Types and Causes of Acne
What is acne?
Acne is caused by the overgrowth of bacteria or fungal yeast on the skin. When developing your acne treatment protocol, we first need to determine what type of acne you have (whether it is bacterial or fungal), and explore the underlying causes through pathology whether this may be hormonal imbalances, gut issues, food sensitivities, dietary imbalances, stress, environmental allergies and more.
What is bacterial acne?
The presence of bacterial acne means that there is an imbalance in the body that is causing a blockage in the pilosebaceous units (the unit containing the hair follicle) in the skin. When these units are blocked, oxygen can’t get in. When there is no oxygen in these units, acne-causing bacteria that are naturally found on the skin can no longer be kept under control and has a big bacteria party, creating an infection. The body sends immune cells to deal with the bacterial infection and the immune response is what creates the redness, irritation, and pus associated with acne.
What is bacterial acne caused by?
The blockages of pilosebaceous units are generally caused by the production of low-quality, thick sebum (a sticky substance created by the skin to protect and moisturise it), issues with skin-cell production and shedding, as well as an imbalance of the natural acidity levels on the skin that naturally protects against bacterial overgrowths.
These issues can all be caused by factors such as:
High stress
Hormonal imbalances
Digestive conditions including unbalanced gut bacteria and issues such as constipation, SIBO, and food sensitivities
Allergies & histamine production
Nutrient deficiencies such as zinc and essential fatty acids
Blood sugar imbalances from eating too much sugar and processed carbohydrates
Using skincare and makeup that is irritating on the skin
What is fungal acne?
Fungal acne is caused by an overgrowth of yeast on the skin that causes an infection in the pilosebaceous units. The fungal culprit is usually Malassezia folliculitis, also referred to as Pityrosporum folliculitis. It can occur when the fungal yeasts get an opportunity to overgrow due to factors such as excessive exposure to heat and humidity, a lowered immune system, a poor diet, and/or overuse of antibiotics.
How do I know if I have fungal acne?
Here are some questions to ask yourself if you think you might have fungal acne:
Is your acne itchy?
Does your acne get worse or feel more itchy after using oily skincare or makeup products?
Does your acne get worse or feel more itchy after being exposed to heat or humidity?
Are all of the bumps a similar size?
Does the acne appear in small clusters rather than in random locations around the face?
Do you also have dandruff?
Does your acne not respond to typical acne treatments or interventions?
If you answered yes to all or most of these questions, you may have fungal acne.
Where acne appears on your body and face and what it means:
It is important to note that although the location of acne on your face and body can give us some clues to the type of acne you have and the causes, nobody follows a textbook description and each client’s case is very unique. In general terms, here are a few clues as to where acne is located on your body and what it might mean:
Acne under the jaw, neck, behind the ears and chest - The Lymphatic System!
The lymphatic system is made up of small lymph nodes, they help transport immune cells and help move wastes around the body. The fluid within the lymphatic system needs to be stimulated to move by physical movement and exercise.
If we are too sedentary and the lymph nodes are dealing with too many waste products from excess toxins, infection, or hormonal imbalance, the wastes are unable to be cleared effectively. The skin then takes on the responsibility of detoxifying the waste, leading to acne in all of these areas. Some clues for us are if as a child you may have had frequent tonsillitis, ear infections, or respiratory infections coupled with the deep painful pimples!
Acne on the jawline, chest & back - Hormonal Imbalance (or fungal)!
True and telling signs of hormonal acne driven by either testosterone or estrogen excess, can present in these key areas. This hormonal imbalance could be driven by various factors such as insulin resistance, poor liver detoxification, dietary imbalances, and more; all these factors are then taken into consideration in the course of your acne treatment. The alternative is potentially fungal acne if it presents where tight clothes rub across your chest or back and also presents as itchy!
Acne around the mouth and chin
This form of acne makes us consider so many areas including food sensitivities, a hormonal imbalance, gut issues, sensitivity to your toothpaste or lip products, or is it mask-ne?
Acne on the forehead
Generally, acne on the forehead indicates digestive issues such as low stomach acid, an imbalanced microbiome, and/or constipation. Also, consider the types of shampoo you are using as well, are they designed to strip too much oil from the hair follicle? Hello rebound oil production.
Acne on the cheeks
Acne on the cheeks often means that there may be allergies or respiratory conditions underlying the inflammation that is contributing to acne. If you have asthma, are a smoker, or have food allergies, these may be contributing to your acne. Silk pillowcases and ensuring your wiping your phone down regularly is very important.
Acne all over the face
General acne on the face may be due to multiple issues including hormonal imbalances, blood sugar imbalances, gut issues, stress, issues with the strength of the skin barrier, reactions to skincare or cosmetics, and/or nutrient deficiencies. Or, it may be fungal acne.
The greatest clue to the cause for us is knowing how and when your acne started, assessment of positive/negative responses to medical interventions, understanding where your acne is located on your body, and patterns of breakouts that may cycle with your hormones or gut symptoms.
This then leads us to know which general pathology or functional pathology we need to run to understand what your acne is caused by and the type of acne you have. Once we have all of these clues together, we then can make a really unique acne treatment tailored to you!