The obvious … and the not so obvious …

Many of our previous articles have discussed the common causes of acne that largely includes androgen-induced increased sebum production, altered follicular keratinization, inflammation and proliferation of the bacteria P.acnes in a genetically predisposed individual.

However, could there be other contributing factors potentially influencing the occurrence, duration and severity of acne?

Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert, shares some thoughts on other potential causes – some obvious, with others potentially less so.

Studies show that dairy products, particularly skim and whole milk (as little as two glasses per day) and hyperglycaemic carbohydrates have an impact on acne. High glycaemic diets and milk consumption can lead to a rise in blood glucose resulting in high secretion of insulin which in turn leads to increased secretion of an insulin like growth factor. This, in turn, can lead to increased androgen levels that promote both sebum production and hyperkeratosis of hair follicles, both of which can further aggravate an existing acne condition. Nutritional supplements (such as whey protein that contains leucine) may also trigger or worsen an acne condition.

Certain hormonal treatments and oral contraceptives (injections, subcutaneous and intra uterine devices) that are mainly progesterone based can lead to the exacerbation of acne in adolescents and adult females. This is due to the conversion of the progesterone into testosterone.
Further, anabolic steroids, that target androgen receptors on the sebocytes and keratinocytes, can also worsen acne. Other medications also known to aggravate include corticosteroids, halogens and TB medication such as isoniazid, lithium and vitamin B12.

Occupational factors
An aggressive skin care regime (excessive cleansing, use of harsh soaps with PH of 8.0 and over exfoliating) as well as inappropriate cosmetics (comedogenic make up, essential oils, greasy or oily foundations not suited to your skin type and powder make up) can further aggravate acne. This is due to the resulting modification of the skin barrier function and imbalance of skin microbiota that, in turn, triggers inflammation. Make sure to completely remove all make up prior to sleeping as failing to do so can lead to clogged pores, further aggravating acne. Make up brushes and sponges can also be a breeding ground for bacteria, so it is advisable to wash these regularly as well. Also, hair products that contain coconut oil and brilliantine can cause comedogenic and cystic acne.
Lastly, mechanical factors such as rubbing, scrubbing and the use of home devices such as sonic brushes may also trigger acne flare ups as a result of inducing inflammation.

Various air pollutants can increase oxidative stress that may alter the normal functioning of lipids and proteins on the skin. To help combat this, daily use of OXY Facial Wipes is recommended. The anti-bacterial properties of tea tree oil and salicylic acid will assist in gently cleansing your skin, leaving it soft, moisturised and free of blemishes.
Industrial pollutants such as prolonged exposure to crude and coal tar can also lead to acne exacerbation, with exposure to halogenated aromatic hydrocarbons or mineral oils potentially leading to chloroacne.
The smoking of cigarettes and/ or cannabis (although a controversial subject), is also thought to worsen acne.

Climatic conditions
Our climate can also play a role with exposure to heat, humidity and UVR known to trigger inflammatory acne flare-ups. UVR exposure is thought to cause hyperplasia of the sebaceous gland, thickening of the stratum corneum and an increase in sebum production and comedo formation. It is therefore important to invest in a good sunscreen, for daily use with reapplication as often as every two hours if possible.

Psychosocial and lifestyle factors
The very items we increasingly rely on are also known to have an impact on acne. Cell phones, tablets and computers emit short wavelength visible light reported to cause proliferation of staphylococcus aureus. This, in turn, leads to imbalance in the skin microbiota, thereby aggravating acne. Cell phones, considered one of the dirtiest objects we carry with us, can lead to contamination of the skin, thereby further exacerbating acne by promoting cutaneous infections and inflammation. It is recommended that you regularly clean and disinfect your mobile device, with OXY Facial Wipes once again an ideal solution to assist with this.
And, of course, factors such as stress and emotions as well as sleep deprivation (poor sleep can lead to increased transepidermal water loss and a poor skin barrier function) are all known to play its part.

Other factors
In the era of the COVID-19 pandemic, masks as an aggravator of acne needs to be mentioned. This is due to increased humidity and proliferation of bacteria as mentioned in our previous article on ‘maskne’. The frequent touching of one’s face with your hands can also lead to further contamination due to the presence of bacteria and oils on one’s hands. A further complication can be caused by the presence of alcohol on one’s hands due to the increased usage of sanitisers.
A further irritant could also be one’s pillowcase that exposes your face to hair products and dirt from perspiration during the night. To help combat this, ensure pillowcases are regularly washed and changed. And be sure to clean gym clothes, towels and exercise mats daily to remove dirt from sweating, grease from hair and other possible bacteria that could further irritate the skin.