Acne may affect 85% of the population at one point or another, but you’d be surprised at how little people understand this condition. There is widespread misinformation about the causes of acne which can directly affect what interventions people seek to cure it.
Being able to determine fact from fiction is the first step to a blemish-free future. So let’s get started!
MYTH - Acne is caused by a poor diet.
Often, people who suffer from acne are told to avoid dairy products, milk, chocolate, and high-sugar foods. If you check “acne diet”, you’ll find the search populated with lists of what to eat and what not to eat in order to control your skin. This might make you think that changing your food habits will lead to a clear and smooth complexion. But this is far from the truth.
The scientific research backing the improvement of acne through dieting is shaky at best. As you can imagine, it would be difficult to measure a direct relationship between what we eat and how frequently or severely we break out. The studies that have tried to find a correlation between dairy or chocolate consumption and acne suffer from small sample sizes, poor reporting, and unclear definitions of acne changes. Moreover, they relied on what people remember eating, leading to possible recall bias.
In contrast to the poor evidence that dietary restrictions of dairy products improve acne, there is abundant research on milk’s ability to curb obesity. Dairy is a good source of calcium, which adolescents experiencing growth spurts will need a lot of. So advising against drinking milk or eating dairy products may have little effect on acne, but a significantly negative effect on one’s overall health.
A potential factor that does appear to exacerbate acne is not a specific food, but rather a general diet. A study comparing people who were asked to eat a low glycemic control diet and people who were made to eat a high glycemic treatment diet found that the latter had more acne lesions at the end of the period. They also had higher levels of insulin in the blood, which is known to increase levels of androgens in the body. Androgens have a stimulating effect on our oil glands. This shows the connection between high glycemic food and an important factor in acne pathogenesis: overproduction of sebum.
While this is definitely an interesting proposition, the jury is still out on whether changing our eating habits will have a strong impact on our skin. For now, dermatologists rely on the tried-and-tested use of topical and oral medications for the clearing of acne, rather than restricting their patients’ diets. More studies with better control should be done before this is accepted as gospel truth.
MYTH - Acne is caused by a bacterial infection.
You may think that maybe acne is infectious because it has something to do with bacteria. After all, a lot of bacterial diseases can be passed on from one person to another. This is the idea behind much of the bullying and ostracization that acne-prone people experience. Both physical and social distance is kept, which deals a serious blow to one’s self-esteem.
But remember that Propionibacterium acnes, the bacteria most associated with this condition, is present on everyone’s skin--regardless if they’re clear or otherwise. Acne only occurs when the stage is set for the massive proliferation of this bacteria. That’s where the other major factors of acne pathogenesis come in. If there is excess oil production and an accumulation of dead skin cells, then the pore gets blocked. And only when this is blocked can there be an overgrowth of P. acnes that causes inflammation.
So that means even if the P. acnes on one person’s face transfers to another, if the skin environment isn’t conducive to growth, then the bacterial population will remain under control.
FICTION - Acne is caused by infrequent washing.
At one point in time, acne-prone people are likely to have been on the receiving end of taunts about poor hygiene and unsanitary habits. This is particularly true of people who suffer from comedonal acne, wherein blackheads are thought to be accumulated dirt rather than oxidized sebum. This can lead to more frequent face washing, use of astringent and alcohol-based products, and overuse of drying agents--all in an effort to get the skin squeaky clean.
Unfortunately, these very habits can cause acne to flare up rather than die down. While excessive sebum production and accumulation of dead skin cells are important factors in the formation of acne, these are not resolved by harsh scrubbing or harsh products. This will only make the skin more sensitive and inflamed. Plus, when the skin is stripped off all sebum, the body’s reaction is to make even more of it.
FICTION - Acne is just a phase.
There are many adolescents who are told to just ride out their acne because it’ll eventually die down as they grow older. This call to non-action is easy to refute because adult acne is very much real. While the hormonal turbulence of adolescence is definitely a factor in the pathogenesis of acne, to say that it will stop when our hormones settle down is a lie.
This misconception can lead people to think that they don’t need to seek medical help for a worsening or chronic condition. By the time they realize that it’s not just a phase, the scars of pimples past have made permanent impressions on their skin and on their self-esteem.
Acne is not a phase. It is a treatable medical condition. The earlier you recognize this, the earlier you can seek proper medical advice. This is a much safer option than giving it a chance to wreak havoc on your skin and mental health.
Conclusion
Misconceptions about the causes of acne accounts for much of the bullying and ostracization that blemished individuals go through. It may also make people turn to interventions that worsen their skin condition and general health.
The fact is, acne is most often caused by a confluence of these factors: increased sebum production, abnormal keratinization, and proliferation of Propionibacterium acnes. There are things that may make it worse, but focusing treatment on those will not lead to a clear face. The treatments that are most touted by dermatologists (aka the treatments that actually work) are the ones that target one or more of the above factors.
Only by understanding the true causes of acne will we be able to differentiate what will work and what won’t.
This content is for general information only and is not a substitute for medical advice.
Resources:
Bhatia A, Maisonneuve JF, Persing DH. PROPIONIBACTERIUM ACNES AND CHRONIC DISEASES. In: Institute of Medicine (US) Forum on Microbial Threats; Knobler SL, O'Connor S, Lemon SM, et al., editors. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington (DC): National Academies Press (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83685/
Dréno B. (2017). What is new in the pathophysiology of acne, an overview. Journal of the European Academy of Dermatology and Venereology : JEADV, 31 Suppl 5, 8–12. https://doi.org/10.1111/jdv.14374
Pappas A. (2009). The relationship of diet and acne: A review. Dermato-endocrinology, 1(5), 262–267. https://doi.org/10.4161/derm.1.5.10192
Magin, P., Pond, D., Smith, W., & Watson, A. (2005). A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight. Family practice, 22(1), 62–70. https://doi.org/10.1093/fampra/cmh715
