Many people struggling with acne feel like they’ve tried everything—only to be met with disappointment. After spending countless dollars on ineffective products, many simply give up, resigning themselves to living with breakouts. Deep down, they still want clear skin, but frustration makes them skeptical, even resistant, to professional advice.
Building trust with these clients can be challenging. I start by listening—asking about their skincare history, what they’ve tried, and what hasn’t worked. Then, I offer a bit of education. Once they understand what acne really is and how it forms, it becomes clear why most drugstore treatments fail. Your acne isn’t hopeless—these products are.
This is the first post in a two-part series. Here, we’ll dive in to the root causes of acne and how it develops. In Part 2, we’ll explore effective treatment options that actually work.
What is Acne?
Acne is a skin condition primarily caused by clogged pores (hair follicles), due to an inherited tendency to overproduce dead skin cells. Though many factors contribute, this is the core issue at play.
How Acne Forms
The outer layer of the skin, known as the epidermis, is made up of various cells, most of which are keratinocytes. These live keratinocytes multiply in the deepest part of the epidermis and gradually move upward, reaching the surface in about a month.
As they rise, keratinocytes lose their nuclei, die, flatten, and become hardened by a protein called keratin. This creates a protective outer layer, similar to roof shingles. As new cells push upward, the outermost “shingles” slough off.
Inside a pore, dead skin cells are also shedding. Normally, these cells are washed away with the flow of sebum (oil) produced by sebaceous glands. However, in people with acne, the shedding of dead cells happens more quickly than they can be cleared out, mixing with oil and forming a plug in the follicle opening. As the follicle wall continues to shed inside the blocked pore, it has nowhere to go, leading to the condition known as Retention Hyperkeratosis—an accelerated shedding of keratinocytes retained within the follicle.
Bacteria and Acne
Three types of bacteria play a role in acne:
- Propionibacteria live near the follicle opening.
- Staphylococcus bacteria thrive in the deeper dermal layers.
- P. acnes bacteria live inside the hair follicle itself.
Normally, oxygen helps control these bacteria. But when a follicle is clogged and oxygen is cut off, these bacteria proliferate, often leading to infection and inflammation within the follicle wall.
Hormones & Oil Production
While hormones and oil alone do not cause acne, they can fuel it in genetically predisposed skin. At puberty, the pituitary gland activates hormones that trigger the production of testosterone. This, in turn, stimulates sebaceous glands to produce more oil. More oil, combined with excess dead skin cells, leads to blocked pores. Additionally, P. acnes bacteria feed on this excess oil.
Inflammation & Scaring
As dead skin cells continue to accumulate within a blocked pore, the follicle wall stretches to its limit. If the pore bursts inward, it releases bacteria and debris into the surrounding skin, triggering a response from white blood cells. These cells release enzymes to digest the debris, but these enzymes also damage the follicle wall and surrounding collagen, leading to scarring.
Pitted scarring often results from the rupture of the follicle wall, which is why squeezing acne lesions is strongly discouraged. The body may heal itself, but sometimes, the lesion recurs in the same spot, leading to additional inflammation and scarring. In an attempt to heal, fibroblast cells produce collagen, which can sometimes result in raised, keloid-like acne scars.
Common Aggravators
Birth Control Pills
Some birth control pills, particularly those with androgen-dominant mini-pills, can aggravate acne. On the other hand, estrogen-containing pills may help clear acne but come with potential health risks (discussed in part 2 of this blog series).
Diet
To help reduce acne, avoid processed foods, sugar, and excessive salt (as salt binds to water and hampers healing). Hormone-containing foods, such as peanuts, corn, wheat germ oils, and meats treated with hormones or steroids, can also contribute to flare-ups. Cutting out dairy may significantly reduce acne lesions.
Recent research suggests a connection between fluoride in drinking water and iodine depletion, which might contribute to acne. Iodine supplementation in small doses may actually help clear acne, though further research is needed to confirm this. Learn more HERE.
Stress
Stress triggers the release of cortisol, which stimulates oil production and weakens the immune system. Elevated cortisol levels can lead to regular infections, chronic inflammation, autoimmune diseases, and, of course, acne.
Climate, Seasons & Environment
Hot, humid climates can worsen acne, as can cooking in a steamy kitchen. Chlorine from pool disinfectants can also trigger breakouts. Additionally, elevated testosterone levels in autumn can lead to increased oil production, fueling acne flare-ups.
Pressure & Friction
Pressure from glasses, shoulder pads, helmets, or frequent facial picking can irritate the skin and trigger acne.
Drugs
Certain medications can aggravate acne, such as: Steroids, Marijuana, Danazol Danocrine (for endometriosis), Lithium Carbonate (Bi-polar disorder), Dilantin (Epilepsy) and other anticonvulsants, Synthetic adrenal stimulating hormone or ACTH (MS and other degenerating diseases), Quinine (Malaria), Isoniazid (Tuberculosis), Immuran (Immune suppressant), Phentermine (appetite suppressant), Cyclosporin (organ transplant rejection).
Hormones
Hormonal fluctuations, particularly during puberty and perimenopause, can trigger acne. During perimenopause, the drop in female hormones leaves higher levels of androgens, causing the sebaceous glands to overproduce oil. Slower skin cell turnover in aging skin can exacerbate this process, leading to acne in women in their 40s and beyond.
Menstrual Cycle
Before menstruation, higher levels of progesterone can aggravate acne. Conversely, estrogen helps reduce acne by inhibiting sebum production.
Pregnancy
Pregnancy often brings breakouts during the first trimester due to high progesterone levels. These typically clear up after the first few months, but acne can return around 90 days post-birth when estrogen levels drop.
Comedogenic (pore-clogging) Formulations
Poorly Formulated Acne Medications
Some acne treatments are ineffective because they contain comedogenic ingredients that block pores. For example, Retin A is an excellent acne treatment when used in an oil-free gel or serum but ineffective in a cream containing oils or pore-clogging additives like isopropyl myristate.
Benzoyl Peroxide
BP attracts oxygen into acne lesions to kill bacteria. It’s highly effective, but you must seek out an effective brand with the correct formulation. Benzoyl peroxide is often rendered ineffective by the oils used in many over-the-counter products. These oils inhibit the penetration of benzoyl peroxide, reducing its effectiveness. Laureth-4 is a common oil used in poorly formulated benzoyl peroxide acne treatment creams.
Isopropyl Myristate
An emulsifier and surfactant ingredient which aggressively penetrates (used in “liquid wrench”), Isopropyl Myristate is commonly used in cosmetics to create a smooth, slick sheer application. Unfortunately, it’s highly comedogenic (pore-clogging). You may rightly wonder why a product marketed as an acne treatment would contain pore-clogging ingredients. Your guess is as good as mine. I can only speculate that ‘run of the mill’ cosmetic companies don’t necessarily specialize in skincare. They often use the same base for all products, and then just change up the active ingredient. For example, they add benzoyl peroxide to their basic cream (containing isopropyl myristate) and call it an acne treatment.
Isopropyl Myristate comes in many forms including Isopropyl palmitate, Isopropyl isostearate, Butyl Stearate, Isostearyl neopentanoate, Myristyl myristate, Decyl oleate, Octyl Stearate, Octyl Palmitate, Isocetyl stearate. PPG 2 Myristyl propionate.
Moisturizers
While hydration is important, oil-free moisturizers and serums are recommended for acne-prone skin. Avoid using coconut oil, as it can clog pores. Look for products with hyaluronic acid, which hydrates without clogging pores.
Foundations
Oil-free water or glycerin-based foundations are preferred. Watch out for algae extract and stearic acid (a potent fatty acid) in ingredient lists.
Blush
Choose powder blush over cream blushes, but look out for D&C red pigments (originally produced from coal tar, now made synthetically) which are highly comedogenic.
Lip Stick
If you get little bumps around the lips, check for Isopropyl myristate. Natural lipsticks use castor oil or hemp oil, a much healthier alternative considering that lipstick will inevitably end up in your mouth.
Hair Products
Small eruptions at hairline can be a sign of aggravators in hair products. Check product ingredients.
Cleansers & Fragrances
Avoid cleansers with Laureth-4, Sodium Laureth Sulfate (foaming agent) and oils.
Softeners & Fragrances
Water softeners, laundry softeners, and detergents leave a waxy, pore-clogging residue. Choose fragrance-free detergents like Arm and Hammer.
Skin Consults
If you’re struggling with acne and looking for personalized advice, I offer skincare consultations via Zoom/Skype at $1 per minute (payment through PayPal/Venmo). Most consultations take just 15-20 minutes.
Pore-Clogging Ingredient Reference List
Acetylated Lanolin
Acetylated Lanolin Alcohol
Algae Extract
Algin
Bismuth oxychloride
Butyl Stearate
Carrageenans
Cetearyl Alcohol & Ceteareth 20
Cocoa Butter
Coconut Oil
Colloidal Sulfur
Corn Oil
Cotton Aws Oil
Cotton Seed Oil
Crisco
D & C Red # 17, 21, 3, 30, 36,
Coal tar
Decyl Oleate
Dioctyl Succinate
Disodium Monooleamido PEG 2-Sulfosuccinate
Ethoxylated Lanolin
Ethylhexyl Palmitate
Glyceryl Stearate SE
Glyceryl-3-Disostearate
Hexadecyl Alcohol
Hydrogenated Vegetable Oil
Isocetyl Stearate
Isodecyl Oleate
Isopropyl linoleate
Isopropyl Isosterate
Isopropyl lanolate
Isopropyl Myristate
High – Isopropyl Palmitate
Isostearic acid
Isostearyl acid
Isostearyl Isostearate
Isostearyl Neopentanoate
lanolic acid
Laureth 23 & 4
Lauric Acid
Linseed oil
Mink Oil
Myreth 3 myristate
Myristic Acid
Myristyl Lactate
Myristyl Myristate
Octyl Palmitate
Octyl Stearate
Oleic Acid
Oleth-3
Oleyl Alcohol
PEG 16 Lanolin
PEG 200 Dilaurate
PEG 8 Stearate
PG Monostearate
Polyglyceryl-3-Disostearate
Potassium Chloride
PPG 2 Myristyl Propionate
Propylene Glycol Monostearate
Red Algae
Shark Liver Oil
Salt – Table Salt or Sodium Chloride
Sodium Laureth Sulfate
Sodium Lauryl Sulfate
Solulan 16
Sorbitan Oleate
Sorbitan Sesquinoleate
Soybean Oil
Steareth 10
Stearic Acid Tea
Stearyl Heptanoate
Sulfated Castor Oil
Sulfated Jojoba Oil
Stearyl Heptanoate
Wheat Germ Glyceride
Wheat Germ Oil
Xylene