We probably all know that hormones are part of it, but surprisingly for many, your hormone levels don’t change. In fact, for 100% of male acne sufferers and for around 70% of female acne sufferers, hormone levels are the same before, during and after acne. The other 30% of women who do suffer from acne have hormonal changes, due to Polycystic Ovary Syndrome.
The true start of acne is the physiological changes which make our skin more sensitive to our hormones, particularly a form of the male (androgen) testosterone hormone called DHT (Dihydrotestosterone).
Dihydrotestosterone is a hormone that stimulates the development of male characteristics (an androgen). It is made through the conversion of the more commonly known androgen, testosterone. This skin sensitisation to hormones leads to a depletion of lipids and fatty acids in the skin which leach out of the skin and fall off alongside our dead skin cells. These ‘fats’ help to control the rate that water escapes from the skin, which is known as trans-epidermal water loss, or TEWL, and is critically important in the development or exacerbation of many skin conditions.
Therefore, it is true that acne is caused by a hormonally triggered loss in the skin’s ability to control water loss.
If water is escaping too fast from the skin, the living skin cells start to suffer and so the skin has to respond; new skin cell production increases which causes thickening of the epidermis in an effort to normalise water loss. Also, more keratin (the waxy protein substance that makes your nails hard) is deposited in the upper skin cells called keratinocytes and this also slows down water loss. The skin becomes harder or ‘hornier’ with increased keratinisation. The skin’s sebaceous glands then increase the production of sebum (oil) which flows out of the hair follicle duct onto the skin. This liquid oil also slows down water loss.
The problem is that, although the skin is thickening upwards, the top layer of the skin also lines the neck of the hair follicle duct, so this thickening narrows the duct and can close it totally. This is exacerbated by the increased number of dead skin cells and oil all combining to help block the duct.
Right now, such a skin would not have acne, but it would have blackheads and whiteheads (closed and open comedones), and therefore a ‘congested skin’.
Many bacteria live on our skin and feed on the oil (sebum) we produce; one such one is known as p. acnes. It doesn’t particularly like living on our skin in a high oxygen environment as it prefers a low oxygen environment. However, it survives on our skin feeding on the oil by secreting enzymes onto the skin and breaking the oil down to glycerol, which is sucked back up by the bacteria as food. What’s left on the skin, as in free fatty acids, just fall off with our dead skin.
Once the hair follicle duct is blocked, the bacteria’s food source is cut off, so the bacteria migrate under the plug to find the oil. However, it also finds a lower oxygen environment which it prefers, so it starts to reproduce and many new bacterial cells colonise the hair follicle duct. Now the free fatty acids produced from the bacterial enzyme break down, build up under the plug and trigger the body’s immune response which leads to inflammation. This can also lead to the breakdown of the hair follicle duct walls and the bacteria invade the surrounding area, which can result in scarring.
When the bacteria are attacked by antibiotics and other treatments, as well as by the body’s immune system, the bacteria protect themselves by grouping together in a colony where they share their protective slimy protein coating. This becomes one shared coating with the bacteria inside it, called a biofilm and it protects the bacteria from immune attack and also from antibiotics which cannot penetrate the biofilm. This is why antibiotics can take so long – if at all – to work on acne. Benzoyl peroxide can be used to break open the biofilm which releases some of them to be attacked by the antibiotics and killed. However, due to benzoyl peroxide only having a short-term effect, the biofilm forms again. This means the antibiotic again cannot penetrate and the surviving bacteria are those less sensitive to the antibiotic, which over repeated exposures become more resistant to the antibiotics.
What can be done?
If you don’t get the blockage, you don’t get the spot.
Using exfoliating agents and benzoyl peroxide tends to thin the skin which accelerates water loss again and can make the situation worse. Using active ingredients like salicylic acid can help to soften and dislodge plugs blocking the duct, but too much can again be exfoliating, and using it on a twice-daily basis can lead to increased water loss and the skin thickening cycle getting worse. Also, if the walls of the hair follicle duct have actually thickened to the point where they meet and the duct is blocked but there is no oily plug, it can be a struggle to resolve.
If you can increase fixed ‘fats’ in the skin, cell production slows, keratin deposition reduces and oil production slows. Hydratime and Nutritime Plus Face Creams can restore TEWL control and the Aknicare range has a unique way of destroying the invading p. acnes (96% in a study), as well as all of the antibiotic-resistant bacteria. Also, by increasing TEWL control, through Aknicare inputting linoleic acid into the pilosebaceous duct, you make the skin less sensitive to the DHT hormone, which is a key initiator of the acne development process.
However the key is Hydratime and Nutritime, with its 50% ceramide mix of the key nine ceramide groups in the exact proportions the skin needs, combined with its 25% of free fatty acids and 25% cholesterol, which mirrors the skins actual make-up and helps restore TEWL control; so the skin does not need to thicken to control water loss, so the closure of the hair follicle duct doesn’t happen, meaning the duct stays open, and no blockage means not spot.
That’s one thing to help, but what about the rest?
Another system is to find a way to kill the bacteria in the biofilm. We have a fast, unique, patented way of doing this that does not use antibiotics, benzoyl peroxide, or even retinol.
Aknicare ingredients get below the blockage, and into the biofilm where the bacteria are feeding and reproducing. The bacterial enzymes are preferentially drawn to these ingredients and break them down instead of oil.
This means three things:
- Intact sebum maintained (oil) means no glycerol food for the bacteria
- Free inflammatory fatty acids from sebum breakdown are much reduced, as the triglycerides within the sebum remain intact, as the bacterial enzyme breakdown of the sebum is reduced and therefore inflammatory byproducts are also reduced.
- Now instead, the bacterial enzyme breaks down the Tebiskin Triethyl Citrate ingredient to release lots of citric acid, making the environment within the biofilm very acidic and killing the bacteria.
But what about the biofilm?
There is another ingredient which opens up the channels into the biofilm and allows the citric acid producing ingredient in. This means we kill 96% of the bacteria while in the biofilm; think of the biofilm, rather than protecting the bacteria, becoming their ‘coffin’.
These results have been supported and tested by top specialists throughout Europe and published in peer-reviewed journals and these ingredients have been accepted in prescribing lists.
SkinMed® provide clinically proven skin solutions, which, unlike cosmetic brands, are medically licensed in the treatment of many skin conditions and suitable for almost all skin types, with thousands of successful users across the UK and Europe.
The products were created through decades of experience, in collaboration with top dermatologists from all around Europe. Professor Tony Chu, President of the Acne and Rosacea Association UK (ARA UK), endorses and prescribes the products for his patients – you can be certain you’re in the right hands.
If you would like to find out where your local SkinMed® accredited clinic near you, all you need to do is get in touch. We have hundreds of clinics country-wide and our dedicated team will be more than happy to point you in the right direction.
We are also offering free skin consultations at many of our clinics for all our loyal customers. If this sounds like something you would be interested in, please let us know and we can find the nearest clinic to you offering a consultation free of charge.