In The Art of War Sun Tzu writes: ”Know the enemy and know yourself; in a hundred battles you will never be in peril.” This advice wins battles not only in the field but also on your skin. So if you don’t wish to be in peril in your fight against acne, you should take the time to properly understand what you are up against.

Many websites portray acne as overtly simple. They might claim it’s caused by toxins coming out of the skin or congestion in the colon. But the truth of the matter is that acne is extremely complicated. And when you understand all the factors that go into making a pimple it’s easy to see why many overtly simple solutions fail.

On this page I want to give you a broad overview of the complicated causes behind acne. And through understanding you can develop effective strategies for beating it.

Genes

Any discussion to the causes of acne should include genes. Because there’s no getting over the fact that the genes you inherited from your parents influence your skin. To the degree that having a first-degree relative with acne increases your risk of getting it by 4 times.

Now, there’s no ‘acne gene’ that directly causes your skin conditions. Rather, genes change the physiology of your skin to be far more sensitive to hormones and inflammation. These then lead blocked pores and eventually pimples.

As of today, there’s nothing you can do about this. You can’t change the hand you were dealt with, but if you play the hand well you can mitigate the damage and most likely even clear your skin. For example there are topical remedies that counter the effect of genes on your skin.

More info: Genes and acne page.

Hormones

All acne is hormonal acne. That’s because hormones affect all the factors that go into making a pimple. These include:

• Increasing sebum production
• Increase skin cell growth
• Prevent skin cell separation after death
• Increased inflammatory response to P. Acnes bacteria

The hormones to blame are called androgens. They are male sex hormones of which testosterone is the most widely known. Besides androgens insulin and insulin like growth factors 1 (IGF-1) are also implicated in acne. Though these hormones have a direct effect on the skin they do more harm by increasing the damage androgens cause.

Acne patients have similar levels of these hormones than those with clear skin. What’s different is how sensitive acne-prone skin is to these hormones, thanks to genes.

To my knowledge diet doesn’t affect the levels of acne-causing androgen hormones that much. But diet and lifestyle are the primary drives behind insulin and IGF-1 levels. And because these hormones 1) increase androgen levels, and 2) make the skin more sensitive to androgens, balancing them goes a long way towards clearing your skin.

More info: Hormonal acne page.

Inflammation

Inflammation is the immune system’s response to injury and infection.

We have to distinguish between two types of inflammation: local inflammation in the skin and systemic inflammation that affects the whole body.

Local inflammation in the skin

When the immune system attacks the bacteria colonizing a blocked pore it creates local inflammation in the skin. This turns the harmless blocked pore into a red and painful cyst. Because of genetic influence acne patients have excessive strong immune response to the otherwise harmless P. Acnes bacteria. Androgen hormones further amplify this inflammatory response.

Bacteria are not the only source of local inflammation. Things such as the following also increase inflammation and possibly trigger acne:

• Exposure to too much UV-radiation from the sun. Note that some sunlight is good for your skin, but too much can cause real damage.
• Exposure to smog and other air pollutants.
• Excess use of acne treatment products with harsh chemicals (such as benzoyl peroxide).
• Exposure to irritating ingredients in personal care products (for those whose skin is sensitive to them).

Local inflammation can both trigger and aggravate acne. There’s no way you can avoid all of it, and that’s why you should use some anti-inflammatory topical treatments.

Systemic inflammation

Systemic inflammation on the other hand affects the whole body. Imagine tiny, tiny fragments of glass floating in your bloodstream, and as they float they make thousands of very tiny cuts into the blood vessels, all over the body.

This is something similar to the effect of systemic inflammation. But instead of being caused by fragments of glass the micro injuries are caused by free radicals and other inflammatory chemicals.

From studies we know that acne patients are under higher load of systemic inflammation, and they have lower levels of antioxidant vitamins when compared to those with healthy skin. Also, there’s a good reason to believe acne seems to get worse as systemic inflammation increases.

We still don’t have a good explanation as to how systemic inflammation aggravates acne. It’s possible that increased inflammation further depletes precious antioxidants, which then leaves the skin vulnerable to further inflammation and breakouts.

Luckily you have a lot of control over systemic inflammation levels, as it largely comes down to what you eat and how you live your life. Things such as these influence systemic inflammation:

• Gut health (tied to stress and diet)
• Dietary omega 3/6 balance
• Intake of inflammatory and anti-inflammatory nutrients
• Eating foods you are allergic or sensitive (silent gluten sensitivity explains why wheat causes problems for many acne patients)
• Stress and emotional poise
• Sleep
• Smoking and air quality issues

So what does this mean

Acne is caused by a complicated mixture of genes, hormonal imbalance and inflammation, each of which is a complicated topic on its own. There’s no way to address any of them with simple solutions, and we aren’t even talking about their combined effect.

What I’m getting here is that there are no simple solutions, and you shouldn’t expect any. But the situation is far from hopeless. You can make a real difference on your skin with an acne treatment program that addresses all the causes talked here.