- Lindsey Dalton
- April 10, 2025
Exploring the Root Causes of Acne
Whether you are 13 years old navigating puberty or 30 years old navigating adulthood, acne does not discriminate! I am sure many of you are familiar with the frustration of dealing with breakouts. Breakouts and acne can be complex with multifaceted triggers. Today, let’s take a deeper look into the root cause of acne!
What is acne?
Acne is one of the most common skin conditions, affecting millions of people worldwide: but what do we really mean when we talk about acne? Acne (or acne vulgaris) is a chronic inflammatory skin disorder presenting with small bumps, pimples, cysts or lumps. Acne is typically found on the face, but may also affect upper arms, trunk, and back.¹,² The severity, type, and characteristics of acne are dependent on each individual but can range from mild whiteheads to severe nodular acne¹,² . The American Academy of Dermatology estimates that 50 million people are affected by acne annually, 85% of those individuals being between the ages of 12 and 24. However, acne is not limited to adolescents and can affect people of all ages, 15% of women experience adult acne throughout their 30s and 40s.³
The cause
Looking at the pathophysiology of acne, we can see 4 main causes: excess oil (sebum) production, excess skin cell proliferation, clogged hair follicles, and bacterial or fungal overgrowth.¹,4 Excess sebum production is primarily driven by hormonal changes, especially during puberty, which leads to an oily skin environment. Excess skin cell proliferation means the skin cells are rapidly multiplying to replace old or damaged cells. In the context of acne, this can lead to an overabundance of dead skin cells on the skin’s surface that can combine with sebum causing clogged hair follicles. These clogged follicles then contribute to the formation of comedones like blackheads and whiteheads. The comedones then create an anaerobic environment, ideal for bacteria, particularly Cutibacterium acnes (formerly known as Propionibacterium acnes), and sometimes fungi like Malassezia spp. and Candida albicans.5 The bacterial overgrowth triggers an inflammatory response causing the hallmark acne presentation of redness, swelling, and pus formation.
The Gut-Skin connection
Acne happens when two important pathways in the body, mTOR and FOXO1, are out of balance. Our mTOR pathway controls cell growth, skin oil production, and metabolism, and when it’s overactive, acne can appear. Things like insulin, hormones (during puberty or pregnancy), sugar, dairy, and inflammation can trigger mTOR, leading to breakouts. On the other hand, our FOXO1 pathway helps keep cells healthy by slowing down cell growth and balancing mTOR’s activity. However, if there’s too much bad bacteria or fungi in the gut, FOXO1 may not work properly, causing more acne. A healthy gut helps maintain this balance, reducing the chances of breakouts.
Acne Triggers
Breakouts can be triggered by a multitude of factors that relate back to the pathophysiology. We have all heard that stress is not good for us, but it’s actually a significant trigger for acne, as it can prompt the body to release cortisol leading to excess oil production. As mentioned previously, hormonal fluctuations can lead to increased oil production in the skin. During the COVID-19 pandemic the new term, “Mask-ne” surfaced as people noticed new acne forming right where their masks sat. Coincidence? Nope! This was a prime example of pressure acne from items such as medical masks or athletic gear irritating skin and exacerbating breakouts. Other acne triggers are certain medications, particularly those containing corticosteroids or androgens like estrogen-containing products or supplemental testosterone and substances like fluoride, vitamin B12, and biotin. Lastly, cosmetics and the common Western diet including foods high in refined sugars, fats, and dairy products have been linked to an increased risk of acne.1,2,4,7
What You Can Do
So we have all of this information on where acne is coming from and what may be triggering new breakouts, so what do we do? I’ve had my fair share of acne struggles and feel like I have tried everything under the sun to help get rid of these pesky pimples. Unfortunately, there is no “one size fits all” treatment for acne and there are many different approaches to take in finding what works for you. The American diet commonly includes highly processed foods that are high in sugar which can cause inflammation and acne. By following a “ low-glycemic diet”, cutting out dairy, and decreasing sugar you can see improvements in acne breakouts. The American Academy of Dermatology recommends a diet consisting of mostly fresh vegetables, some fresh fruits, beans, and steel-cut oats to help battle acne. Incorporating skin care such as probiotic cleansers or using acne medications can also help prevent new breakouts.
While diet can contribute to breakouts, keeping your skin clear may require more than just dietary changes and skincare: we can look more to a cellular level to see what is going on in our body. One option is looking into the gut microbiome health by having a stool test to see what’s going on with your gut. Other options would be to address hormone levels or to look at organic acid levels.4 At PharmToTable, our pharmacists specialize in functional medicine, adopting a lifestyle-based approach to healthcare. Our team includes health coaches who are here to guide you in initiating positive changes to enhance your well-being. Check out our previous blog post about gut microbiome testing for more information or schedule a free 15-minute discovery call today!
Written by Jill Patrick, PharmD Candidate 2025
Edited by Lindsey Dalton, PharmD
Sources:
1. Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne Vulgaris. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 17, 2023.
2. Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. December 15, 2023. Accessed May 27, 2024. https://www.niams.nih.gov/health-topics/acne.
3. Skin conditions by the numbers. American Academy of Dermatology. Accessed May 27, 2024. https://www.aad.org/media/stats-numbers.
4. Greenberg J. Treating the root cause of acne: The gut skin connection. YouTube. May 7, 2024. Accessed May 27, 2024. https://www.youtube.com/watch?v=wLcZAjZSKrQ.
5. Chilicka K, Dzieńdziora-Urbińska I, Szyguła R, Asanova B, Nowicka D. Microbiome and Probiotics in Acne Vulgaris-A Narrative Review. Life (Basel). 2022;12(3):422. Published 2022 Mar 15. doi:10.3390/life12030422
6. Laplante M, Sabatini DM. mTOR signaling at a glance. J Cell Sci. 2009;122(Pt 20):3589-3594. doi:10.1242/jcs.051011
7. Lee YB, Byun EJ, Kim HS. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med. 2019;8(7):987. Published 2019 Jul 7. doi:10.3390/jcm8070987
8. Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. Journal of the American Academy of Dermatology 2006;55:490-500.
9. Knutsen-Larson S, Dawson AL, Dunnick CA, Dellavalle RP. Acne vulgaris: pathogenesis, treatment, and needs assessment. Dermatol Clin. 2012;30(1):99-ix. doi:10.1016/j.det.2011.09.001
10. Can the right diet get rid of acne? American Academy of Dermatology. Accessed September 15, 2024. https://www.aad.org/public/diseases/acne/causes/diet#:~:text= findings%20from%20small%20studies%20suggest,%2C%20and%20steel%2Dcut%20oats.
11. Chilicka K, Dzieńdziora-Urbińska I, Szyguła R, Asanova B, Nowicka D. Microbiome and Probiotics in Acne Vulgaris-A Narrative Review. Life (Basel). 2022;12(3):422. Published 2022 Mar 15. doi:10.3390/life1203042
Dr. Dalton’s areas of focus include disease state management, medication therapy management, and health/wellness coaching. She is a Whole30 Certified Coach, and is passionate about helping people improve their lives through lifestyle modifications. She has seen first hand how changing food alone can vastly improve your health.
