The Pimple Puzzle: Overlooked Causes of Breakouts

Written by Ginger Downey, MS, CNS, co-owner of DermaMed Solutions, LLC

Many have experienced the incredibly annoying experience of waking up on the day of some important event only to look in the mirror and see a pimple, that was not there hours before. Why do these bad skin days seem to occur for no apparent reason, even despite the best of homecare routines? The answer is that there are a number of lesser known causes of breakouts that many individuals are just not aware of.

For most, a cell phone is always in sight. This constant contact with phones exposes individuals to a lot of germs. In fact, scientists at the University of Arizona found that cell phones carry 10 times more bacteria than most toilet seats.1 Even those who use earbuds or a wireless device to speak on the phone mindlessly touch their phones and then their faces numerous times per day, depositing germs directly onto their skin. As bacteria is one of the main causes of pimples, every time this occurs, the chance of getting a pimple increases.
What can be done? To start, avoiding direct phone-to-cheek contact is a good idea. Cleaning one’s phone several times per day is also important. Mealtimes can be an easy time to create a routine in cleaning one’s phone. Antibacterial soaps and hand sanitizers may do more harm than good. Instead, use an alcohol wipe or spray a soft cloth with an alcohol and water mixture. A simple soap and water mixture used in the same way has proven to be quite effective at killing germs, as well. The idea is to stop bacteria from taking up residence on one’s phone and, ultimately, on one’s face.

Proper pillowcase hygiene is essential. If a client is experiencing frequent breakouts, they may want to invest in some extra pillowcases and consider changing them more often. Though it is gross, many people drool in their sleep. This can be caused by using certain medications, allergies, sinus problems, or simply sleeping position. Mouths contain a variety of bacteria that do not belong on the skin and these can get transferred during sleep. In addition, most women use several hair products each day, such as mousse, styling cream, oil, or hairspray. At night, these are deposited onto pillowcases and onto skin, which can clog pores and cause breakouts. The same goes for facial creams and serums. These are great and can help improve skin quality, but when these creams attract dust, germs, and hair products, the pores can become clogged.
What can be done? Pillowcases should be changed every day. It sounds extreme, but it can make a difference for skin. It is also good practice to choose a laundry detergent that is fragrance-free and clean in formulation. White sheets and pillowcases may be ideal because they can be laundered in hot water with some bleach added, for extra disinfection.

Hormones are often most troublesome. During puberty and peri-menopause – the times when individuals experience big changes. Fluctuations and dips in estrogen, progesterone, and testosterone can lead to increased sebum production, another key cause of acne. Taking certain nutritional supplements can have a similar impact. Some people take DHEA and other testosterone-boosting supplements to increase their muscle mass and physical performance. These supplements increase androgens and, in turn, increase oil production in the skin. There have been cases of full-blown cystic acne triggered by the simple addition of a DHEA supplement. There is a time and place for these types of supplements, but they need to be taken under the supervision of a physician or clinical nutritionist, as they can cause serious problems.
What can be done? In terms of diet, the cruciferous or brassica vegetables have some powerful attributes, including the reported ability to prevent cancer and regulate hormones. Cruciferous vegetables are rich in zinc and vitamins A, B, C, D, and E. Scientists have isolated a constituent in cruciferous vegetables called Indole-3-Carbinol (I3C) that is especially beneficial to estrogen metabolism. I3C and stomach acid create 3,3-Diindolylmethane, or DIM. The metabolism of DIM promotes healthy estrogen metabolism, which many report eases hormonal acne flares and other symptoms, like hot flashes. Two servings per day provide the best results. Another way to positively influence estrogen is by use of estrogen- mimicking foods called phytoestrogens. Basically, phytoestrogens mimic the body’s estrogen and balance the levels. Natural food sources are milled flax and yams, as well as natural sources of soy, like organic soybeans and tempe. Supplements should only be used under supervision of a healthcare provider. An aesthetician should never recommend supplements, as it is outside of the scope of practice.

Emotions have a significant impact on skin. A fairly new field of medicine called psychodermatology focuses on the intricacies of the mind-skin connection. Doctors who specialize in psychodermatology treat skin problems that are caused or worsened by stress.
When a person becomes stressed, the level of cortisol, the body’s stress hormone, rises. This increase signals to sebaceous glands to produce more oil, which leads to clogged pores and acne. Stress also makes it more difficult for skin to heal because it reduces the barrier function of the skin resulting in water loss and an inability to repair damage after injury.
What can be done? Stress is not easy to overcome, but a useful tool is the science of mindfulness. Mindfulness practice incorporates so many useful tools for calming the mind – from attention to breathing, to journaling about what one is grateful for, to just taking the time to notice and acknowledge whatever one is experiencing at any moment and being okay with it.

The skin is alive with healthy bacteria, similar to what is found in the gut. Skin microbiota serve a vitally important role and act to prevent the adherence of harmful bacteria to the skin, while enhancing immune function. When healthy skin bacteria are stripped away, the door is opened for bad bacteria to settle in. This can be done by overuse of harsh chemicals and cleansers on the skin. Peels and the use of alpha hydroxy acids are great for antiaging, but must be balanced by reapplication of topical probiotics (healthy bacteria) and prebiotics (the food that keeps the bacteria alive). Research on the benefits of topical lactobacillus – in particular to reduce skin inflammation and inflammatory skin conditions, such as acne – is growing.
What can be done? Daily application of a topical probiotic, combined with oral ingestion through diet or supplementation, is a great way to ensure skin flora are being nourished to keep a good balance. Prebiotics for the skin come from fruit sugars, often labeled as fructo oligosaccharides. Using a cleanser with these sugars, as part of a post peel regimen, is a must. Also, antibacterial soaps or hand sanitizers should be avoided, as they can be transferred to the face and kill off healthy flora.

Sometimes the cause of skin problems are ordinary, everyday acts that can easily be remedied. Taking a mindful moment to notice how the skin is compromised and, then, taking action will lead to great results.

1 Koljalg, Siiri, Rando Mandar, Tiina Sober, Tiiu Roop, and Reet Mandar. “High level bacteril contamination of secondary school students’ mobile phones.” Germs 7, no. 2 (2017): 73-77.

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