Acne is a skin condition caused by excessive sebum secretion, which piles up inside the hair follicles to form open and closed comedones; also called blackheads and whiteheads, respectively.
Mild, moderate and severe forms of acne are usually distinguished clinically.
The condition is most common in adolescence and early adulthood, albeit can occur well into the forties.
It has been postulated to be affected by the levels of sex hormones; however, this in turn may only be a symptom of a deeper anomaly.
In keeping with this, the following indicators have been found to be associated with acne in males:
- A higher body mass index (BMI) and waist-hip ratio (WHR) which correlate with greater body fat
- Higher levels of blood pressure, both systolic and diastolic
- Higher basal glucose concentrations
- Insulin levels when challenged with an oral glucose tolerance test (OGTT)
ALSO READ: Does masturbation cause acne?
Insulin Resistance and Acne
In some patients with acne there is the existence of a metabolic derangement which revolves around the presence of insulin resistance.
Treating insulin resistance would, therefore, be a key target in preventing acne exacerbations in young males.
Reducing the glycemic load in food has been suggested and proved in many patients to be helpful in decreasing the incidence of acne.
This may be because of the following factors:
- Increased glycemic load increases the insulin requirement, is associated with hyperphagia (i.e. extreme drive to consume food) and obesity, as well as increased levels of free fatty acids in the blood
- Insulin production may cause increased androgen secretion and potentiate androgenic effects by inducing the enzymes in steroidogenic pathways, and by stimulating the secretion of gonadotropin-releasing hormone and increased sex hormone binding globulin
- Insulin decreases the level of insulin-like growth factor 1 (IGF-1) binding protein, leading to increased activity of IGF-1 which stimulates cell proliferation
These effects of insulin produce the following changes:
- Basal keratinocytes within the duct of the hair follicle proliferate
- Superficial keratinocytes in the follicle are shed excessively
- Increased androgen activity stimulates sebum secretion
- The blocked follicle is colonized by Propionibacterium acnes with resulting inflammation
ALSO READ: Foods that cause acne
This is further supported by the well-known finding that females with polycystic ovarian syndrome (PCOS) have a higher prevalence of acne.
The earliest metabolic disturbance here is insulin resistance, and it is associated with hyperinsulinemia and high androgen levels; with high IGF-1 and low sex hormone-binding globulin (SHBG) levels.
When oral hypoglycemic agents are used to treat PCOS, it helps increase tissue sensitivity to insulin and thereby reduces acne.