do they form? In this episode we will cover the causes of acne and the differences between the different types of acne.
What are the causes of acne formation?
As teens enter into puberty, there is an increase in the production of sex hormones called androgens. Androgens are hormones- testerone in males and estrogen in females. However, females can have both testosterone and estrogen. Testosterone is the hormone that is responsible for stimulating the oil glands, or the sebaceous glands in both males and females during the onset of puberty. When these glands are active, certain area of the skin produces more oil. These areas include the T-Zone of the face – the forehead, nose, and chin; as well as the chest and back.
Not everyone will develop acne at puberty. The process of acne begins with inflammation. To develop acne, one requires the specific genetic makeup for androgens to bind to certain receptors in the skin. One is much more likely to develop acne during the onset of puberty if they have a family history of acne. This specific genetic makeup will cause inflammation to start underneath the deeper layers of the skin. This will result in “micro” whiteheads, or microcomedones which can rise to the top of the skin in the span of two to four weeks before it appears on your skin as either a visible whitehead or blackhead.
Are pores blocked in the process of developing acne?
Yes and no. Yes- because you must first have a genetic predisposition to developing acne to have your “pores blocked”. If you do, inflammation is what causes the skin to trap bits of dead skin. Dead skin accumulates as debris. This combines with excess oil and dirt to form whiteheads and blackheads.
At the same time, the answer to this question is also a “no”. There are those who produce excess oil during the onset of puberty, but lack the genetic tendency to develop acne. Hence, they do not find that they have blocked pores at all.
Is acne contagious? is bacteria one of the causes of acne?
Propionibacterium acnes. is a type of bacteria that is present on the skin of those who suffer from acne and those who don’t. However, individuals who develop acne have far greater amounts of P.acnes on their skin – and are colonized with this bacteria.
However, acne itself is not contagious. One of the main causes of acne is your genetic makeup.
Why does my friend not have acne?
There is nothing to be ashamed about because it is the same genetic makeup that you have which makes you an individual. Research has shown that individuals who suffer from acne tend to age much better than their counterparts who do not suffer from acne. This is because individuals who suffer from acne tend to have greasier skin and the overall oil of the skin helps to preserve the skin’s elasticity and increased sense of facial fullness when they grow older. Besides, the purpose of this book is to let you know that acne is 100% treatable. So read on!
What are the factors that trigger the causes of acne?
- Genetics
The root cause of your acne is your genetic makeup. However, many other factors go towards triggering the development of acne.
2. Excessive oily complexion
Seborrhea is a condition that causes an excessive oily complexion. Often, this can be due to the use of an inappropriate face wash. Many face washes for oily skin contain strong lathering agents or astringents that strip the skin of its natural moisture.
If your face wash leaves your skin feeling “squeaky clean”, it likely is too drying. Instead, this can result in reactive seborrhea, a condition that causes your skin to produce even more oil.
One tip you may find helpful is to switch to a lotion or serum-based moisturiser, rather than a cream formula which contains more oil. Remember, the key is to maintain a healthy skin barrier, not to dehydrate it!
3. Your diet matters
Research shows that consuming dairy, foods high in saturated fat as well as foods with a high glycemic index can increase the body’s tendency to inflammation. Instead, a diet rich in plant antioxidants and olive oil is beneficial for healthy skin.
Find out more about how diet affects acne here:
Moving on to the different types of acne and what causes them:
Whiteheads
Before we delve into what whiteheads are, lets talk about blind pimples. Blind pimples are pimples without a head. Individuals just starting to develop acne may notice that they have more whiteheads and blackheads. The medical term for whitehead is closed comedone; and blackhead, open comedones. Understanding this terminology is simple.
When they are closed, there is no visible tract to the surface or an obvious opening to the surface of your skin. Consequently, the pimple may feel “hidden”. Conversely, when they areopen, this means that there is a tract that leads to the surface of the skin. This helps to explain why you may be able to see the blackhead at the surface of your skin.
Can I pop my pimple and squeeze the whitehead out?
Many squeeze, prick, or extract to remove their whiteheads. However, we do not recommend this from a dermatologist’s perspective. This is because it can introduce bacterial infection which can lead to inflammatory scarring.
Why is that so?
Squeezing the whitehead may temporarily remove the underlying debris. However, this will cause scarring and introduce bacteria which may cause a deeper cyst to form. Also, this does not solve the underlying cause – your genetics causing inflammation which is responsible for acne development. As we cannot change our genetics, a much better plan is to remove the whitehead without physical trauma to the skin. This is because traumatizing your skin in any way will increase the risk of getting skin infections. As you have heard before, acne formation can be triggered by bacteria. Therefore, squeezing this is a surefire way to cause your acne to get worse. Furthermore, it can also develop scarring.
How do I get rid of whiteheads?
First of all, if you have 1-5 whiteheads, using a gentle face wash with antibacterial properties, maintaining good hygiene, and using an over the counter pimple cream may help to remove them. Some common ingredients present in these over-the-counter treatments are salicylic acid, benzoyl peroxide, or sulfur. These may work for mild acne. However, if you develop skin irritation, you should stop using it. This is because these ingredients work by drying up your skin. Prescription retinoid creams will also be available via your dermatologist. These are effective against whiteheads and blackheads.
A note about benzoyl peroxide formulations is that they come in different concentrations – with 2.5%, 5% and 10% being the most common. Some formulations have up to 40% benzoyl peroxide. My personal experience with patients using benzoyl peroxide is that it can be extremely drying for their skin. It can even give rise to the issue of “oily dehydrated skin” common in acne sufferers who also use drying ingredients like benzoyl peroxide for different types of acne treatment.
My personal preference for anti-acne formulas those with antioxidant botanical extracts. Rather than just drying the surface of your skin with astringents like salicylic acid and benzoyl peroxide, newer acne cream formulations utilise anti-inflammatory plant extracts.
The Blemish Spot cream which I formulate as a spot acne treatment incorporates an algae extract, Chlorella Vulgaris. Chlorella has been shown to inhibit oil gland activity, and works with amino acids which also function as natural moisturising factors to heal acne blemishes.
Anti-scarring for different types of acne
It is important to note that you want your pimple to heal well and with minimal scars. For that, you should consider applying a serum or a light moisturizer that also contains natural moisturizing factors such as amino acids, polyglutamic acid, and hyaluronic acid. These are moisturizers that are formulated without grease and it will help your skin to heal well. If you find that these methods don’t work for you, you may have to visit a dermatologist.
What happens if I am visiting a dermatologist for whiteheads?`
Here is what a standard visit to a dermatologist looks like. First, an evaluation to determine if you have comedonal acne. This is to rule out other diagnoses such as “fungal acne”, an acne-like eruption affecting the hairline, chest and back. The culprit causing this is Malessezia furfur, a yeast that causes ‘fungal acne’ or Pityosporum Folliculitis.
For this, your dermatologist will prescribe anti-fungal shampoos and creams with or without anti-acne medication. Examples of treatments that are very effective for whiteheads, or closed comedones would be retinoids. Retinoids are derived from vitamin A and they work by regulating the rate of cell turnover. With that, your skin will have less dead skin cells to work with to produce debris.
Check out more beauty related news and tips on beauty podcasts by Dr.TWL on spotify and follow our IG @drtwl.tv