Introduction
Acne is a frequently occurring skin problem that causes skin outbreaks like whiteheads and blackheads. It is often associated with the menstrual cycle, and most affected people develop acne after reaching puberty. Acne can cause worsening breakouts during the menstrual cycle. In women, acne can develop earlier compared to men as they hit puberty early. Genetics plays an important role in causing acne. However, acne is considered multifactorial, and a number of factors contribute to acne formation. It is important to note that while genetics can increase acne formation, environmental factors, lifestyle, diet, skincare habits, stress, pollution, etc, can also cause acne formation.
What Are Acne Vulgaris and Its Effects?
Acne vulgaris, also called adolescent acne, is a chronic and inflammatory skin disease that affects women and men of almost all races. It started appearing during puberty, and the healing time in each individual differs. The exact cause of acne formation is unknown except for a genetic predisposition. Acne begins to appear on the face, back, and chest. They begin as comedones and progress to severe conditions like pustules, papules, and cysts. Acne also leads to persistent scarring. Therefore, a quick, active treatment is important to negate the harmful long-term ill effects on appearance.
What Is the Pathogenesis of Acne?
During the onset of puberty, male sex hormones, also called androgens, are released into the body. Both men and women possess these hormones, but men have this in excess compared to women. Sebaceous or oil glands can enlarge due to the androgens, resulting in sebum production from the face, back, neck, shoulders, and chest. A common pathogenesis of acne formation is a bacterial invasion into the skin's surface. These bacteria can digest the sebum and its byproducts, and as a result of digestion, skin irritation occurs, which further leads to clogged pores and blackhead production. These blocked pores and blackheads will lead to pimples or acne and cysts.
There is not a specific gene that is responsible for acne formation, but research suggests that acne is impacted by genetics. Conditions like PCOS (polycystic ovary syndrome) are factors responsible for acne development that tend to run in families. Inheritance, however, can increase the size and activity of sebaceous glands. The offspring is more often likely to be affected by acne scars if one or both parents have a similar history. Pathogenesis of acne includes the following four factors:
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Increased sebum excretion.
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Keratinization abnormalities in the infra infundibulum.
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Inflammation.
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Bacterial colonization of hair follicles.
How Does Genetics Contribute to Acne Formation?
Acne is influenced by genetics in the following ways:
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Heritability: Research suggests that genetics contribute to a high risk of acne formation. If any of the parents or close family members have a history of acne, then there is a high risk of acne occurring in their family. However, the genetic factors causing acne are not yet fully understood.
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Sebum Production: Sebaceous glands in the skin produce sebum, an oily substance. Genetic factors can trigger the regulation of sebum production. Some individuals might produce excess sebum compared to others, making them more prone to acne as a result of an increased risk of clogged pores.
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Inflammation and Immune Response: Acne formation is closely linked to inflammation and the body's immune response to bacteria present in the hair follicles. Genetic alteration can impact how the immune system responds to these bacteria, affecting the severity and persistence of acne.
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Hormones: Hormonal changes can worsen or trigger acne. Androgen hormones, especially testosterone, will trigger sebum production, and existing genetic alterations can make the sebaceous glands sensitive to these hormones.
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Keratinization: For individuals with acne-prone skin, there can be irregularities in keratinization (dead skin cells shedding from hair follicles). Abnormalities will result in blockage of follicles when combined with sebum, causing white and blackheads. Genetic factors are known to influence the regulation of the process.
Is Acne Strongly Due to Genetic Factors?
Acne has a strong genetic component, as found in many research papers and studies:
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In a study involving 458 pairs of identical twins and 1099 fraternal twin pairs, it revealed that only 19 % of factors causing acne were linked to environmental factors, and the remaining 81 % was attributed to genetics.
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In a similar investigation that included 20 pairs of fraternal and identical twins, researchers observed identical twins had the same sebum production rate but varied levels of severity of the acne. Meanwhile, fraternal twins had differing acne severity and sebum production rates. This led to a conclusion based on the paper that sebum production can be influenced by genetics and not the acne severity.
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Another group of scientists collected data from 204 individuals who had acne and 144 individuals who did not have acne. They also collected information on their family history involving first and second-degree relatives. Through regression analysis (a statistical method), the researchers found that having a first-degree relative with acne increases the likelihood of acne development by four times compared to those without a similar family history.
How Can Acne Be Managed?
Topical treatment is crucial for managing acne. It can be done alone or in combination with other systemic treatments. Mostly, topical treatment alone is efficient in managing acne. Various agents employed in acne management include antibiotics, antiseptics, keratolytics, and comedolytics. These can be effective in treating non-inflammatory types of acne with mild to moderate amounts of inflammation. Regular washing of the face can reduce the development of acne. It is also important to avoid using skin irritants and excessive rubbing or washing the face. Instead, gentle cleansing of the face can help manage acne effectively.
Conclusion
Dealing with acne can be enduring and life-challenging, which necessitates medical and professional assistance, along with patience, persistence, diet modifications, and lifestyle modifications from the patient. Based on studies, it is believed that 81 % of the cases of acne development are due to genetic factors. However, by modifying the other factors, the risk rate can be reduced.
