keratinocytes: human skin cells

Thanks to modern medical science, we know that for some reason, acne follicles tend to overproduce cells, which in turn stick together and cause a clogged pore and ensuing zit. But why does this happen? Scientists have performed very few studies in an attempt to figure this out.

I just got through reading what was only the second study to ever attempt to scientifically understand what happens inside acne follicles vs. control follicles. Researchers from the University of Leeds in England performed the study back in 1994. Unfortunately, I think this control follicles were poorly selected. The researchers took biopsies of acne follicles from the upper back of patients who were an average age of 22. The control follicles were taken from the chest of people who were an average age of 41 during open heart surgery. In my opinion, the vast difference in age and location of biopsy between the acne follicles and control follicles largely discounts this study. Regardless, the researchers did make a couple of interesting points when discussing what might cause acne-prone skin to overproduce cells.

1) When sebum production increases, as it often does in acne-prone individuals, the sebum, as it leaves the follicle, takes with it too many of the cells lining the follicle wall. The follicle then reacts by overproducing cells to counteract this loss.

2) Linoleate (a.k.a. linoleic acid, an essential fatty acid) deficiency in sebum: Researchers have discovered that sebum in acne-prone skin contains less linoleate than normal. One hypothesis is that when sebum increases, linoleate content is diluted, and this decrease in linoleate signals overproduction of cells.

But in reality if you asked these researchers to tell you what cases acne, I think if they’d honestly reply, “well heck, who knows…”

The more you read about the potential cause of skin cell overproduction and clogged pore formation, the more complex it becomes. We have the hormone system to look at, sebum overproduction, the skin’s inflammatory response, systemic vitamin and mineral deficiency, bacteria over-proliferation, or a combination thereof…the possibilites are endless and the list goes on and on.

So, if and when science does finally figure it out, will we uncover a silver bullet? Or is the cause of acne a combination of factors? I’ll keep reading and let you know what I find. Please do the same if you can and let me know what you find out.

I recently came across an August, 2004 survey sponsored by Galderma Laboratories which presented some interesting findings regarding how parents view their son or daughter’s acne. It turns out their concern does not sometimes translate, and does not always reflect their teenager’s reality. Researchers surveyed 504 teenagers with acne along with 500 parents of teens with acne.

— 69% of parents claimed they were “supportive and understanding” about acne, but only 48% of the teens thought the same.

— 15% of parents said their teen experienced body image issues because of acne. 36% of the teens claimed they experienced body image issues.

— Only 1% of parents said acne caused problems with other family members. 18% of teens claimed problems, however.

— 9% of parents said their teens were “angry” as a result of acne. 25% of the teens said they were angry.

Do parents care? Yes, it appears that they really do, even more than we might think.

Do parents understand? While parents do seem to care, they may not understand the full ramifications of acne. From this survey, it appears that parents underestimate the negative emotional effects of acne. This could be because teenagers are not forthcoming with their feelings, or because our modern hectic lifestyles leave little time for engagement.

Bottom line: While the results of this survey point to a chasm in understanding, I’m walking away feeling good about the findings as a whole. The bottom line for me is that parents really do care about how their kids are feeling, even more than kids might know. Sure, they may not understand how much acne bothers you, but the care is there. If you are experiencing acne, or are on the Regimen now and clear but are still carrying around some anger toward your parents for not understanding your plight, just keep in mind that you may be misperceiving the situation. Give your parents some slack. They probably care more than you think…even if they may not understand as well as they could.

[I am not providing a link to the survey because the link appears to be broken. From what I can tell, this survey was published on a web site called losethezits.com but the page appears to be down.]

A February, 2010 article in the JDDG (Journal of the German Society of Dermatology) entitled “FoxO1 – the key for the pathogenesis and therapy of acne?” came across my desk recently. For those of you out there who are medical researchers or just into this stuff, if you want to look into this with me, it would be cool to see if we agree with the author’s hypothesis.

Basically, what the author, Bodo Melnik, proposes is that lowered levels of Fox01 (a nuclear transcription factor) leads to all of the processes we see in acne formation: the androgen/acne connection, cell wall overgrowth, increased sebum, higher levels of acne bacteria, and ensuing inflammation. He proposes that environmental factors which upregulate Fox01, such as diet, retinoids, and antibiotics, may all work to a degree because of this Fox01 stimulation.

We know that acne has a genetic component, so it’s worthwhile to look at gene expression when attempting to gauge what causes acne, and how it might be treated. If in fact Fox01 turns out to be a key factor in acne pathogenesis, perhaps Fox01 therapy could be around the corner. It’s interesting to think about. I hope to see more study in this area.

Recently I made the decision that acne just needs to be cured. So I started research in that vein, and I found that in 2001, scientists started work on an acne vaccine. More specifically, it is an anti-P.acnes bacteria vaccine. Since P. acnes is the bacteria implicated in acne formation and is a major culprit in acne development, if we can somehow turn off its genetic expression, the hope is that we can prevent or cure acne.

A brief history of the vaccine: A company called Corixa worked with a French company to decode the 2.8 milion base pairs that make up the P. acnes genome back in 2001. They then started working on identifying antigens in order to create a vaccine. Glaxo Smith Kline acquired Corixa in 2005. From there, mention of the vaccine seemed to fall off the map, until an article published in 2008 in the Journal of Investigative Dermatology surfaced. The article outlined research at the University of California San Diego in which scientists developed vaccines against P. acnes and successfully used the vaccine in both mice and in the lab using human sebum (skin oil) cells.

The trail seems to end there again. I’m in the process of contacting the researchers at UCSD to get more information. I find this area of work fascinating. I’ll keep you posted on anything I uncover. For now, let’s not get our hopes up too much however. Acne development is multi-faceted. While P. acnes plays a part, it is unknown how much it directly causes the other factors in acne development such as pores becoming clogged, oil overproduction, or inflammation.

Cool news you guys. I’ve been working with Daniel, our intern, as well as a statistician, and a well known doctor to put together a “prospective dietary trial” on milk and acne. What is a “prospective dietary trial”? Well, it means basically that we’re going to ask people on Acne.org to stop eating and drinking dairy and to fill out surveys and take pictures to document changes in their acne symptoms. If we get enough people to volunteer and follow through, it could be seminal research on the topic. Pretty darn cool.

Daniel, our intern, has been amazing with all of this–big shout out to him. He’s basically running the show. But all of us can be involved too! I’ve decided to be a candidate for the study, which will be hard because it will mean no pizza, but I’ll do it in the name of science! I’ll let you all know when this starts and when you can sign up.

Rosacea: It’s not acne vulgaris, but it’s similar. I’d like to make a nice rosacea page to outline what it is, how it’s different, and appropriate approaches to therapy.

Free radicals: Questions I’d like to answer: Free radicals are necessary for bodily maintenance, but how much is too much? When are anti-oxidants best utilized?

Scarring: I have not looked into the latest scar revision techniques for a couple of years. It’s time! I’ll update the scars pages accordingly.

B5
: Despite the severe paucity of research on this topic, it keeps coming up, so I’ll delve as deeply as I can and make a page about it.

Hormones
: In particular, you guys keep asking me questions regarding masturbation and acne. As is often the case, there is zero research on this exact topic, but looking more widely at hormones may shed some light. I’ll see if I can’t make a hypothesis or two regarding this sensitive topic.