Acne Could Be A "Natural Transient State" Linked To Teenage Skin's Changing Flora, Study Suggests

Teenage acne is the bane of existence for high-schoolers far and wide, affecting up to 95 percent of adolescents and young adults. Despite its prevalence, the cause of teenage acne remains remarkably hazy and the subject of much misinformation (like, for example, it’s caused by bad hygiene).



Doctors usually refer to it as a chronic condition, like psoriasis, however, a new study has brought a new hypothesis to the table. A team of Hungarian researchers argues that teenage acne (13-19 years) is a “transient inflammatory state” that naturally occurs when the maturing skin is exposed to new microbes and new chemicals during the teenage years.

“Instead of considering acne as an accidentally occurring disease accompanied by pathological processes, we propose that acne is unavoidable inflammation precipitated by physiological changes of sebaceous skin during adolescence," first author Andrea Szegedi of the University of Debrecen in Hungary said in a statement.

Your skin is covered in tiny pores, known as hair follicles, that house sebaceous glands to produce an oily substance called sebum. Hair follicles and sebaceous glands can be found on most parts of human skin, except for hand palms and feet, but they are in their greatest numbers on the face and scalp. If these pores become blocked with dead cells or oil, they become inflamed, producing those characteristic red pimples we all know and love.



Hair follicle anatomy demonstrating a healthy hair follicle (pictured left), a whitehead or closed comedo (middle picture), and a blackhead or open comedo (pictured right). WikiJournal of Medicine CC BY 3.0
While this new theory sticks to the same idea of high sebum levels and blocked pores, they place a greater emphasis on bacteria and other microbes. Your skin, just like your gut and many other parts of the body, is home to a tiny biome of bacterias, fungi, archaea, and viruses that typically live alongside us. Although some strains of microbe can infect and harm us, flora skin is overwhelmingly harmless and actually plays a helpful role in many biological functions of the body.

Reporting in the journal Trends in Immunology, the study on mice hypothesizes that high sebum production in teenagers disrupts the skin flora of childhood and creates the perfect environment for bacteria, like Cutibacterium acnes or Corynebacterium simulans, to thrive. These abundant bacteria take over the skin surface and hair follicles, provoking a response from the immune system.

Using mouse models, the researchers found that an increase in C. acnes bacteria results in elevated concentrations of pro-inflammatory cytokines, such as interleukin-1β and tumor necrosis factor-alpha. This inflammation caused by the new bacterium in town, the researchers argue, could be central to our understanding of acne.

Of course, this new avenue of research is very much in its early days – after all, this study is based on mice models. Furthermore, there are some wider drawbacks to the research that needs to be acknowledged. Teenage acne is a complex condition that’s likely to be associated with a multitude of related factors. This study largely ignores the role of hormones, for example, which are widely known to be associated with acne. Equally, it’s difficult to ascertain how “transient” we can consider the condition if it lasts in some adults into their 40s and 50s.

As Adam Friedman, a dermatologist at George Washington University School of Medicine who was not involved in the new paper, told Gizmodo: "I disagree with the transient element. As a practicing dermatologist, the number one patient I see is an adult, not a teenager."

Nonetheless, the researchers hope that new insights could challenge some of the conventional treatments used to tackle acne in teenagers, or offer up new ones. While some current treatments use antibiotics to tackle this problem with the microbiome, the new research suggests there should be a greater emphasis on fostering the symbiotic relationship between skin and its microbial tenants, rather than destroying it.

"We are convinced that this research will be highly instrumental for the development of new and innovative treatments for acne," Szegedi concluded.

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