Is acne caused by bacteria?
Research and everyday evidence suggests not. We all have a similar population of bacteria on our skin. It was built into our design. Our body is comprised of 100 trillion cells and reportedly 80 trillion of them do not have our DNA because they are foreigners (bugs) that provide support to our system. The skin houses roughly the same number of bugs on all of us, even after three months of antibiotics, according to research. These bacteria are intricately involved in skin maintenance of the barrier and its protective pH. While one may see a slight increase in the population around an acneic lesion, it is not an infection in the same way those bacteria are found in your digestive tract. Staphlococcus epidermidis and propionibacterium acnes are not inflammatory; they are a support system. From a common sense perspective, we can challenge the popular view, as well. Why would a 30-year-old mom develop cystic acne out of the blue? Did her bacteria levels suddenly jump? If so, would not it be a superficial acne lesion since the bug infection would have started at the surface? Why do so many teenagers with poor hygiene not get acne, if bacteria are the cause? Why are there so many cases of non-pustular, non-productive acne? How does changing a diet in some cases clear acne? Why does Accutane work on bacteria? Why does acne usually affect only parts of the face if the bacterial population on all of the facial skin is the same? Why would topical antibiotics not solve virtually every acne case on its own, if bacteria were the cause?

Is acne caused by oil?
The research and everyday evidence suggests it is not. Research shows that increasing oil production does not lead to acne in most cases. Increased testosterone does, but oil does not. And people who develop acne from excess testosterone develop it in the less-sebaceous areas like the jaw line. If we are oily throughout the face, then why does the acne typically stay near the jaw line? If oil is feeding the bacteria, then why is not feeding and increasing all facial bacteria? Why do so many people have “dry” acne, if oil is the cause? Is acne caused by retention hyperkeratosis? Research and everyday evidence says it is not. Retention hyperkeratosis is supposedly an inherited “defect” of the sebaceous gland that allows cellular debris to block sebum output, resulting in an infection. However, if this were the cause, would not all the pores on the body be affected? Why is acne found in certain areas? Why would all acne not look the same if that cause were the problem? Should not all those who have the “defective gene” develop a similar cystic acne appearance? How can there be mild acne if the same deep anatomical infection of our sebum gland is occurring in everyone? How can we be born with this issue and not develop acne until we are old? Why does acne get better in teenagers if they have the problem for life? How do acids correct a genetic deformity like this? Do we really believe that burning the sebum duct repeatedly with acids fixes the problem?
The contradiction you will find in review of the research is that the bacteria researchers are saying that oil or retention hyperkeratosis must be the cause because it does not appear to be the bacteria causing the problem. Oil researchers are saying it must be the bacteria because oil is not the problem. There is very little information on retention hyperkeratosis to make a decision. Reportedly, in Dr. Fulton’s research, he found that sebum flow was never blocked 100 percent, which, if true, completely removes retention hyperkeratosis as a cause of acne. However, I have not found anything published on the matter.

The Classic Approach to Acne
That leaves us with the big question of why acids, antibiotics, benzoyl peroxide, and other classic approaches to acne work in some cases. There is a common theme that can be found in products considered to be the gold standard of acne therapy, immunosuppression. Our skin, like the rest of the body, operates at its highest and best when our immune system operations, like detoxification and repair, are healthy. Treatments including antibiotics, Retin A, Accutane®, steroids, alpha and beta hydroxyl acids, benzoyl peroxide, chemical peels, and lasers all have a negative impact on the skin’s immune system. When we harm the skin or when harsh ingredients are used, the immune functions of the skin go into emergency mode. Much of the wound repair activity shifts from the acne lesion to the damage created by the ingredients themselves. In other cases, antibiotics, Accutane, and/or steroids reduce the performance of the skin’s immune function, creating a similar effect on acne, whereby the skin no longer mounts the same response in its drug-induced immunosuppressed state. The skin can look less inflamed from these protocols, but they do not solve the cause of their acne and they definitely increase the likelihood of permanent scarring. Think about severe cystic acne and the common technique of injecting steroids into the lesion to shrink it. If this were really a horrible infection, steroids would reduce our ability to fight it. The reason it helps, is that we have wound repair operations going on and the steroids stop that process in its tracks. To drive that home, if you had a serious bacterial infection in your body, it would be a very bad idea to prescribe steroids because the infection would only worsen dramatically. "

The Real Causes of Acne
Candida. Candida produces at least 70 different toxins and some strains cause acne by creating toxins that are best disposed of by the skin. This type of acne shows up primarily on the upper cheeks, temples, and forehead. Pregnancy, birth control pills, sugar, antibiotics, and stress are all known to increase candida population. The difference between cystic and non-pustular forms of this type of acne have to do with toxin stacking (when the infection is significant) and/or different strains of the same bug.
Hormones. Testosterone does not have to be elevated to create acne, as long as the balance of estrogen/progesterone/testosterone is off. This can happen from being very thin or, more commonly, from ovarian inflammation. When the ovaries are inflamed, either excess testosterone or related toxins are sent to the skin for removal. Polycystic ovarian syndrome (PCOS) or earlier stages of the same condition have become an epidemic in our society. The causes include chlorinated swimming pools, pesticides, hormone-laced meat and dairy and food preservatives, to name a few. All of these sources produce estrogenic toxins which inflame ovaries. Any teenager or adult with oily skin should be considered likely to have this condition. However, oil and/or menstrual irregularities do not have to be present. This acne is found in the beard line (if women had a beard).
Diet. Dietary acne is the result of food toxins. It can show up in random places around the face, depending on what toxin was ingested. Most anyone with teenagers can see the variation in acne that fluxuates based on diet. I find that synthetic candies are the worst offenders. Dairy can be a contributor, but more likely that is the source of blackheads. If excess dairy is going to lead to cystic acne, it is probably through increased candida levels. The acne from diet is more often around the mouth area.
A combination. While each of these causes of acne has a typical pattern, it is not uncommon to see a combination of one to three of these issues and each source should be discussed separately.

In summary, the main goal of any aesthetician is to get their client’s acne under control before too much scarring occurs. There is no question that delicate acne wounds are harmed by acids, benzoyl peroxide, and Retin A. In addition, steroids, Accutane, and antibiotics are known to suppress skin repair so they, too, almost guarantee that the scar will be worse than it would have otherwise been. Any explanation for the cause of acne should be applicable to everyone else and as we discussed, most is not explainable by the causes we were taught in school. Finding the right cause is critical to fast and effective results. Taking a holistic approach that includes addressing internal sources for acne may very well be the future of skin care.