Topically, there are several factors to consider when it comes to the causes of acne:
- hormonally mediated sebum overproduction (skin overproduces oil and makes the oil stickier than normal)
- follicular hyperkeratinization (dead skin cells stick together and clog pores)
- chronic inflammation of the pilosebaceous unit (in people with acne, the skin releases more inflammation causing chemicals )
- different types of p.acnes bacteria (which is why some skins do not react to antibacterial topicals)
- lipid peroxidation caused by free radicals (when sebum oxidizes it becomes highly comedogenic)
Recent research shows us that this last topical factor – lipid peroxidation – actually helps to drive the acne process and may in fact be the genesis of the whole acne-causing chain of events. Research also reveals that people with acne simply experience more oxidative stress than those without, both in their skin and in their bodies. It is still unclear whether higher oxidative stress is the result or the precursor of being acne-prone. It may be a little of both, but regardless, oxidative stress is a factor that is extremely important to address in healing acne.
We used to think that follicular plugging (comedones) is what caused the colonization and growth of p.acnes bacteria, which then resulted in inflammation (pimples).
In recent years, it has been discovered that there are several things going on in the skin long before the micro-comedone is created that help to create the perfect storm for a pimple to occur.
We don’t know exactly why it happens, but for some reason, in people prone to acne, there is an elevated amount of pro-inflammatory factors around pores and sebaceous glands. This means that even before sticky sebum and skin cells cause a plug, high amounts of inflammatory chemicals cause the sebum in the pore to oxidize. The lipid peroxidation of the sebum causes the sebum to go from being an inhospitable environment for p.acnes, to one in which anaerobic bacteria like p. acnes can survive and thrive. It also greatly increases the comedogenicity of the sebum.
It is now thought that inflammation and oxidative stress within the skin (pilosebaceous follicles) might set the stage for all subsequent factors leading to acne.
In fact, did you know that back when antibiotics were being heavily prescribed for acne sufferers, the theory was presented that the antibiotics were actually working to heal the acne because they functioned as antioxidants within the body? In fact, a recent investigation showed that doxycycline, a common antibiotic used orally to treat acne, when given at sub-antimicrobial doses, reduced acne by over 80% after 3 months in test subjects with moderate facial acne.
Here’s how it works: Inflammatory mediators cause the sebum to oxidize. Oxidized sebum then becomes hospitable for p.acnes; p.acnes begins to proliferate. The p.acnes bacteria then generate free radicals that further increase both the oxidation and inflammation already present, and a pimple springs up.
This gives us some clues as to why Zinc is so often linked (both internally and topically) to being helpful for acne – it is an important antioxidant co-factoring mineral.
In later blog posts, I will hopefully go into what we can do holistically/internally to help balance these higher than normals amounts of inflammation and oxidation in the body, but for the skin topically, research has shown that using certain antioxidants is key.
The antioxidant Sodium Ascorbyl Phosphate (the stable form of Vitamin C we use in Illumina) showed superior efficacy to Benzoyl Peroxide in healing acne.
DMMC (Dimethylmethoxy Chromanol) a synthetic, extremely stable, powerful and expensive antioxidant – found in Potentci and also AMBAR’s Daily Antioxidant Primer – shows great ability to prevent lipid peroxidation, which is the specific kind of oxidation that is related to acne.
Other antioxidants to explore topically that research has indicated are effective against this particular acne trigger include Vitamin E, green tea and zinc.
Takeaway: making sure your skincare has acne-appropriate antioxidants may help to control what is thought to be the root topical cause of acne – lipid peroxidation of the sebum.