Most of us have encountered clients whose acne is stubborn to treat or whose skin successfully clears under our guidance, only for it to return without an obvious cause. Such is the frustrating and often confusing nature of the condition.
What makes acne treatments especially complicated is the fact that, outside of its four main causes (follicular keratinization, overactive sebaceous glands, prevalence of P.acnes bacteria, and inflammation), there are numerous secondary factors believed to influence its development. We have certainly heard about some of them – stress, certain medications, use of harsh products – but, truth be told, acne research has not always given us clear answers as to the degree that these and other factors play a role. For that reason, acne treatment is fraught with myths that have easily become accepted as facts by clients and even many skin care professionals. Research has even pointed to the low level of acne comprehension among physicians – an alarming fact, given that an estimated 5.1 million Americans seek medical treatment for it each year.1,2
To help you up your acne game and improve your ability to assist clients in overcoming stubborn acne, let’s walk through three persistent myths that have permeated even the aesthetics industry. After getting the facts, you’ll certainly agree that it is time we put these to rest.
MYTH: DIET DOESN’T PLAY A ROLE IN THE ONSET OF ACNE
For decades, researchers have worked to determine how much of an impact diet has on the development of acne. Remember when chocolate and even greasy foods were thought to cause breakouts? As those theories were (for the most part) debunked, the idea of diet having any real influence on acne was in large part thrown out the window. Today, we see discussion about the diet and acne link re-emerging, with modern research focusing, in particular, on dairy and simple carbohydrates.
Several studies have demonstrated a higher prevalence of acne in those who consumed milk, especially skim and lowfat varieties.3,4 In 2018, a study went a step further, demonstrating that “intake of any dairy, any milk, full-fat dairy, whole milk, low-fat and skim milk, and yogurt, regardless of amount or frequency, were associated with a higher odds ratio for acne.”5 It is suspected that lactose, a sugar present in milk, increases production of insulin and other messenger proteins. This leads to hormonal imbalances, which activate factors that directly cause acne, such as sebum production and inflammation, while making the skin more hospitable to P.acnes bacteria. The mechanism is similar in diets high in sugary drinks, starchy vegetables, fast foods and white breads – all foods high on the glycemic index, which cause levels of glucose (blood sugar) to spike. In one study, a low-glycemic diet was shown to improve acne symptoms.6
Bottom line: Clients with particularly stubborn acne should be encouraged to keep a food diary. If processed foods and dairy make a regular appearance, cleaning up their diet could make a big difference in their skin.
MYTH: IF IT LOOKS LIKE ACNE, IT’S ACNE
While we would all agree that symptoms of true acne are pretty easy to spot, there are several skin conditions whose symptoms are easily mistaken for acne. Among them are:
- Folliculitis: Characterized by small, inflamed papules, folliculitis is caused by inflammation and infection of the hair follicles. Folliculitis is often found on the upper forehead, extending into the hairline.
- Rosacea: Subtype two rosacea is often accompanied by redness and breakouts. Rosacea breakouts are isolated to the central area of the face and begin with redness or small, dilated blood vessels before progressing to breakouts.
- Sebaceous hyperplasia: This condition occurs when the sebaceous glands become enlarged due to blockages caused by overproduction of sebum. It appears as small-to-large bumps under the skin. While acne is typically characterized by a raised center, sebaceous hyperplasia bumps are usually indented.
Bottom line: While professional acne treatments can be effective in improving the symptoms of conditions like these, it can also worsen them. Therefore, before jumping to the conclusion that a breakout is definitely a sign of acne, take the time to closely inspect the skin. If a condition other than acne is suspected, refer the client to their physician, as medical intervention may be necessary.
MYTH: SUN EXPOSURE CAN IMPROVE ACNE SEVERITY
How many times have you heard a client say that their skin improves after they’ve spent time in the sun? The idea has become increasingly popular in recent years as research has shown a potential link between low vitamin D levels and acne severity.7 While sunlight is indeed a source of vitamin D, it is not a good one. In the long run, as we all know, skin pays the price for sun exposure and those with acne often find their tendency for breakouts worsens due to the increase in sebaceous activity caused by the sun’s drying effect on the skin.
Bottom line: While there is not strong research behind it, it is possible that vitamin D supplementation may help improve acne symptoms. Clients with acne should be advised that unprotected sun exposure is especially damaging to their acne-prone skin. Instead, encourage them to consider taking vitamin D supplements and stress the importance of daily use of a non-comedogenic sunscreen that is appropriate for their skin.
1 Brajac I, Bilic-Zulle L, Tkalcic M. Acne vulgaris: myths and misconceptions among patients and family
physicians. Patient Educ Couns. 54 1 21-5 (July 2004)
2 Source: American Academy of Dermatology https://www.aad.org/media/stats/conditions/skin-
3 LaRosa C, Quach K, Koons K. Consumption of dairy in teenagers with and without acne. J Amer Acad
Derm. 75 2 318-22 (August 2016)
4 Danby FW. Nutrition and acne. Clin Derm. 28 6 598-604 (Nov-Dec 2010)
5 Juhl C, Bergholdt H, Miller I. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-
Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. 10 8 1049. (August 2018)
6 Smith R, Mann N, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris
patients: a randomized controlled trial. Am J of Clin Nutr. 86 1 107:115 (July 2007)
7 Seul Ki Lim et al. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control
Study Combined with a Randomized Controlled Trial. PLoS One (2016)
Ahmed Abdullah is a board-certified plastic and cosmetic surgeon and the CEO and founder of Lexli International, Inc. A recognized expert on the restorative and medicinal effects of aloe vera, Abdullah is the lead formulator of the Lexli line of aloe-based skin care. He is a member of the International Aloe Science Council (IASC) and has served on its board of directors. Abdullah is a diplomat of the American Board of Surgery and the American Board of Plastic Surgery. He earned his medical degree from Northwestern University in Chicago, Illinois and completed his residency at the University of Texas Medical Branch in Galveston, Texas.