A response to the age-old phenomenon of unwanted skin advice

“Dorothy, is your forehead okay? Did you fall?” My friend’s father asks, as I sat down to eat dinner with her family.

I didn’t fall, quite the opposite really. The area of my forehead that he was studying was along my hairline and was littered with small, red dots. If I hadn’t itched at them earlier, he would’ve seen that they were bumps. Pustules, to be more specific.

This memory was from seventh grade when I had been dealing with various skin concerns. At that dinner table, I distinctly remember reassuring her father that I was alright and moving my hair to cover the problem area. My skin had only cleared once I had visited a dermatologist and gotten prescriptions for tretinoin, a Vitamin A derivative, and clindamycin, an antibiotic. 

At the same time, while my condition improved, the same friend happened to experience similar symptoms as I did, to which I recommended her a personalized routine and to book an appointment with the same dermatologist. While her discipline, or her absence of, in applying the prescriptions may have been a factor, she didn’t get the same results as I did.

Such differences are frustratingly commonplace, as the same treatment can’t always work for everyone, due to the uniqueness of each individual’s skin. Although this results in individuals experiencing acne differently, stigma around acne can often cause large, unfair generalizations. Many of us perpetuate these misconceptions, maybe unknowingly, so addressing them is especially important.

What is Acne?

First of all, what is acne? Acne, or Acne Vulgaris, is an extremely common skin condition, caused by a variety of factors including genetics, hormonal changes and excess sebum production.

There are two primary lesions, or damaged regions of organs or tissues, in our skin: open comedones, or blackheads, and closed comedones, or whiteheads. On the skin’s surface, hair follicles with attached oil glands, or sebaceous glands, secrete sebum, or oil. When the gland over-secretes sebum, it blocks up the pore, along with dead skin cells and bacteria. 

A closed pore becomes a whitehead, while a blackhead develops from an open pore when the sebum oxidizes in contact with oxygen, causing the characteristic color shift from yellow to black. When a pore is plugged, it can also develop inflammation, an immune response, resulting in a red papule, or the common pimple that most recognize. The other skin lesions develop in similar ways.

Although acne is something the vast majority of the population can’t control, it is unfortunately a major cause of insecurity and discomfort. 

Florence Le, a sophomore at MVHS, shares her personal experiences. “I felt that my own self-esteem went down a little bit because I had it,” Le said. “I wanted to wear concealer to cover it up a little bit more.”

The cause of these feelings can be traced back to the social stigma attached to acne. This stigma, among many other reasons, is caused by the many misconceptions about the correlation between acne and a person’s hygiene and lifestyle.

Acne Stigma

Acne is often associated with a lack of cleanliness, neglect in self-care and an unhealthy diet. While these sayings may be true to some small extent, generalizing everyone with acne as unclean and unhealthy is both unfair and untrue.

Better hygiene and self-care can lead to a decrease in acne, but this correlation isn’t as close as many think. Touching the face with dirty hands and infrequent showers are going to predispose to breaking out, but they are not usually the root cause. 

According to the United Kingdom National Health Service, “[m]ost of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin has no effect on your acne. Washing your face more than twice a day could just aggravate your skin.”

In the same way, an unhealthy diet with carbohydrates may aggravate acne, but this isn’t the same for every person. 

Doctor Jenny Murase is the Director of Medical Consultative Dermatology for the Palo Alto Foundation Medical Group and an Associate Clinical Professor of Dermatology at UCSF. “[An unhealthy diet] might be 3% [of the problem], so if you change your diet, [your acne] might get a little better,” Murase said. “But the medicines take care of [around] 97%.

Despite this, a study by the National Library of Medicine found that 84.6% of patients believe that dietary changes can reduce or prevent acne.

The saying, “Just drink more water,” is also especially untrue, as dehydration is not a direct cause of acne. Not drinking enough water leads to an overall decrease in bodily function, which only indirectly impacts the skin, so drinking more water is not any type of miracle cure as many make it seem to be. The same study found that 62.3% of the patients believed that high water intake would improve acne, revealing how common this misconception is.

In reality, acne has a huge genetic and hormonal component. According to the popular genetic testing service 23andMe, factors contributing to the development of acne include genetics, hormone levels, and family history, as acne is, “associated with changes…with puberty and the menstrual cycle. In addition, conditions that cause high levels of androgen hormones — including polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia — can increase the chances of developing severe acne.”

Many skincare companies feed off the prevalence of these misconceptions for marketing, while their claims end up being empty promises due to the relative triviality of these factors. As a result, many people can spend a fortune on acne products, eat well and shower often but still have acne.

This reality, alongside the existence of external variables, renders random advice from both relatives and strangers useless as well, especially if the comment addresses diet or lifestyle choices.

Carina Chan, a junior at King’s Academy, shared a personal experience with this phenomenon, coming from her aunt.

“I still remember this aunt of mine would like to point out, ‘Oh, you have pimples!’ like, thank you?” Chan said. “It’s very discriminating in a way.”

Such comments will only cause more stress in the person on the receiving end, as shown in how Chan still remembers these interactions despite her aunt’s assumed good intentions. This kind of comment, combined with unsolicited advice that Chan also received, generalizes the treatment of acne, which is evidently impossible.

For example, hormonal acne, which usually appears in adult women, is more difficult to treat than a teen’s acne. In these cases, treatments would actually include different oral therapies, like spironolactone, oral antibiotics, oral contraceptive pills and isotretinoin or Accutane.

Treatment Options

Many medications are available to treat other types of acne as well. Murase, when asked about the common mistakes her patients make, said, “they might be treating the open comedones and not the closed comedones, or vice versa…You want to make sure that you’re both unplugging the pores and treating the inflammatory papules.”

To treat open comedones, commonly known as whiteheads, Murase suggests using vitamin A derivatives, like Tretinoin, Tazarotene, or Adapalene. While these are often only attainable through a prescription, Differin, an over-the-counter retinoid, is an option that can be bought over the counter. Additionally, products with salicylic acid, or beta-hydroxy acids (BHA), can also help unplug pores. The most popular product with this ingredient is the Paula’s Choice BHA Solution, but there are many other options at the drugstore as well.

To treat inflammatory papules, the recognizable red pimple, Murase recommends topical (or oral) antibiotics, like Clindamycin and Benzoyl Peroxide. The latter can be found over the counter in the form of a 2.5 to 10% wash, particularly the one from PanOxyl.

These treatments will be more helpful compared to anything you could find at your home or make by yourself. Natural, or plant-based remedies, aren’t inherently better for the skin. As an example, poison oak is found in nature, but causes allergic contact dermatitis. Additionally, Benzoyl Peroxide, mentioned earlier, is also used as a food additive, meaning an average person would get more exposure to the ingredient orally compared to applying products to your skin.

Chan adds to this idea, contrasting the concept of natural and plant-based treatments with formulated products.

“Natural isn’t always better because it’s sometimes way too strong and concentrated and not fit for skin,” Chan said. “Skin products have to go through a lot of lab process [iterations] and research before they’re sold…It’s definitely better to get stuff that has been worked on with estheticians and dermatologists who have put time into making sure the product will work.”

Chan credited the cosmetic formulation process to the effectiveness of over-the-counter products and prescriptions. However, Le believes that although these products are effective, many are often out of an average consumer’s budget.

“I feel like when people think that if they need to treat their acne, it has to be super expensive,” Le said. “If someone that has acne doesn’t have the access to a prescribed ointment or something from Sephora, sometimes just going to the drugstore like Target and just spending some time to research and look at ingredients could be more helpful in the long run.”

Le shares the idea of the availability of skincare for the general public. While acne products are still not as accessible as they should be, many should be able to treat minor acne at home once they cross a certain learning curve.

Looking Ahead

Overall, it’s important to stay informed about the newest advancements in skin treatments and to ensure that you aren’t being influenced by the media or by that aunt you haven’t seen in years. Understanding your skin and what you want to do for it individually will ultimately lead to the best results.

If you want to treat your acne, whether it’s out of inconvenience or due to cosmetic reasons, modern science and technology has resulted in the availability of the treatments specified above. 

However, treatment is never absolutely needed. Acne is by no means a fatal medical condition and isn’t an indication of skin health or overall body health, and furthermore, shouldn’t invalidate beauty.

Acne positivity will slowly result in the dissolution of historical biases, and widespread education will dispel the misconceptions surrounding the condition, allowing us, as a society, to revisit our mentality about acne as a whole. However, while we wait for such change to occur, as individuals, we must start seeing acne as what it is: normal and something that is not to be regarded as shameful.

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