Acne vulgaris, commonly known as acne, manifests as plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) on the face, neck, chest, back, shoulders, and upper arms. While most teenagers experience acne to some degree, it can affect individuals of all ages, even adults in their 20s, 30s, and 40s. Although not life-threatening, acne can be emotionally distressing and cause disfigurement. Severe cases may result in significant and permanent scarring, while even milder cases can leave scars.
**Understanding the Causes of Acne**
Inflamed spots arise from the release of inflammatory fatty acids by the bacterium *Cutibacterium acnes* (*C. acnes*, formerly known as *Propionibacterium acnes*), triggering the body’s immune response. However, *C. acnes* colonization requires a plug within the hair follicle duct.
This plug forms due to increased skin cell turnover, heightened keratin deposition narrowing the follicle opening, and elevated sebum production. The excess sebum mixes with cellular debris, creating a blockage.
Reduced levels of linoleic acid in the skin can contribute to this process. This reduction is often linked to sensitivity to dihydrotestosterone (DHT), a hormone derived from testosterone. The conversion of testosterone to DHT is catalyzed by the enzyme 5-alpha reductase.
**Effective Solutions for Addressing Acne**
While completely halting hormonal fluctuations is generally not advisable, several approaches can target the underlying causes of acne:
1. **Topical DHT Reduction:** Products like tri-ethyl citrate and ethyl linoleate can safely alter skin conditions, slowing down 5-alpha reductase activity and reducing DHT levels locally in the pilosebaceous unit (the hair follicle and sebaceous gland). This minimizes systemic effects.
2. **Linoleic Acid Replenishment:** Restoring linoleic acid levels in the skin can decrease oil production, skin cell turnover, and keratin deposition. Topical applications are preferable to oral supplements, as the latter may require high doses to impact skin levels.
3. **Specialized Delivery Systems:** Techniques like Oleosomes and Drysyst technology can enhance linoleic acid delivery to the skin. Ethyl linoleate is also beneficial, as skin bacteria can break it down to release linoleic acid.
4. **Normalizing Cell Turnover:** Retinol-based creams and triethyl citrate can normalize skin cell turnover and reduce keratin deposition. However, retinol products may increase sun sensitivity, necessitating sunscreen use. Triethyl citrate offers a non-photosensitizing alternative.
5. **Oil Control:** While harsh detergents can worsen oil production, mild cleansers, combined with ingredients like triethyl citrate and ethyl linoleate, can effectively reduce sebum production without triggering a negative feedback loop.
6. **Exfoliation:** Exfoliants, particularly chemical exfoliants like salicylic acid and pyruvic acid (hydroxy acids), can unclog ducts and remove debris. Salicylic and pyruvic acids also possess sebo-static effects, temporarily slowing oil production. Gentle, non-irritating cleansing agents containing silicone and glucose-based cleansers, along with triethyl citrate, are suitable for sensitive skin.
7. **Controlling *C. acnes* Levels:** Maintaining open, oxygen-rich hair follicle ducts helps. When controlling *C. acnes*, it’s beneficial to avoid broad-spectrum antibiotics that can disrupt the skin’s natural flora and potentially lead to antibiotic resistance. Focus on strategies that inhibit the bacterium’s ability to thrive by changing the conditions in the pilosebaceous unit so that the enzymes don’t work as well, thus slowing down this process and reducing food and the growth of *C. acnes* without attacking good skin bacteria.
8. **Reducing Inflammation:** Control bacteria and reduce inflammation. This can be achieved by using anti-inflammatory products and antioxidants. Antioxidants, such as skin-soluble versions of vitamin C (ascorbic acid, Ascorbyl Palmitate, and Ascorbyl tetra-isopalmitate), can neutralize inflammatory free radicals.
**Summary**
A comprehensive acne treatment approach involves a product range that addresses DHT production, increases linoleic acid levels, normalizes skin cell turnover and sebum production, incorporates mild sebo-static chemical exfoliants or gentle cleansers, utilizes staph-friendly antibacterials to manage *C. acnes*, and includes antioxidants to control inflammation. Such a product range would be supported by dermatologists worldwide.