The Most Frequently Asked Questions and Answers About Acne

Acne is one of the most common skin diseases in adolescence.

Acne is more common in adult women than men.

Psychological problems and unemployment are more common in acne patients.

Adult acne in women may be a precursor to ovarian cysts.

Medications and vitamins used can cause acne

Protein powders and androgens used for bodybuilding cause acne

Genetic factors are the most important factor in acne development.

Western-style (fast food) carbohydrate-heavy diet can cause acne development

Industrial milk and dairy products, especially of skim milkExcessive consumption can cause acne.

The hunter-gatherer peoples, who constitute the largest group of Eskimo-Aleut peoples, do not have acne.

In addition to drug treatment in acne, Mediterranean diet positively affects the effectiveness of treatment.

Stress negatively affects acne

Some cosmetic products used can cause acne

Adult patients with severe acne are at increased risk of developing prostate cancer.

Acne heals faster when probiotics are added to acne treatments

What is acne?

Acne, commonly known as puberty acne, is a chronic inflammatory disease of the sebaceous glands (pilosebeseous unit) in the skin.

At what age is acne most common?

Acne is most common in adolescence. It affects approximately 85% of individuals between the ages of 12-25. After puberty, approximately 25% of women and 12% of men can experience acne in their 40s. It can be seen less frequently in newborns and childhood.

What are the factors that affect the development of acne?

More than one factor is effective in the development of acne.

  1. Increased oil production in the sebaceous glands in the skin

  2. Occlusion of the sebaceous gland channels that allow the sebaceous gland secretion to be transferred to the skin surface

  3. Increased acne bacteria in the sebaceous glands (Cutibacterium acnes)

  4. Increasing sebaceous gland secretion due to increased hormones (androgen effect) in the body

In which parts of the body is acne most common?

Acne is most common on the face. Depending on the severity of the disease, it can also be seen on the back, shoulders, front of the chest and rarely in other parts of the body where the sebaceous glands are dense.

What are the clinical signs of acne?

In mild cases with acne, black (open comedones or blackheads) and white spots (closed comedones) are seen on the skin, especially on the face, as a result of occlusion of the oil gland ducts.

In severe cases, red, purulent, sometimes painful cystic lesions may be added to open and closed comedones due to inflammation in the sebaceous glands.

In very severe cases, larger purulent structures may develop under the skin. While these wounds heal, they can cause sunken scars, discoloration (hyperpigmentation) and redness.

How is acne diagnosed?

The diagnosis can be made easily with clinical findings, but it is important to investigate the factors that may affect the disease.

Can systemic findings other than skin develop in acne?

Acne may rarely show severe (fulminant type) joint pain, fever, and systemic involvement that may affect bone tissue.

Why is acne more common in adult women than in men?

It is thought that the incidence of acne in women in adulthood is 4-5 times higher than in men, due to hormonal and immunological reasons.

It is thought that an increase in the acne microorganism (cutibacterium acnes) that causes acne and located in the sebaceous gland may create an immunological response.

What are the additional clinical findings that should be investigated in female patients with acne?

The presence of polycystic ovary syndrome (PCOS) in women develops due to the increase in hormones secreted from the ovaries in the development of acne.

PCOS should be considered in women with sudden onset, very severe acne and treatment-resistant cases.

Serum total and free testosterone levels should be checked in these patients. Ultrasonographic examination should be performed to investigate ovarian cysts in these patients.

Along with acne, increased body hair growth and menstrual irregularity should suggest polycystic ovary syndrome (PCOS).

Very rarely, in cases of sudden onset, severe course, and resistance to treatment in adulthood, acne may be related to hormones originating from ovarian tumors.

Is there a relationship between protein powders used for bodybuilding, hormones and acne?

Andogenous drugs and protein supplements used for bodybuilding (whey protein powder contains IGF-1 and 2, platelet derived growth factor, fibroblast growth factor 1 and 2) cause acne development or aggravation.

In these patients, acne lesions develop on the back and shoulders besides the face.

What is the psychological state of patients with acne?

Acne can cause psychological effects such as anxiety, social isolation, lack of self-confidence and depression in patients. The unemployment rate is higher in individuals with acne.

Is there a relationship between acne and stress?

With the effect of stress, there is an increase in the release of cortisol from the adrenal cortex and adrenaline from the adrenal medulla. Increasing stress hormones in the body are thought to cause exacerbation of acne by suppressing the immune system, increasing the virulence and proliferation of acne-causing bacteria (cutibacterium acnes).

There are studies showing the negative effect of stress on acne by disrupting the microbiota in the intestines.

Can cosmetics cause acne?

Zinc, copper, resveratrol, kaolin, essential and vegetable oils contained in the cosmetics used can cause acne in some people, especially when used as a scrub.

Is acne a genetic disease?

Genetic factors are important risk factors in the development of acne and are effective in approximately 80% of cases.

Acne prognosis and severity vary depending on personal and environmental factors in patients with a genetic predisposition, that is, a history of acne in their parents and siblings.

What are the personal and environmental factors that can be effective in the development of acne?

It has been reported that nutrition, used cosmetics, drugs, air pollution, lifestyle, stress, mechanical and hormonal factors may affect acne development especially in individuals with genetic predisposition.

What is the relationship between acne diet and nutrition?

Until recent years, it was accepted as a doctrine in dermatology that diet was not directly related to acne. Due to this definite judgment, the relationship between diet and acne has not been investigated for many years, but studies and developing medical information have been published in recent years showing that diet may be effective in the development of acne.

In these studies, it has been observed that excessive consumption of carbohydrate foods and dairy products with a high glycemic index (Western diet “fast food”) is effective in the development of acne. The increased plasma (insulin-like growth factor) IGF-1 levels of these products are thought to cause acne through hormonal mediators.

In addition to medical treatments, it is important to make dietary arrangements in acne patients. Especially in our country, Mediterranean type diet can be recommended as the best option.

How do milk or dairy products cause acne?

Anabolic steroids, growth factors and progestin, testosterone precursors and 5 alpha reductase molecules found in industrial milk are thought to increase the production of sebum (oil production in the sebaceous glands) and cause acne development.

It is thought that UHT (Ultra High Temperature) technology in industrial milk does not affect androgenic hormones in milk.

Is it oily? Skim milk? What causes acne?

Especially whole skimmed milk (skim milk) consumption was found to be more effective in the development of acne. It may increase acne because industrial skimmed milk undergoes changes during processing or contains less estrogen. It is thought that the IGF-1 in skimmed milk and the estrogen hormone in fatty milk may be effective.

IGF 1 increases the synthesis of androgen hormones in both the ovary and testis, and also decreases the synthesis of sex hormone binding protein in the liver. Increased androgens in the blood cause acne development.

What is the relationship between acne and obesity?

Information between the development of acne and obesity differs from each other. But in Israel Igor Snast In a large study by J Am Acad Dermatol, published in the journal J Am Acad Dermatol in 2019, involving 600,404 people, it was observed that acne severity decreased as the body mass index (BMI: Body Mass Index) increased in both men and women. Presumably, androgens are converted to estrogen in increased adipose tissue. Estrogen reduces the severity of acne by reducing acne sebaceous gland secretion.

Acne Eskimos?

The fact that acne does not occur in hunter and gatherer peoples, which constitute the largest group of Eskimo-Aleut peoples, but the development of acne in groups whose diets change supports the existence of a relationship between diet and acne.

Is there a relationship between acne and prostate cancer?

Made in Sweden by Henrik Ugge et al. Int. In a study of 243,187 people published in the journal J. Cancer, it was reported that the risk of prostate development increases 6 times with acne seen in adult men. The risk of developing prostate cancer increases with the formation of chronic inflammation in the prostate tissue by the microorganism that causes acne (cutibacterium acnes) and/or the effect of hormonal factors.

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