Root Cause of Acne: Your Genes

Ever wonder why some teens and adults can do everything ‘right’  – eat great, wash their faces, etc. –  and still have acne? While others can eat pizza three times a day, shower once a week — and end up with perfectly clear skin!  Yep, you guessed it. Genes are important when it comes to acne.

Below you will find information on why acne forms, the genetic variants that increase susceptibility (check your genes!), and solutions that may work best for you.

Why does acne run in the family?

A 2013 study puts the cost of acne treatment in the US alone at over $3 billion /year.[ref] About 80-95% of teens deal with acne, and over 40% of adults in their 20s are still struggling with it.[ref]

Moderate to severe acne affects 20% of teens. Researchers estimate that acne is about 80% heritable, so there is a strong genetic link to susceptibility to acne.[ref]

There is no single gene that causes acne. Rather, there are multiple genetic variants (small changes in a gene) that increase the risk of acne — when combined with the right environmental factors. 

There have been quite a few studies digging into the genetic variants that may increase susceptibility to acne. These genetic studies tell us a lot about the root causes of acne, and they also point towards several solutions.

Genetics research (details in the genetics section below) shows that there are four genetic factors that can be involved:

  1. inflammatory genes
  2. dairy (lactose) genetic variants
  3. hair follicle growth genes
  4. vitamin A conversion

Lifestyle factors combine with the genetic susceptibility. And targeting the right root cause may get you on the path to naturally clear skin.

What are the causes of acne?

There are four factors that you need for acne:

  • bacteria, specifically Propionibacterium acnes (P. acnes),
  • plugged pore, known as “infundibular hyperkeratinization of the pilosebaceous unit”
  • excess sebum, an oily/waxy substance produced by sebaceous glands
  • inflammation

All four of those come together in acne.

The bacteria P. acnes is a common resident on most people’s skin. P. acnes is referred to as Cutibacterium acnes in some newer studies. The use of antibiotics to eliminate P. acnes has given rise to strains that are now resistant to common antibiotics.[ref]

For male teenagers, increased androgen hormones lead to excess sebum.

Can diet affect acne?

I’ve always ‘known’ teens get acne due to their poor diet, but it turns out, the diet may not be as big a factor as I thought. (A lot of things that I’ve always ‘known’ turn out not to be backed by a lot of science!)

The studies on dietary factors causing acne are not all that convincing when it comes to solid results. Many studies are inconclusive or contradictory.[ref]

Here are a couple of dietary links with acne that seem to be backed by several studies:

According to a meta-analysis, dairy intake increases the risk of acne by about 25-40%, depending on the frequency of dairy consumption.[ref]  So why would dairy matter? One theory is it upregulates mTOR and IGF-1 due to its amino acid composition.[ref]

But… not all studies on dairy and acne agree. This may be due to population differences and whether as adolescents/adults they are likely to still produce lactase (the enzyme that breaks down lactose in milk).  A Danish study (with 93% of participants producing lactase as adults) found dairy consumption decreased acne only in people who still produced lactase.[ref]

In general, people of Asian descent are much less likely to produce lactase as an adult. So the meta-analysis results on dairy may be more accurate in populations that tend to not produce lactase. The majority (over 90% usually) of people of Northern European heritage still produce lactase. Other population groups vary between those two extremes.

Related article: Lactose Intolerance Genes

Does sugar make acne worse?

Everyone knows that sugar is the devil…

Instead of being able to directly point a finger at sugar, it seems insulin resistance may be a problem with acne.  In a study comparing teens with acne and without, their fasting blood glucose levels were actually very similar. Interestingly, though, insulin levels were higher in the group of teens with acne compared to those without.[ref] Thus a diet with a high glycemic load (whether sugar or other highly processed foods) may play a role in acne. An individual’s response to sugar and starch may be important — e.g. two people can eat the same diet and have a different glycemic response.

Not getting enough vitamin A in your diet could also increase the risk of acne. A new study shows that vitamin A is important in the skin’s defense against pathogens, such as P. acnes.[ref]  Vitamin A derivatives, known as retinols, are often used topically for acne.[ref]

Related Article: BCO1 Gene: Converting Beta-Carotene to Vitamin A

Is acne caused by inflammation?

A recent study used biopsies of acne skin to see which genes were upregulated, or turned on, more than normal. Most of the upregulated genes were in the inflammatory pathways.[ref]

The genetics of acne risk:

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Below are the genetic variants associated with an increased risk of acne covered in 23andMe or AncestryDNA. There are other genetic variants and repeated segments of genes that are also linked to acne that aren’t covered by common sequencing companies.

How can you use this information? Knowing which genetic variants you carry that are associated with acne may help you figure out the solutions that would work best for you.

Inflammatory genes associated with acne:

TYK2 gene: codes for tyrosine kinase 2, a signaling molecule involved in the inflammatory response.

Check your genetic data for rs33980500 (23andMe v4, v5; AncestryDNA)

  • C/C: typical
  • C/T: slightly decreased risk of severe acne
  • T/T: decreased risk of severe acne[ref]

Members: Your genotype for rs33980500 is .

TNF-alpha gene: Tumor necrosis factor, alpha is part of the immune response against pathogens.

Check your genetic data for rs1800629 (23andMe v4, v5; AncestryDNA):

  • A/A:  3 to 4-fold increase in acne/severe acne risk.[ref][ref] possibly more of a risk factor in Asian and Turkish populations compared to Caucasian populations[ref]
  • A/G: 3- fold increased risk of acne
  • G/G: typical

Members: Your genotype for rs1800629 is .

Check your genetic data for rs1799724 (23andMe v4, v5)

  • C/C: typical risk of acne
  • C/T: protective against acne
  • T/T: protective against acne[ref]

Members: Your genotype for rs1799724 is .

CTLA4 gene: cytotoxic T lymphocyte-associated antigen-4

Check your genetic data for rs3087243 (23andMe v4, v5; AncestryDNA):

  • A/A: decreased risk of acne (European population)[ref]
  • A/G: decreased risk of acne
  • G/G: higher risk of acne

Members: Your genotype for rs3087243 is .

IL1A gene: inflammatory cytokine

Check your genetic data for rs1800587 (23andMe v4, v5; AncestryDNA):

  • A/A: increased risk of acne, especially with dietary triggers[ref][ref]
  • A/G: increased risk of acne
  • G/G: typical risk of acne

Members: Your genotype for rs1800587 is .

Check your genetic data for rs17561 (23andMe v4; AncestryDNA):

  • A/A: increased risk of acne[ref]
  • A/C: increased risk of acne
  • C/C: typical risk of acne

Members: Your genotype for rs17561 is .

Check your genetic data for rs846910 (23andMe v5 only)

  • A/A: increased risk of acne[ref]
  • A/G: increased risk of acne
  • G/G: typical

Members: Your genotype for rs846910 is .

IL6 Gene: interleukin 6 is another inflammatory cytokine. Higher levels of IL-6 are linked with an increased risk of acne.

Check your genetic data for rs1800796 (23andMe v4, v5; AncestryDNA):

  • C/C: increased risk of acne[ref][ref]
  • C/G: increased risk of acne
  • G/G: typical risk of acne

Members: Your genotype for rs1800796 is .

RETN gene: produces resistin, which is important in sebum production and inflammation.

Check your genetic data for rs3745367 (23andMe v4, v5; AncestryDNA):

  • G/G: typical
  • A/G: increased risk of acne in females
  • A/A: increased risk of acne in females[ref]

Members: Your genotype for rs3745367 is .

TGFB1 gene: encodes TGF-beta, an inflammatory signal

Check your genetic data for rs1159268 (23andMe v4, v5; AncestryDNA):

  • A/A: slight increase in the risk of acne [ref]
  • A/G: slight increase in the risk of acne
  • G/G: typical

Members: Your genotype for rs1159268 is .

Check your genetic data for rs38055 (23andMe v4, v5; AncestryDNA):

  • A/A: slight increase in the risk of acne [ref]
  • A/G: slight increase in the risk of acne
  • G/G: typical

Members: Your genotype for rs38055 is .

Vitamin A genes and acne:

Vitamin A deficiency is linked with skin disorders, including acne. Strong, prescription-based retinol is available for treating acne, but the side effects can be severe.

People can convert beta-carotene, from plants, into the form of vitamin A used by the body (retinol).  That conversion, though, varies according to genetic variants in the enzyme for beta-carotene conversion (BCMO1).  An informal study (not published in an academic journal) found that people who didn’t convert beta-carotene to vitamin A very well were more likely to have acne.

People with a T allele on both rs12934922 and rs7501331 have a 69% decreased conversion of beta-carotene to retinol.  For people with only a single T in the rs7501331 SNP, the conversion is decreased by 32%.[ref]

Check your genetic data for rs7501331 (23andMe v4, v5; AncestryDNA):

  • C/C: typical
  • C/T: decreased beta-carotene conversion
  • T/T: decreased beta-carotene conversion

Members: Your genotype for rs7501331 is .

Check your genetic data for rs12934922 (23andMe v4, v5):

  • A/A: typical
  • A/T: decreased beta-carotene conversion
  • T/T: decreased beta-carotene conversion

Members: Your genotype for rs12934922 is .

Hormone genes and acne:

Hormonal changes at puberty trigger increased sebum production.

CYP17A1 gene: This enzyme is involved in steroid hormone metabolism

Check your genetic data for rs743572 (23andMe v4; AncestryDNA):

  • A/A: typical risk of acne
  • A/G: increased risk of acne
  • G/G: increased risk of acne[ref]

Members: Your genotype for rs743572 is .

HSD11B1 gene: this codes for 11β HSD1 involved in the production of cortisol

Check your genetic data for rs846910 (23andMe v5)

  • G/G: typical risk of acne
  • A/G: a 4-fold increase in acne risk[ref]
  • A/A: increased risk of acne

Members: Your genotype for rs846910 is .

Lactose genes and acne:

LCT gene: codes for whether you produce lactase (the enzyme that breaks down lactose) as an adult

Check your genetic data for rs4988235 (23andMe v4, v5; AncestryDNA):

  • G/G: no longer produces lactase as an adult, more likely to have problems with dairy causing acne[ref]
  • A/G: still produce lactase as an adult; less likely to have problems with dairy causing acne
  • A/A: still produce lactase as an adult; less likely to have problems with dairy causing acne

Members: Your genotype for rs4988235 is .

Hair follicle growth genes:

There are a couple of genetic variants identified by a genome-wide association study involving the way the hair follicle grows. These aren’t covered on 23andMe.

Check your genetic data for rs121908120 (AncestryDNA only):

  • A/A: protective against acne[ref]
  • A/T: protective against acne
  • T/T: typical

Members: Your genotype for rs121908120 is .

Lifehacks for treating acne:

Here are some solution options that may work, based on your genetics.

Vitamin A for reducing acne:

If you carry the BCMO1 variants and don’t eat much liver or pasture-raised dairy, you may want to look into a retinol-based vitamin A supplement, such as a retinyl palmitate or cod liver oil.

Vitamin A is a fat-soluble vitamin, so taking high doses of vitamin A for long periods of time could lead to toxicity. High doses of vitamin A should not be taken if pregnant or trying to get pregnant.  If you have questions on how much vitamin A, talk with a doctor or get a blood test done to determine your current vitamin A status.  (UltaLabs has a serum vitamin A test for $63, and you can usually get a 20% off coupon for your first order.)

Treating acne with light therapy:

Light at different wavelengths seems to be effective for reducing bacteria and for reducing the inflammatory response.

Red light therapy shows to reduce IL-1a in acne in a lab setting.[ref] If you have IL1A variants (above), this may be something to look into.

Light therapy in the blue wavelengths (449 nm, 50 uW/cm2 ) kills the bacteria that causes acne – in a lab setting.[ref]

The majority of studies on light therapy (red-blue wavelengths) show a benefit for acne.[ref] I don’t know if light therapy is a total cure for everyone, but it is a non-pharmacological approach worth checking out.

Fight fire with fire – using bacteria to treat acne:

Bacteriophages, which are viruses that kill bacteria, are one exciting possibility for treating acne. There are identified phages that kill P. acnes. Other bacteria can also weed out an overgrowth of P. acnes.[ref][ref]

Creams are available with bacteriophages that target acne bacteria.

Another option to look into is Mother Dirt. It is a probiotic spray for the skin. Lots of good reviews on this – get the science behind it on the Mother Dirt website.

Does intermittent fasting or a Paleo diet help with acne:

Here is an interesting paper on how our modern diet (refined carbs, trans fats, etc) is upregulating mTOR and downregulating FOXO1.  The conclusion is that a Paleo-style diet or periodic calorie restriction may help with acne.

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About the Author:
Debbie Moon is the founder of Genetic Lifehacks. Fascinated by the connections between genes, diet, and health, her goal is to help you understand how to apply genetics to your diet and lifestyle decisions. Debbie has a BS in engineering and an MSc in biological sciences from Clemson University. Debbie combines an engineering mindset with a biological systems approach to help you understand how genetic differences impact your optimal health.