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Hormonal changes, like menstrual cycles or puberty may be a contributing factors to the development of acne. During these times androgens, a sex hormone, makes the follicular gland grow large and it makes more sebum. Another way to affect hormones is by using anabolic steroids and the outcome may be similar with the increase of sebum production in the body. Apart from androgens testosterone, dihydrotestosterone and dehydroepiandrosterone sulfate, as well as growth in insulin production also causes an increase in sebum production which causes acne on the skin.
In older patients, cases of acne may be caused from pregnancy or other hormonal disorders like aspolycystic ovary syndrome, hirsutism, or Cushing’s syndrome. In later years with the onset of menopause acne occurs when natural occurring anti acne hormone fails.
There is a group that may have a higher likelihood in having acne because of genetics. This idea is based on a number of studies that have distinguished the relationship between first degree relatives and case study participants. Acne follows a poygenic pattern where a number of genetic factors pass on the susceptibility of getting acne and does not follow classic inheritance patterns.
It is unclear as to the direct connected between acne and stress. There has been scientific research that suggests that there is correlation between severe acne and increased stress levels. The National Institutes of Health adds stress as a factor that can flare up acne but not as a cause. A study in Singapore seems to disagree with a direct relationship between stress and acne.
There is a bacterium that the medical community has identified to produce acne. Propionibacterium acnes P acnes are the bacteria identified as the main case but Staphylococcus epidermidis also plays a role in acne development. Clonal sub-strains of P. acnes have been associated with normal skin health and others with long-term acne problems. These strains have yet to produce inconclusive evidence that they develop on the skin in adverse conditions or they pathogenically acquired, it could simply depend on the individual. These bacteria either have a great ability to change or adapt to inflation and oil production of the skin.
It is large debate as to how diet causes acne and if at all. The medical community is still discussing this on an ongoing fashion with each study. There is basis to believe a glycemic loaded diet is associated with worsening acne. Traditional western diets are low in omega 3 oils and vitamin A. The low levels of these elements may increase the skins propensity to get a severe case of acne.
Positive associations have been shown with the parasitic mite Demodex however the studies to date do not isolate a cause and it is unclear whether Demodex or Demodex associated bacteria produces the effects at this time.
Some have been able to produce a relationship between Demodex and acne. The studies have yet to show clearly if it Demodex or if Demodex associated bacteria actually produces acne.
It is clear that concerning diet and parasitic influences in acne production more studies are required. Patients can use the information as a guideline rather than medical instruction.