Introduction

This paper refers to the pathophysiology of adult acne along with exploring a treatment
for the same. Acne is a common problem faced by men and women from the onset of
puberty and can continue well into adulthood. There are two types of acne: Acne
Vulgaris and Acne Conglobata. These can contribute to whiteheads, blackheads,
nodules, cysts and pustules. Acne vulgaris is a less severe form of acne, whereas acne
conglobata is a more severe form, resulting in cyst formation. According to a study done
by the National Institute of Health (PMID: 29872679), acne vulgaris can persist into
adulthood.

The aim of this paper is to explore the causes of adult acne through a hormonal and
dietary manner. The paper will focus on how acne gets formed on the body, as well the
mechanics that govern this formation. It will also explore the dietary effects on acne, as
well as treatments to reverse the acne that could severely affect the individual.

Body
Acne lesions can be caused by four primary processes: the formation of closed or open
comedones, increased sebum production under androgen control, colonization of
follicles by bacteria and inflammatory responses. Testosterone can cause the
sebaceous glands to produce more sebum, leading to the pores getting blocked and
comedones being formed. Overproduction of keratin can also block the skin pores.
When excess keratin starts getting produced, the hair canal can get blocked resulting in
the formation of whiteheads or blackheads, If the canal gets fully blocked, whiteheads
will be formed. If the canal is partially blocked, blackheads will be formed as they get
oxidized at the surface of the skin and get a darker colour. When the canal gets
blocked, a certain type of bacteria can break down the sebum trapped and thus produce
redness and inflammation which can form nodules or deep cysts resulting in scarring.
Androgens also stimulate sebum production as well as insulin-like growth-factor 1 (IGF-
1). Receptors for IGF-1 and androgens are present on the sebaceous glands, which
stimulates sebum production.

Though the imbalance of male hormones can cause the formation of acne ,a noteworthy
correlation can also be an enzyme known as 5-alpha-reductase, which converts
testosterone to a more potent form of testosterone called dihydrotestosterone(DHT).

Acne can also be significantly linked to food. In a study by the National Institute of
Health (PMID30096883), milk derived amino acids promote insulin secretion and induce
IGF-1 synthesis. IGF-1 has been suggested to be a pivotal driver of acne. Milk also
contains trans fatty acids, an aggravator for acne as a driver for inflammation.
Elimination of all dairy products as well as high sugar foods are recommended. Foods
with a high iodine content should be restricted as well as substances with fluoride, found
in tap water and common toothpastes. A diet high in refined carbohydrates can also
lead to insulin insensitivity and result in a high blood sugar level. A diet with increased
levels of refined carbohydrates results in a faster conversion of testosterone to DHT.

Drugs like isotretinoin or commonly known as Accutane can benefit the elimination of
acne. However, the drug should not be given to pregnant woman and can lead to
suicidal thoughts and depression. According to The Encyclopedia of Natural Medicine,
nutritional supplements like vitamin A, zinc, Vitamin E and selenium have been shown
to be effective in the treatment of acne and restoring the skin back to normal function
with lower sebum production. Supplementation should however be supervised by a
practitioner to not reach toxicity levels in the body.

Topical treatments like tea tree oil have been shown to significantly improve mild to
moderate acne. According to a study done by the National Institute of Health
(PMID:20808513 ), a low glycemic diet may be helpful in treating active acne.

Conclusion
In conclusion, it has been explored that the two types of acne can be caused through
excess male hormones as well as the inclusion of dairy, refined carbohydrates and high
glycemic foods. Acne is also aggravated by high iodine and fluoride. There are many
options in treating acne, ranging from drug treatments like Accutane or milder more
natural treatments like topical application of tea tree oil. It can be noteworthy to keep in
mind that while there are many triggers of acne, the treatment options are vast.
However, keeping in mind the bio individuality of the individual, one could have to
explore the possibility of trying out multiple treatments at once.