Acne (Navarini, 2019) – Is acne genetic?

face acne

Nebula Genomics DNA Report for Acne

Is acne genetic? We created a DNA report based on a study that attempted to answer this question. Below you can see a SAMPLE DNA report. To get your personalized DNA report, purchase our Whole Genome Sequencing!

Acne sample report by Nebula Genomics
Acne sample variants from Nebula Genomics
To learn more about how Nebula Genomics reports genetic variants in the table above, check out the Nebula Research Library Tutorial.

Introduction (Part 1 of Is acne genetic?)

Acne vulgaris (acne) is a very common skin condition that causes pimples (zits), whiteheads, blackheads, and red, inflamed patches of skin (such as cysts). It most commonly manifests as pimples on the face, forehead, chest, shoulders and upper back. The blemishes observed in this condition are a result of the blockage of pores by excess oil, dead skin cells, and bacteria. The condition only occurs in the hair follicles and oil glands.

Acne scarring
Acne scarring. Pixabay.

Although it can affect people at any age, it is most common in adolescents during and after puberty. An estimated 80% of all people between the ages of 12 and 30 experience some form of acne in their lifetime. It can be caused by a number of genetic and environmental factors, including higher levels of hormones, fluctuating hormones, stress, and humidity.

Is Acne Genetic?

While there is no acne gene, genetics determine whether you are susceptible to developing the condition. Genes that affect sensitivity to hormones are probably involved. Additionally, some people naturally have more oily skin than others, causing more acne prone skin.

The field of genetic research on acne is relatively new. In fact, a study published in 2018 claims to be the “world’s first acne genetics study”. Here, scientists linked 15 genome regions to increased risk of developing acne. 

While some studies have suggested that those with a family history of acne are more likely to develop it themselves, there needs to be additional research in this area. 

Epidemiology (Part 3 of Is acne genetic?)

According to The Global Burden of Disease Study 2010, acne is the eighth most common skin disease. The worldwide prevalence of the condition at that time was 9.4%, including 50 million Americans. This statistic is still quoted today. The burden of the condition varies between different countries and age groups, with adolescents having a higher risk of acne than other age populations. 

It usually begins during puberty and continues into adolescence and young adulthood. Approximately 85% of young adults between ages 12 and 24 reported at least a minor form of the condition. 

Although the condition generally approves as people age, it can still occur into adulthood affecting those in their 30s and 40s. As of 2014, it was thought to affect up to 15% of adult women.

Symptoms (Part 4 of Is acne genetic?)

The four most common symptoms of acne are pimples, whiteheads, blackheads, and nodules and cysts. Patients may have one or a combination of these signs. They may also come and go as the condition progresses. The American Academy of Dermatology Association describes each of these symptoms in detail:

Whiteheads

A whitehead is a blemish on the skin that is raised and white or fleshed color. Whiteheads are caused when oils and dead skin cells build up on the skin and plug the opening of a pore. Because of this, it is also referred to as a “closed pore”.

Whiteheads
Whiteheads are a common symptom of acne. Wikipedia. CC-Attribution-Share Alike 4.0 International.

Blackheads

Like whiteheads, blackheads begin to form when oils and dead skin cells plug the opening of pores. As this process continues, the pores may widen and cause what is seen as a blackhead or “open pore”.

These blemishes form their characteristic color when buildup inside the pore reacts with oxygen in the air. 

It’s important to use acne treatment for blackheads since squeezing them can cause an infection and permanent scarring.

Blackheads
Blackheads may also appear on acne patients. Wikipedia. CC-Attribution-Share Alike 3.0 Unported.

Pimples

Unlike whiteheads and blackheads, which are caused solely by the buildup of oils and dead skin cells, pimples occur when normal skin bacteria also get trapped in the pore. Bacteria can multiply quickly in excess oil. As more and more bacteria accumulate, the area in the pore swells (becomes inflamed) and forms a pimple. Inflammation is a result of an overactive immune system.

Pimples
Pimples can become inflamed. Pixabay.

Nodules or cysts

This type of symptom occurs when the oils, dead skin cells, and bacteria penetrate deeply into the skin and cause inflammation from there. Because the inflammation is so deep, these blemishes tend to be larger and can be tender or painful. Cystic acne and nodules are essentially the same thing except that cysts will contain liquid pus while nodules will be harder and contain no pus. 

Although many people outgrow the condition, sometimes it results in lasting signs that go beyond the condition itself. Acne scars are permanent scars that form after the condition clears. It is difficult to predict who will develop scars, but it can occur if someone has long lasting acne without treatment.

Dark spots are another condition that may occur after the acne clears. Unlike scars, the spots will eventually clear on their own but this process can take years. Darker spots take longer to clear although there is treatment to help reduce these spots. 

Patients with acne may experience low self esteem issues that negatively impact a person’s life, especially in adolescents and young adults. Low self-esteem often leads to other mental health problems like anxiety and depression

Causes (Part 5 of Is acne genetic?)

The condition is most closely related to fluctuating hormone levels, which is one of the reasons it is so common in the teenage years and as young adults. Androgen hormone activation, which occurs during puberty, is thought to be the main driver. If you are particularly sensitive to these hormones, you are more likely to develop and retain acne. 

Other environmental factors can make acne worse. These risk factors of acne include:

  • Fluctuating hormone levels around the time of a woman’s period
  • Picking at skin blemishes
  • Clothing and headgear
  • Heavy sweating or high humidity
  • Using oily or greasy hair or skin care products or working in an area where you routinely come in contact with grease (such restaurants where there are greasy food surfaces and frying oil)
  • Stress, which increases the hormone cortisol, can lead to a temporary flare
  • Some medications, especially those that manage hormones like testosterone or estrogen

There is popular belief, especially among young people, that certain foods cause the condition. According to the Cleveland Clinic, there are some research studies that link certain foods such as skim milk, whey protein, and diets high in sugar to breakouts, but that research is still controversial. There has been no evidence to suggest that chocolate causes the condition. Overall, patients should check with their doctor before starting the so called anti-acne diets.

Diagnosis (Part 6 of Is acne genetic?)

While acne can typically be diagnosed by any health care provider, it is usually best to make an appointment with a skin specialist called a dermatologist. Specialists in clinical dermatology will observe the breakouts on your skin, paying attention to where the breakouts are located and what types they are. Based on this information, the dermatologist can determine if you have the condition.

Skin care for acne
Dermatologists often recommend skin care for acne. Pxhere.

It’s often most helpful to have a specialist assist with diagnosis. They can provide additional health information and access to more effective treatments. Sometimes, traditional acne can look like other conditions that need alternative treatment, like acne inversa or perioral dermatitis. A dermatologist can also rule out more serious conditions like skin cancer.

Treatment (Part 7 of Is acne genetic?)

Many people treat acne with over-the-counter skin care products. If you find that these products are not effective, you may want to talk to your dermatologist, who can prescribe stronger treatments to add to your skin and hair routine. 

Acne treatments work to reduce oil production or treat bacterial infection. Even with prescription medications, it can take up to 8 weeks to notice improvement and months or years for the condition to clear up completely. 

The recommended type of treatment often depends on the patient’s age and the severity of the condition. Treatment options for pregnant women are limited due to the potential for side effects. Your dermatologist will most likely recommend follow-up appointments 3 to 6 months until the condition improves.

Mayo Clinic describes some of the most common prescription treatments:

Topical medications

Retinoids and retinoid-like drugs: Used to treat moderate acne, these acne medications come as creams, gels and lotions. Patients apply this medication directly to the skin in the evenings. It works by preventing hair follicles from being plugged. Topical retinoids may make your skin more sensitive to the sun. They can also cause dry skin and redness, especially in people with skin of color. 

Antibiotics: These medications kill excess skin bacteria and reduce redness and inflammation. They are used in combination with other treatments. For the first few months, you may use both a retinoid and an antibiotic. The antibiotic is applied in the morning while the retinoid is applied in the evening. Then, the antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance.

Acne treatments
Different types of acne treatment. Ben Rose. Flickr.

Azelaic acid and salicylic acid: Azelaic acid is a naturally occurring acid produced by a yeast that has antibacterial properties. It can also be used to manage discoloration that may result from the condition. This is one of the few treatment options available to pregnant women. Side effects include skin redness and minor skin irritation.

Salicylic acid may help prevent clogged pores, but research on its effectiveness is limited.  Like azelaic acid, salicylic acid may cause discoloration and minor skin irritation.

Dapsone: This medication is recommended for inflammatory acne, especially in women with acne. Side effects include redness and dryness.

Oral medications

Antibiotics: Used for moderate to severe acne, antibiotics reduce bacteria. Since long term antibiotics increase the risk for antibiotic resistance, it is recommended to only take these medications for as short a time as needed. Also, they are combined with other drugs such as benzoyl peroxide to reduce this risk. 

Combined oral contraceptives: These medications combine progestin and estrogen and may also be used for women with acne who are also prescribed contraceptives. Side effects may include weight gain, breast tenderness and nausea. They are also associated with increased risk of cardiovascular problems, breast cancer and cervical cancer.

Anti-androgen agents: This drug works by blocking the effect of androgen hormones on the oil-producing glands. Possible side effects include breast tenderness and painful periods.

Isotretinoin: A derivative of vitamin A, it is used to treat moderate to severe acne that hasn’t responded well to other treatments. Potential side effects include inflammatory bowel disease, depression, and severe birth defects. All people receiving isotretinoin must participate in an FDA-approved risk management program. 

Other therapies may include light therapy and corticosteroid injections, which quickly relieve the pain and size of a severe outbreak. 

If you liked this article, you should check out our other posts in the Nebula Research Library, including those that cover eczema and psoriasis.