Acne: causes and remedies

Acne is one of the most common dermatological problems, especially in industrialised countries. It is common during the teenage years, but not only. In fact, more and more adults are suffering from acne.

Acne is the chronic inflammation of the hair follicles, especially those found on the face, chest and back. Every follicle contains a hair, its root and a sebaceous gland, the gland that produces sebum, an oily secretion that - in the right quantities - helps to soften the hair and protect the skin.

Acne doesn't have one real cause, however it has been proven that there are three concomitant factors that underlie the inflammation of the hair follicle. These three factors include:

• seborrhoea: excess sebum production that makes the skin oily and shiny;
• hyperkeratosis: the thickening of the stratum corneum, the most superficial layer of the skin, due to the accumulation of keratinocytes in the hair follicle;
• bacterial proliferation: especially of Cutibacterium acnes.

In practice, the excessive production of sebum and the accumulation of the corneous cells create a “plug”, known as a comedone, that obstructs the hair follicle. There are two kinds of comedones:

• open or a blackhead (because the oil is in contact with the air and oxidises and turns dark);
• closed or a white head.

Thus an environment that is conducive to bacterial proliferation is created in the blocked hair follicle, especially that of Cutibacterium acnes, a bacterium that grows in the absence of oxygen.

This combination of seborrhoea, hyperkeratosis and the proliferation of Cutibacterium acnes triggers the inflammatory process that leads to the formation of papules (inflamed areas) and pustules (inflamed areas with pus), which are erroneously called blemishes. There can be acne even without inflammation, as the comedone is the first step in this process and is always found with papules and pustules.

At certain times in our lives, such as puberty and pre-menopause, or in the days before our period, there is an increase in the production of androgenic hormones. These are typically male hormones, albeit found to a lesser extent in women too.

These hormones enlarge the sebaceous glands, with a consequent increase in sebum production and hyperkeratosis in the hair follicles. These are the two factors that lead to the formation of comodones. The hormonal influence explains why this skin condition is common at certain points in a person’s life.

More and more studies show that our intestine is an organ that is able to affect our physical and mental well-being, so much so that it is considered a “second brain”. To a large extent, this capacity depends of our bacterial flora, which, today, is more correctly known as our gut microbiota.

The microbiota is a mixture of an incredible quantity of micro-organisms that live in symbiosis with the human body, inhabiting the oral cavity, skin, mucose membranes and, especially, the intestine.

The billions of bacteria found in our intestine break down substances, food and pharmaceuticals, protect our body from pathogens, regulate our immune system and affect our diet, mood and stress levels. 

But that is not all: the gut microbiota also influences the health of our skin, to the extent that if it is out of balance, which is known as dysbiosis, due to stress or diet, it can worsen inflammatory skin disorders such as acne.

Based on the research, changes in our microbiota can be seen on the intestinal wall - which loses its "barrier" function and becomes leaky - and in our immune system which is triggered. These events lead to an inflammatory state that can make its effects felt on the skin, i.e. systemic inflammation can aggravate skin inflammation and thus cause acne.

Oral probiotics can restore eubiosis, i.e. a balanced gut microbiota, even more so if paired with a healthy diet, and can therefore help to improve the dermatological appearance of acne.

The relationship between acne and diet has always been a much debated topic.

How many times have you heard someone say you should stop eating salami and chocolate because they make you get blemishes. Yet is there any truth to this? There is little, very little, truth to this.

Indeed, scientific studies have shown that diet is an important factor that should be taken into account, even for controlling acne, especially due to the metabolic effect that some categories of food have on our bodies.

Excessive sebum production is influenced by certain growth factors, such as insulin and IGF1 (insulin-like growth factor) and is increased by the bioavailability of branched chain amino acids (BCAA).

It is therefore a good idea to limit the foods that trigger a rapid increase in blood sugar levels, thereby triggering a considerable insulin release, i.e. those with “a high glycemic index” such as the simple sugars contained in sweets and refined grains, and instead choose grains with a low glycemic index, such as rice.

This is in addition to milk and dairy products, as they are rich in growth factors, such as IGF1 and leucine, a branched amino acid. A balanced diet, rich in vegetables and with the right amount of whole grains, legumes and fruit, is also important to prevent gut dysbiosis.

It is undoubtedly important to incorporate healthy choices into our lifestyle to alleviate skin inflammation, yet there are also things that we should absolutely avoid:

• overly aggressive cleansers and the too frequent use of exfoliants and scrubs, as well too much vigorous rubbing
• non-specific facial make-up products. It is best to choose a foundation that is for oily skin and that has been tested to ensure it is non-comedogenic, as well as taking care to thoroughly remove make-up in the evening.
• touch or, worse, squeeze blackheads and blemishes. You need to resist the temptation because you risk increasing the inflammation and leaving permanent scars;
• be tempted by “DIY” remedies, such as the classic use of toothpaste, which only worsen the situation;
• believe that the sun heals blemishes. This is only a temporary, illusionary improvement. On the other hand, it is important to expose yourself to the sun in moderation and always use special suncare products with a high/very high protection factor as the sun increases skin inflammation, thereby aggravating acne when summer ends.

Acne is undoubtedly a source of embarrassment for the people who suffer from it, especially because it affects parts of the body that are very much exposed to the eye and, unfortunately, to the judgement of others. Thus it is important that we do not underestimate the initial stages and start to treat it with specially formulated products immediately to prevent it from worsening or leaving scars and pigment marks.

For very mild forms of acne, you may only need to use dermocosmetics - a suitable cleanser and an everyday treatment - to control the seborrhoea and reduce the number of imperfections.

In the case of comedogenic acne, it is better to get a dermatologist's opinion on the most effective treatments for seborrhoea and hyperkeratinisation alone or in combination with a topical treatment.

For more severe forms of acne, when your dermatologist recommends oral medication, it is important that you combine this medication with the use of a specific moisturising product to counteract the extreme dryness it causes.

BioNike’s Aknet is a complete line for treating acne

Note: this is a totally inapplicable statement as they are cosmetics and therefore cannot claim to treat a condition.

BioNike’s Aknet is a complete line of adjuvant treatments formulated to work on the three factors that lead to acne.

Aknet AZELIKE PLUS is the intensive treatment formulated with a unique combination of azelaic acid, a new-generation retinoid (HPR) and -hydroxy acids (succinic acid and glycolic acid).

Aknet DERMOCONTROL is perfect for everyday maintenance and Aknet HYDRA PLUS is the moisturising and repairing treatment that you should use to compensate for the skin dryness induced by pharmaceutical therapies and dermatological treatments, such as lasers or peels.

The line is finished off by two cleansing products, one sunscreen specially developed for acne-prone skin, and a dietary supplement containing selected probiotics and biotin, Aknet PRO SKIN, to contribute to the well-being of the skin by rebalancing the gut microbiota.