Health Focus, Issue No. 521 — Troublesome Acne: Why Does It Appear?

Why Do We Get Acne? Dermatologist Dr. Hsiao-Yu Lee Explains the Causes and Treatments

Genetics determine a person’s physical appearance, and skin conditions can vary greatly among individuals. Clear, smooth, and healthy skin—free from acne—is something almost everyone desires. But when skin issues like acne arise, what can be done? To help answer this question, the Taiwan Food and Drug Administration (TFDA) invited dermatologist Dr. Hsiao-Yu Lee to provide expert insight.

What Causes Acne? From Environment to Stress

Acne comes in many forms—acne vulgaris, comedones, pimples, cystic acne—and all of them fall under the umbrella of inflammatory disorders of the hair follicles. Dr. Lee emphasizes that every individual’s skin is different. While genetic predisposition plays a role, environmental factors are equally influential. These include temperature fluctuations, humidity changes, prolonged sun exposure, psychological stress, consumption of irritating foods, lack of sleep, and the use of cosmetic products—all of which may affect skin condition externally.

Additionally, hormonal changes can also lead to breakouts. Adolescents, for example, often experience increased sebum production due to hormonal fluctuations. In women, polycystic ovary syndrome (PCOS) can also trigger acne. Certain oral medications have also been linked to acne flare-ups.

Different Types of Acne Have Different Causes

Acne manifests in several forms. One of the most common is comedonal acne (blackheads and whiteheads), which results from hyperactive sebaceous glands that overproduce oil. When this oil combines with abnormal follicular keratinization and clogged pores, comedones may form.

• Whiteheads (closed comedones) occur when pores are completely blocked.
• Blackheads (open comedones) appear when the clog is exposed to air and oxidizes.

Another factor is the proliferation of Propionibacterium acnes (also known as Cutibacterium acnes), a bacterium that thrives in hair follicles and can cause localized infections. Inflammatory responses in the surrounding tissue can further exacerbate acne.

Dr. Lee notes that dermatologically, skin types are typically categorized into five groups: oily, dry, combination, normal, and sensitive skin. Regardless of skin type, the key to acne prevention is maintaining an oil-water balance and keeping the skin clean.

For treatment, oily skin may benefit from agents like azelaic acid or topical retinoids, although these can be too harsh for sensitive skin. Combination skin, which includes both oily and dry areas, requires a tailored skincare and medication regimen.

TFDA's Reminder: Seek Professional Help for Severe Acne

The TFDA advises individuals with severe or persistent acne to consult a licensed dermatologist and follow their treatment plan carefully. Proper medical guidance is essential for effective results and to avoid worsening the condition.

Treating Acne: Topical vs. Oral Medications

Acne has multiple underlying causes, and accordingly, there is a wide variety of treatment options. Dr. Lee classifies treatments into two major categories:

1. Topical Medications

These include:

• Topical antibiotics (e.g., clindamycin), which are widely used to combat C. acnes.
• Benzoyl peroxide, which helps both reduce bacterial count and dissolve comedones. However, it may cause side effects such as dryness, peeling, redness, or itching, and should be applied only to affected areas.
• Topical retinoids and azelaic acid, both of which may cause irritation, a burning sensation, or increased sun sensitivity.

2. Oral Medications

These include:

• Oral antibiotics, which inhibit bacterial growth and are used for more severe acne. However, prolonged monotherapy may lead to antibiotic resistance, so dosing must follow medical guidance.
• Oral isotretinoin (Accutane), which may initially worsen acne before improvement is seen within 1–3 months. Side effects include severe skin dryness, vision changes, liver enzyme abnormalities, and teratogenicity, requiring close monitoring and blood tests.
• Hormonal therapies (such as oral contraceptives or anti-androgens) are effective for women but not suitable for male patients.

Dr. Lee stresses the importance of medical supervision for all treatments. Self-medication or dosage adjustments without professional consultation can result in ineffective treatment or serious side effects.

Daily Habits Matter: Sun Protection, Cleansing, and Patience

In daily life, it is important to practice adequate sun protection and thorough skin cleansing. Acne treatment often takes time—visible improvements may require 4 to 8 weeks depending on individual conditions. Consistency and patience, along with adherence to medical advice, are key to overcoming persistent acne and achieving clearer skin.

(This article is from: 食藥好文網: https://article-consumer.fda.gov.tw/subject.aspx?subjectid=3&id=3715&parentid=76 )