Many acne sufferers feel they’ve “tried everything” to no avail. Rather than spend more money on useless products, they’re resigned to live with the condition. Deep down, they would love to get clear, but they’re frustrated and resistant to my professional guidance regarding their skin.
It’s tricky building trust with such clients. I ask a lot of questions about what they’ve tried, and then offer a bit of education about what acne is and how it forms. Once they understand acne then it’s easy to see how and why most drug store acne treatments fail. Your acne condition is not hopeless, these products are!
This two-part blog post discusses the cause of acne and how it forms. Part 2 goes deeply into treatment options.
What is Acne?
Many factors contribute but primarily, Acne is a condition of clogged pores (hair follicles) due to an inherited propensity of over-producing dead skin cells.
How Acne Forms
The outer layer of skin (called the epidermis) is comprised of different types of cells, the majority being keratinocytes. Live keratinocytes multiply at the deepest epidermal layer then gradually push upward, reaching the surface in about a month.
As they push upward, keratinocytes lose their nuclei, die, flatten-out and become hardened with a protein called keratin. These hard and flattened dead skin cells create a protective outer layer much like roof shingles, and as new cells continually push upward, these outermost “shingles” slough-off.
Dead skin cells are sloughing-off inside a pore as well. They’re normally washed up and out of the pore with the flow of sebum (oil) from sebaceous glands, but people with acne are genetically predisposed to slough keratinocytes faster than they can be pushed out of the pore. So all these dead skin cells (thousands) mix with the oil from the sebaceous glands, create a paste that plugs the follicle opening. As the follicle wall continues to shed inside the blocked pore it has nowhere to go. The medical name for acne, Retention Hyperkeratosis, refers to the accelerated shedding of keratinocytes being retained in the follicle.
Bacteria
Three types of bacteria affect acne. Propionibacteria live near the follicle opening. Staphylococcus bacteria live in the deep dermal layer, and P.Acnes bacteria thrive inside the hair follicle. Oxygen usually keeps these anaerobic bacteria in check, but when a follicle is plugged and oxygen blocked from entry, bacteria have a heyday, often leading to infection and inflammation of the follicle wall.
Hormones & Oil
Neither hormones nor oil cause acne, but they do feed it in genetically predisposed skin. At puberty, the pituitary gland activates hormones and the body starts producing testosterone. Testosterone triggers a chain reaction stimulating the sebaceous glands to produce more oil. Oil mixed with an abundance of dead skin cells means more blocked pores. P.acnes bacteria feed on this oil as well.
Inflammation & Scaring
As dead skin cells continue to shed inside a blocked pore, the follicle wall stretches to its maximum. If the plug is not removed the pore can burst inwardly, releasing bacteria and debris into the skin matrix. When this happens, white blood cells rush in delivering digestive enzymes. But the body doesn’t produce an enzyme strong enough to dissolve the keratin-covered hard dead skin cells, so these enzymes digest the wounded follicle wall and destroy surrounding collagen instead. This creates pitted acne scaring… which is why you should never squeeze an acne lesion. If the follicle wall bursts, you risk this type of scaring.
Sometimes the body heals itself, other times the lesion reoccurs in the same spot, bringing another wave of the immune response. In an attempt to mend, replace and wall-off destroyed tissue, fibroblast cells rush in producing collagen. This sometimes leads to raised ‘keloid’ type acne scarring.
Common Aggravators
Birth Control Pills
Androgen is a general term for male hormones, Testosterone being the major player. Androgen-dominant mini pills are safer and have fewer side effects, but they aggravate acne. Conversely, female hormone (estrogen) birth control pills can clear acne, but with serious health risks (see the ‘Treatments with Major Drawbacks’ section in part 2 of this blog series).
Diet
Avoid processed foods, sugar, salt (salt binds to water and prevents healing), and all hormone-containing foods such as peanuts, corn, wheat germ oils, and meats injected with hormones or steroids. Cutting out dairy can also significantly decrease acne lesions.
It’s a common belief that iodine aggravates acne, but current research suggests a connection between fluoride in drinking water creating iodine depletion. Iodine supplementation (starting in small doses) may actually clear acne! There’s a book I’d like to read before I’d be convinced enough to comment on this theory. Learn more HERE.
Stress
Stress activates the adrenals and cortisol. The adrenals stimulate oil production and cortisol weakens the immune system. If cortisol levels go too high or low, it can lead to regular infections, chronic inflammation, autoimmune diseases, allergies, and acne.
Climate, Seasons & Environment
A hot, humid climate aggravates acne. Cooking in a steamy, oily kitchen will aggravate acne flareups. Frequent swimmers may find that pool disinfectants can cause major acne flare-ups. Testosterone levels peak in Autumn producing more oil to feed p.acnes bacteria.
Pressure & Friction
Glasses, shoulder pads, helmets, and facial picking.
Drugs
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
Androgens are male hormones that stimulate the sebaceous glands to produce oil. Levels of Androgens rise at puberty, but also midlife in females. During perimenopause, levels of female hormones drop leaving androgens higher. As testosterone rises, the sebaceous glands go into overdrive producing oil. The problem is exacerbated by a slower cell turn-over in aged skin. A build-up of dead skin cells mixed with increased oil production equals 48-year-old acne for women.
Menstrual Cycle
Progesterone peaks before menstruation aggravating acne flare-ups (Conversely, estrogen reduces acne by inhibiting sebum production).
Pregnancy
Breakouts often occur during the first 3 months (from high progesterone), then clears for the rest of pregnancy. Another breakout can occur 90 days after birth when the body is deprived of estrogen.
Comedogenic (pore-clogging) Formulations
Poorly Formulated Acne Medications
Because consumers complain of dryness, manufacturers add moisturizing ingredients to acne treatments. For example, Retin A can be a highly effective acne treatment when used in an oil-free gel or serum, but not in a cream containing oil and isopropyl myristate, both of which clog pores.
Benzoyl Peroxide is another highly effective treatment for acne. It attracts oxygen to kill bacteria. However, many benzoyl peroxide products contain oil. Oils inhibit the penetration of benzoyl peroxide, canceling out the benefit. 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
It’s important to keep skin hydrated so pores won’t constrict, trapping in dead skin cells. But there’s a difference between water hydration and oil. Many people seem to think coconut oil is an exception. Not so! Coconut oil is a very small molecule that will clog pores. Acne-prone skin should never use oil on their skin. Hydrate with hyaluronic acid serums and oil-free moisturizers instead.
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
I offer skincare consultations via Zoom/Skype at $1 per minute paid through PayPal/Venmo. Usually, only 15-20 min. needed.
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