Why do I have acne?Acne is caused by a combination of four factors; higher production of sebum, clogged pores, the presence of a specific bacteria and inflammation. The production of sebum is influenced by hormones. Therefore acne often exists during puberty, but can occur in any age, especially in women since they have more hormonal changes during their lifetime. Not every person gets the same amount of acne because people’s sebum follicles react in different ways to the changes in the body.
It is known that acne runs in families. When (one of) your parents had acne, it’s more likely that you have it as well. Also stress and wrong skin care can worsen acne.
Often the specific cause of acne is unclear and difficult to determine. However, with the right treatment it can be possible to manage the acne. (1,2)
I am not in puberty anymore, how come I still have acne?
During puberty, hormones make you skin produce more sebum, which causes acne. But also in later ages, hormonal imbalances can cause more acne. This happens a lot in women, for example before menstruation or during pregnancy, but also other factors can contribute. Stress, sensitive skin, skin-care products, smoking, diet, certain medication and endocrine diseases are only a few examples of what can can worsen acne at any age. (3,4)
Does popping pimples make it worse?
In most cases, this is indeed true. Some professionals can indeed clear (‘pop’) some types of pimples, but doing it yourself will almost always make it worse than it was before. By having acne, your body is responding to blocked pores and bacteria, the bump means your body is trying to heal the skin.
Instead of making progress, you will force bacteria and oil even deeper into the skin, making the pimple larger and the healing process longer. Also, the bacteria and oil can spread and lead to more acne on another site. Lastly, popping will likely cause a permanent scar, while a pimple is only temporary.
Am I allergic to something?
This is a possibility. Even if you don’t develop typical allergy symptoms like sneezing or itchiness, it can be that your skin reacts to certain foods. This happens through the intestines, that lets through bigger molecules that the immune system reacts to and causes an inflammation process. What type foods these are, can be different for each person. Dairy consumption and high glycemic foods are linked to worsening acne in some people, but also other foods can cause inflammation. To find out if you are sensitive to any foods, try to limit the foods that you suspect for 6 weeks. This is the time your skin needs to heal. If you see no improvement after this period, it is likely that your acne has another cause.
Also a sensitivity to certain skin-care products like creams, soaps or makeup can cause acne. (5,6,7)
Does it depend on what I eat?
What you eat can have an influence on your skin, since there is a connection between bacteria in the gut and the skin. However, this can vary from person to person. Research shows that a high glycemic diet and dairy can worsen acne in some people. We recommend a balanced diet with enough fiber (wholegrain products) and to avoid highly processed foods, and to limit dairy consumption. Since every body reacts differently, it is not guaranteed that these dietary changes will cure acne. If the acne persists, contact the GP or dermatologist. (8,9,10)
What about acne and chocolate?
Maybe people told you that eating chocolate will make your acne worse. However, this is not entirely true. High glycemic foods like chocolate are in general worse for your overall health and therefore also for your skin. Since sugar is often added to chocolate, this can indeed cause an increase of acne. However, like with all diets, balance is key. As long as you eat a balanced diet with a majority of low glycemic and unprocessed foods, a piece of chocolate every now and then will not hurt. A healthier alternative can be dark chocolate. Pay attention to the percentage of cacao in the chocolate (70% or higher); the higher this percentage, the less sugar is added. Excessive amounts of chocolate (or sugar in general) can indeed worsen acne. (9)
Does washing often help?
Obsessive washing can make acne worse, because it damages the natural protective barrier of the skin. Since a pimple forms inside of the sebum follicle, you are not able to remove that by washing your face with soap.
Washing your face 1-2 times a day (in the morning and/or evening) is enough. It is very important to cleanse your face at the end of the day, especially when you wear makeup. The product you use to cleanse, is also important. Some ingredients can dry out and/or irritate the skin.
Washing with a mild 2% salicylic acid cleanser is recommended. Salicylic acid is the only ingredient that does reach inside of the follicles and can clear up acne. Make sure to use at least SPF30 during the day, since the salicylic acid makes your skin more sensitive for the sun. (5)
I use only natural cosmetics, why does my acne not get better?
A lot of brands claim that their natural product does wonders to heal your acne. However, just as any other product, they can clog your pores and cause acne. It is also possible to have an allergy to natural ingredients. And some ingredients that are not ‘natural’, can help clear up your skin a lot without damaging it. Therefore; natural is not always better. When it comes to skincare, it is important that the products you use, are based on your skin type. Since acne occurs in different ways from person to person, it is important to use a product that treats your specific type of acne and does not have unnecessary additives. (11)
Does wearing makeup/foundation make my acne worse?
Wearing makeup, and especially foundation or face powders, can indeed cause or worsen acne. The products can clog pores, which helps acne-bacteria to grow. If you still choose to wear makeup, it is important to choose a foundation that is non-comedogenic. Besides that it is very important to cleanse the face thoroughly after a day of wearing makeup. You can do this by using a micellar water and afterwards using a mild cleanser with 2% salicylic acid to reduce the acne. (5,7)
Why do acne creams from the drugstore not make it better?
Since there are different types of acne, every type needs a different method to treat it. In order to find the right product, it is best to let a dermatologist look at your acne. He can diagnose what kind of acne you have, and inform you about what treatment or cream would be best to treat your acne.
How does the birth control pill help my acne?
The factors that cause acne are influenced by hormones, mainly by the hormones estrogen and testosterone (androgens). In short; testosterone tends to make acne worse, estrogen makes it better. Any change of hormones in the body, can therefore lead to worsening of acne. During puberty, an increase of testosterone makes the sebum follicles larger, which makes them produce more sebum and can result in more acne. But also after puberty decreases of estrogen and increases of testosterone are normal, and can worsen acne at any age.
To treat this hormonal factor, some types of birth control pill are used in the treatment of acne. The hormones in these pills reduce the amount of testosterone in the body, and therefore reduce acne. (12)
Is the birth control pill a good way to treat acne?
The birth control pill can indeed be effective to treat acne in women, when they’re in fertile age and also have a wish of using contraception. Some types of birth control pill are more effective than others. For the treatment of acne, it is often used in combination with a cream or antibiotic pills.
However, for some types of (mild) acne, it is better to start with only a cream or antibiotic without hormonal therapy. This might be enough to treat the acne. Also a hormonal treatment of acne will not be the solution for everyone. A GP will be able to advise you on this. (13,14)
Acne creams make me allergic, what can I do?
Certain ingredients in acne creams like benzoyl peroxide and salicylic acid, can irritate the skin. It can cause redness, burning, itchiness and flakes. This is likely to happen when the natural protective barrier of the skin is damaged. To prevent this damage, it is important to not wash the skin too often and to not use too many different products at the same time. If you tend to have sensitive skin, it can be difficult to find an acne cream that works for you. A dermatologist can help you with finding an effective treatment. (15)
How can I prevent acne scars?
The best thing you can do to prevent scars, is to not pop or scratch any pimples. When you pop a pimple, there is a big chance that some residue will stay behind, and the inflammation process will take longer. If you let the skin take care of the pimple by itself, there is a bigger chance that it will heal fast without scars. Besides that, you can cleanse your skin 1-2 times a day with a salicylic acid cleanser to prevent any new pimples. (5)
How can I make the scars less visible?
Depending on the type and size of the scars, there are different options to make acne scars less visible.
When you have red, flat scars, they usually disappear over time. Chemical peelings or certain products can help speed up the recovery. To mask the scars you can use makeup, it is important to remove this at the end of the day to prevent the formation of new pimples. Darker colored scars can fade a bit over time and can be covered up with makeup. To treat them, laser treatment, chemical peels or retinoids (cream) are possible.
For atrophic scars (dimples) it is more difficult to cover them up with makeup. Depending on the size, there are some treatments possible, like laser, chemical peeling, fillers or excision.
If you choose to have treatment to reduce the visibility of acne scars, a dermatologist will be able to advise you on which treatment will work best for you. (16,17)
What can I do about acne on my back, shoulders and chest?
The reason you have acne on your back, shoulders and chest, is because there are a lot more sebum follicles on those parts of your body and your face, compared to the rest of your body. Therefore this area is more sensitive to friction (from for example a backpack) or hair products (like an oil but even conditioner) that clog the follicles.
For your shoulders and chest you can use the same skincare as for your face (2% salicylic acid cleanser in the shower), but treatment for the back can be more difficult as it is hard to reach. We recommend spray formulations as they are easy to use.(5)
Are tanning beds good for acne?
Some people might say that tanning beds will help clear up your acne. This is not entirely true; the darker skin just makes the appearance of red spots less visible. Even if this may seem like a good solution, we recommend to not use tanning beds. There is a high chance of developing skin cancer, just like with the normal sun. Always use at least SPF30 when you spend time outside to prevent skin cancer. There are plenty of alternative treatments that can help you manage the acne. (18)
What can I do to clear up my acne?
To manage the acne, it is important to follow a few simple steps. Wash your face 1-2 times a day with a mild 2% salicylic acid cleanser, use a hydrating cream without alcohol/perfume and use non-comedogenic products. Try to touch your face as little as necessary, and don’t scratch or pop the pimples. To see if you have any food intolerances that cause or aggravate the acne, you can try to limit diary and eat mostly low glycemic foods. A healthy, balanced diet with enough vegetables and fruits can help contribute to your health and skin. If your acne persists or if you have any questions, contact your dermatologist. (5,6)
References
(1) Degitz, K., Placzek, M., Borelli, C., & Plewig, G. (2007). Pathophysiology of acne. Journal der Deutschen Dermatologischen Gesellschaft. 5(4), 316-323.
(2) Baumann, L. (2009). The Baumann Skin-Type Indicator: A Novel Approach to Understanding Skin Type. In A.O. Barel., M. Paye, & H.I., Maibach (Ed.), Handbook of Cosmetic Science and Technology (3rd ed.) (pp. 29-40). New York, United States: Informa Healthcare.
(3) Bagatin, E., Freitas, T.H.P., Rivitti-Machado, M.C., Machado, M.C.R., Ribeiro, B.M., Nunes, S., & Rocha, M.A.D.D. (2019). Adult female acne: a guide to clinical practice. Anais Brasileiros de Dermatologia. 94(1), 62-75.
(4) Chlebus, E., & Chlebus, M. (2017). Factors affecting the course and severity of adult acne. Observational cohort study. Journal of Dermatological Treatment. 28(8), 737-744.
(5) Baumann, L., & Keri, J. (2009). Acne (Type 1 Sensitive Skin). In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 121-127). New York, United States: McGraw-Hill.
(6) Bowe, W.P., & Logan, A.C. (2011). Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future? Gut Pathogens. 3(1), 1-11.
(7) Singh, S., Mann, B.K., & Tiwary, N.K. (2013). Acne cosmetica revisited: a case control study shows a dose dependent inverse association between overall cosmetic use and post-adolescent acne. Dermatology. 226(4), 337-341.
(8) Matsui, M.S. (2019). Update on diet and acne. Cutis. 104(1), 11-13.
(9) Baumann, L. (2009). Nutrition and the Skin In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 46-66). NewYork, United States: McGraw-Hill.
(10) Perricone, N. (2003). The Acne Prescription: The Perricone Program for Clear and Healthy Skin At Every Age. New York, United States: Harper Collins.
(11) Weisberg, E., & Baumann, L. (2009). Cosmetic and Drug Regulation. In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 241-244). New York, United States: McGraw-Hill.
(12) Zaulyanov-Scanlan, L. (2009). Hormones and Aging Skin. In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 29-33). New York, United States: McGraw-Hill.
(13) Katsambas, A.D., & Dessiniori, C. (2010). Hormonal therapy for acne: why not as first line therapy? Facts and Controversies. Clinics in Dermatology. 28(1), 17-23.
(14) Zouboulis, C.C., & Rabe, T. (2010). Hormonal antiandrogens in acne treatment. Journal der Deutschen Dermatologischen Gesellschaft. 8, 60-74.
(15) Baumann, L. (2009). Sensitive Skin. In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 94-97). New York, United States: McGraw-Hill.
(16) Obagi, S., & Casey, A. (2009). Facial Scar Revision. In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 227-234). New York, United States: McGraw-Hill.
(17) Baumann, L., & Saghari, S. (2009). Skin Pigmentation and Pigmentation Disorders. In L. Baumann, S. Saghari, & E. Weisberg (Ed.), Cosmetic Dermatology - Principles and Practice (2nd ed.) (pp. 98-108). New York, United States: McGraw-Hill.
(18) Radack, K.P., Farhangian, M.E., Anderson, K.L., & Feldman, S. (2015). A review of the use of tanning beds as a dermatological treatment. Dermatology and Therapy. 5, 37-51.