Acne is "the most common skin disease," affecting about 80 percent of the population between the ages of 11 and 30. But even babies get pimples, and people in their 40s and 50s experience breakouts as well. The market is saturated with products promising clear skin, but the first step in defeating ugly breakouts, is understanding just what causes them.
There are plenty of theories and old wives’ tales about what causes acne, like eating too much chocolate, or not having clean skin. But I wanted real, expert advice. So, I talked to doctors and skincare specialists around the country, and they told me about some surprising things that cause acne, and how to rid your face of those unsightly blemishes.
Ditching the myths
The best place to start, is by dispelling the myths of what actually causes acne. Dr. Fayne Frey, a board certified dermatologist, said there are only four main causes of acne — clogged pores, hormones, oil production, and bacteria. She said things like hormones, steroids, facials, and a diet full of pasta, chips, dairy, and junk food can make acne worse, but those four causes are the real reason for breakouts.
Frey said there is no scientific evidence that makeup, greasy foods, or dirt on the face are actual causes for acne. However, washing your face twice a day with a mild cleanser has been shown to reduce adolescent acne. Dr. Gabrielle Francis adds that skin infections, blood sugar imbalances, stress, and toxins can also cause acne. "Acne can be one of the side effects of living life like a rock star," she said.
Health and wellness expert, Dr. Will Cole, said when the trillions of bacteria in your gut — called your microbiome — are imbalanced, it can lead to a weakened intestinal lining. That weakened lining is also known as "leaky gut syndrome," and it’s linked to almost every inflammatory health problem, including acne.
Cole said your doctor can order bloodwork to determine how leaky your gut is, which will help them decide what the next course of action should be. A healthy gut will lead to a healthy face.
You are what you eat, and if you’re eating something that your body is rejecting it will show in your skin, Dr. Cole said. Every person’s body is different, so it’s important to nail down exactly what is upsetting your digestive system and what foods are helping you thrive. An elimination diet is an easy way to figure out which foods are triggering a negative reaction, Dr. Cole said.
Toxin traffic jam
Dr. Cole said methylation is the body’s biochemical superhighway that helps you flush out all the toxins that are dragging your health down. When that highway gets jammed, your body holds on to toxins and it can show up as skin flare-ups, he said. Foods that are rich in folates and B-vitamins like Brussels sprouts, mushrooms, cauliflower, grass-fed beef, and green leafy vegetables are the key to a healthy detox.
Ever notice that while your hair is on point, your skin is looking busted? That’s because a buildup of hair-styling products can get onto the skin and clog your pores, said Dr. Sonam Yadav, a cosmetic dermatologist and founder of Juverne.
Dr. Yadav said dandruff, or long bangs, or hair in front of the face can all contribute to breakouts as well, so people should try to keep their scalp clean, and avoid heavy hair gels and waxes if they’re having a problem with acne.
Your cell phone is crawling with bacteria, and it’s the one device that spends the most time pressed up against your face. Dr. Yadav recommends cleansing your phone with an antibacterial wipe daily to avoid spreading that bacteria to your skin.
Your warm fluffy pillow might be betraying you. Dr. Yadav said one place people don’t realize bacteria lurks, is in their own bed. You shed thousands of skin cells every minute and those cells have trace amounts of bacteria. Since you spend a big part of your life cheek-to-cheek with your pillow, it’s only natural that all those cells and bacteria are snuggled up with you. Washing pillow cases frequently can help cut down on cheek acne, Dr. Yadav said.
Your facial cleanser
It seems counterintuitive, but an aggressive approach to bacteria can be even worse than doing nothing at all, Dr. Yadav said. Scrubbing, comedone extraction, and facials can make delicate skin prone to bacterial infections. A mild soap-free cleanser is typically all you need. However, using a stronger acne medication as a preemptive measure can help if you know you have a high-stress event coming up. Looking at you, bridezilla.
Chin and jawline breakouts are hotspots for adult acne, and hormones are most likely to blame. Your monthly menstrual cycle, or hormone imbalance from conditions like PCOS can cause acne breakouts, so contraceptive pill treatments can be a lifesaver, Dr. Yadav said.
No doubt a good day at the gym is great for your overall health, but not showering properly after your workout can be a dealbreaker for healthy skin. Dr. Yadav recommends showering with a benzoyl peroxide wash after a sweaty workout, but a plain cold shower to wash off sweat and bacteria before opening pores with steam is the best way to go.
It might be the most important meal of the day, but your breakfast choices may be sabotaging your skin. The dermatological community has mixed views on diet and its effect on acne, but Dr. Gene Rubinstein, M.D., F.A.A.D., at Simi Valley Hospital in California, links foods to breakouts and oil production. Diets that are full of sugar, bread, cereal, pasta, and potatoes have been linked to acne and rosacea. Try to replace those staple items with whole wheat bread and pasta, brown rice, and sweet potatoes instead. Even the sugars in fruit can cause a flare, so he encourages teen patients to moderate their fruit juice intake.
Milk is another culprit that has been named a "problem child" for skin. Milk products may increase the oil production that leads to acne, and because most milk in the United States comes from pregnant cows, there are pregnancy hormones that can trigger hormonal acne.
Dr. Rubinstein recommends his adult patients cut down on caffeine, hot and spicy foods, and chocolate. And citrus fruits can react with sunlight to cause skin problems, so using a sunscreen that contains zinc or titanium dioxide can help.
Dr. Francis named alcohol as a culprit people don’t often think about, but it’s a very common cause. That hungover feeling you get in the morning is often due to dehydration and toxins trying to leave your body. It results in your skin looking like you feel.
That dehydration effect dries out the skin, and the toxins in alcohol speed up the aging process. A fizzy cocktail may seem like a well-deserved treat at the end of a long week, but soft drinks and alcohol are a losing combination, since soft drinks rob the skin of vital nutrients. A dull, aged complexion is the price to pay for too many Jack and Cokes, Francis said.
Steroids and supplements are culprits for massive facial breakouts, but they can also be a culprit for "bacne" which is difficult to treat without cessation of the steroids or supplements, according to board certified dermatologist Robin Evans.
But other medications like anti-seizure meds, psychiatric meds, and meds to treat tuberculosis can cause acne as well. Oral contraceptives are a fairly common culprit, especially those high in progesterone, like Depo-Provera, and the Mirena IUD. You should never stop taking medication without first talking to your doctor. But if acne becomes a problem, don’t hesitate to ask about your options.
A rash around the mouth can be a form of acne called "perioral dermatitis," and the culprit is disguised as an oral healthcare hero. Fluoride-based products, like toothpaste, can actually cause the irritation. So talk to your dermatologist about other oral care options if you notice an outbreak, Evans said.
Keeping acne at bay
Acne can be problematic and unsightly, but it’s often just a reflection of what’s really going on inside your body. Maintaining a healthy diet, and a clean and low-stress lifestyle, can all go a long way in preventing breakouts and improving your overall health.