Why do I have acne and why can’t you cure it?

Acne treatment can be frustrating for the patient, who asks, “why do I have acne and why can’t you cure it?” Many factors combine to cause acne and the factors involved can vary in different individuals. The short answer is that, basically, it boils down to heredity, or genetic tendency, and hormones.

The long answer is that overactive sebaceous (oil) glands can produce too much oil. Pores are designed to empty this oil onto the surface of the skin to keep the skin protected from drying out and to keep it supple. Unfortunately, some people have a genetically based tendency for the skin cells lining the pore to stick together instead of shedding normally so that the pore becomes clogged. When the pores in the skin become plugged, a blackhead or whitehead results. It is a myth that a blackhead is dirt; it is actually dead skin cells that are stuck together plugging the pore. The dark color comes from melanin, the pigment that is inside skin cells that gives our skin its natural color. The cells clump together and the buildup of melanin causes the clogged pore to look dark.

After the pore is clogged, the bacterium P. acnes that is present in everyone’s oil glands, multiplies. The body’s reaction to the overgrowth of P. acnes is to send in white blood cells and various bacteria-fighting compounds to kill it. This reaction is called inflammation and is responsible for the redness, tenderness, and pus that causes the enlarging pimples, nodules, cysts and can cause scarring.

Acne occurs in areas of the skin that have numerous and more active oil glands—the face, jawline, chest, upper back and shoulders. These are the areas where pores are more visible. Oil glands and the cells lining the pore are stimulated by androgenic or male-type hormones. Androgenic hormones rise in both males and females in puberty, and some adult females produce excess male hormones causing some combination of irregular menstrual cycles, acne, excess hair growth, and infertility.

Hormones are a very complicated topic that we will discuss in more detail later. For now, just know that certain hormones cause and make acne worse in people who have a genetically predetermined tendency preventing normal shedding of the cells that line the pore. Since hormonal status and changes often are long lasting and genetics can’t be changed, acne is a long lasting condition that may persist for years. It can usually be controlled, but treatment must be continued indefinitely until the tendency to get acne has passed. This causes a great deal of frustration in patients who do not understand why acne cannot be “cured” and why they have to continue treatment “forever.”

Most people eventually outgrow the tendency to acne as their hormonal status changes, but that may be in their 50’s, especially for women. One treatment for acne, isotretinoin (Accutane, Sortret, Claravis, Amnesteem) can permanently change the genetically determined tendency for skin cells to stick together so that they shed normally instead.

So the answers to the questions about acne:

Why me? Genetics and hormones

Why can’t acne be cured rather than just controlled? Ditto

Next: A Pandora’s Box of hormones