Root Causes of Acne: Personal Solutions

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 very strong genetic link to susceptibility to acne.[ref]

There is no single gene that causes acne. Rather, multiple genetic variants (small changes in a gene) 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 point toward several solutions.

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

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

Lifestyle factors combine with 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 convincing regarding 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. It may be due to population differences and whether adolescents/adults 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 not to 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 point the finger at sugar directly, 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, insulin levels were higher in the teens with acne group than 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 essential 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

Does inflammation cause acne?

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]

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 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 has been shown 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.

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