Few skin conditions are surrounded by as many wild theories, myths, and misconceptions as acne. Research has made great strides in this area, yet many old myths persist, and like most legends, they are hard to dispel. Unfortunately, this often leads affected individuals to experiment with "revolutionary" cures and obscure miracle remedies that either have no effect or may even worsen the problem. You can’t "wash away" pimples, but you can treat them. The key is knowing how.
Acne itself is certainly no myth, as anyone who has experienced it knows. But if you don’t understand how it actually develops, it’s difficult to know how to treat it. Here, we explain the facts, plain and simple.
First and foremost, acne is not contagious, nor is it caused by poor hygiene, dirt, or an unhealthy diet. Acne is primarily a genetically predisposed condition, but many different factors influence the severity of symptoms. Let’s start from the beginning.
The first changes that lay the foundation for acne-prone skin begin during puberty. At this stage, the body starts producing androgens, male sex hormones, primarily testosterone. Through an enzyme found in the hair follicles of the skin, testosterone is converted into the steroid hormone dihydrotestosterone (DHT), which in turn stimulates the sebaceous glands to produce sebum. Up to this point, everything is normal, and these processes occur in everyone during adolescence. But for those genetically predisposed to acne, something more happens.
As sebum production increases, a process called hyperkeratinization is triggered in acne-prone follicles. Essentially, this means that skin cells in the hair follicle are produced too quickly and become trapped inside the pores. As a result, individuals with this predisposition are more likely to develop comedones than the general population. If this clogged pore becomes inflamed, a pimple forms.
The key components required for acne to develop are testosterone and the enzyme that converts it to DHT. People who lack these substances cannot develop acne, even if they have a genetic predisposition for hyperkeratinization. Theoretically, acne could be prevented from the onset of puberty by blocking one of the initial steps in this process, but this would also inhibit normal sexual maturation, which would significantly impact an individual’s development.
Acne typically appears around ages 12-14 and gradually worsens over the following decade. The condition progresses almost like a wave across the body, as sebaceous glands mature in different phases. The follicles in the T-zone are the most sensitive to hormonal changes and react even to relatively low testosterone levels. This is why the first pimples tend to appear on the forehead, nose, and center of the chin at the onset of puberty. The sebaceous glands on the cheeks, upper chest, and back become active around ages 15-16, while the follicles along the jawline, neck, and lower back are typically activated later in the teenage years.
Testosterone is often seen as the main culprit, but hormones themselves do not cause acne. Men do not necessarily have more pimples than women, and those who suffer from acne do not produce more testosterone than others. However, androgens act as a trigger for those who are already genetically predisposed to acne.
By understanding exactly what causes acne and what it truly entails, it becomes easier to treat it effectively. Acne cannot be "cured," but that doesn’t mean you have to suffer needlessly. With the right skincare, symptoms can be managed, and severe inflammation leading to scarring can be prevented.
