Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert


Acne and its causes


Acne is a chronic inflammatory disease of the pilosebaceous unit, evidenced by seborrhoea (oily skin) in most patients, comedones (which can be open or closed), papules and pustules and sometimes nodules. At times, it can also be complicated by scarring.


The causes of acne include follicular hyperkeratinisation, excessive sebum production, hypercolonization of the duct by cutibacterium acnes and inflammation. Recently, the enzymes matrix metalloproteinases (MMPs) have been proven to also play a role in the pathogenesis of acne vulgaris – especially the associated scarring.

The sebaceous gland is a key component involved in acne. Excess sebum production or alteration in its fatty acid composition can interfere with follicular keratinization, leading to pore blockage and the formation of comedones. A sebum-rich environment also promotes colonization by C. acnes.

Excessive sebum production is thought to be due to the potent androgen 5α-dihydrotestosterone (5α-DHT). This 5α-DHT is produced from testosterone via 5α-reductase type 1, an enzyme expressed mainly in the skin – particularly in facial sebaceous and sweat glands.

Do hormones play a role?


It is a known fact that acne vulgaris first develops in many people at the onset of puberty as a result of hormonal changes that occur during this stage of development. Hormones are thought to play a role by regulating sebaceous gland activity.

These hormones include androgens (the most important of all hormones in regulating sebum production), oestrogens, progesterone, growth hormone, insulin, insulin-like growth factor-1 (IGF-1) and stress hormones amongst others.

With the onset of puberty, there is increased secretion of androgens (5α-DHT and testosterone). Increased androgen secretions lead to stimulation of the sebaceous glands, resulting in increased sebum production in both sexes and therefore the onset of acne.

Stress hormones such as the corticotrophin-releasing hormone (CRH) and cortisol, which are released during stressful times, also mediate sebaceous activity. These hormones stimulate sebum production and increase expression of the enzyme hydroxysteroid dehydrogenase that activates androgens. All this leading to the worsening of or triggering of acne lesions.

In previous articles, we have spoken about the consumption of high glycaemic index food and dairy products and its role in increasing serum insulin and insulin-like growth factor-1. Both these hormones stimulate the growth and maturation of sebaceous glands, that ultimately leads to increased sebum production and thereby exacerbating acne.

During puberty, there is a surge in growth hormone (GH) which leads to increased production of IGF-1. IGF-1 induces adrenal and gonadal secretion of androgens leading to more sebum production.

The role of hormones in acne has also been seen in women who suffer from PCOS (polycystic ovary syndrome). PCOS is an endocrine condition characterised by the over production of androgens leading to acne. It often responds poorly to treatment and can result in women growing hair in a male pattern. Often these patients also have hyperinsulinemia.

Hormones have also been seen to play a role in acne in neonates, which is thought to be due to androgens neonatal and maternal androgens passed to the baby via the placenta. These androgens lead to overactivity of the sebaceous glands in babies that can last up to one year, after which time the androgen levels drop again.

From age 1-6 children rarely get acne. Any child with acne in this age group, needs to be evaluated by an endocrinologist for abnormal hormone production.

Now that we know hormones do play a role in acne, exactly what can we do about it?

We can’t run away from puberty and the hormonal surge that comes with it, but we can limit over production of excess androgens by eating healthy, reducing intake of high glycaemic index food, dairy (especially) milk and fatty foods. It is also recommended to increase one’s consumption of fruit and vegetables to lower insulin production and the production of IGF-1.

Further, it is also advisable to try and reduce one’s stress levels where possible by exercising, meditating, and getting sufficient sleep.

There have also been some suggestions that drinking spearmint tea can help to regulate hormones and is something worth trying.  Most importantly, if hormones are thought to play a role in aggravating an existing acne condition, consult your dermatologist for a potential hormonal treatment.