Updated: Sep 27, 2019
Following on from our last post, the acne formation chain is a series of domino like events. When one domino topples it creates a cascade of events which can lead to acne. Just over 81% of acne is genetic at source but even for those who don't have a genetic disposition, certain lifestyles & the environment can also trigger flare ups. And for those that do have a genetic domino - not keeping an eye of this 19% can create a 'perfect storm' for an acne flare up.
The diet & lifestyle environment domino can be thought of as a combination everything going on inside you (diet, stress & monthly hormone fluctuations) and everything going on around you (the climate, sun, heat & humidity, pollution and what we put on our skin).
The link between diet & acne is often argued, but science does agree that what we eat affects our hormones (ask any diabetic) & certain foods are more likely to result in an imbalance in the hormones related to acne.
Without turning this post into an epic saga not everyone is affected the same amount by the same foods (that's those genetics again) e.g. for some sugar is a key culprit to acne (it spikes insulin which in turn spikes the hormones & hormone like factors related to sebum production) while for others there's little or no link. One persons hormone levels may be perfectly in check (their acne being caused by another domino) and by dramatically changing a diet in a hope to change their skin may actually throw their hormones out of whack actually making their acne worse. This is why 'acne diets' work for some but not all and why for some cutting out on some foods or changing to a restricted diet can make acne worse and not better.
A solution is to keep a diet diary which can help identify food triggers and help manage that 'diet domino'. A diary also helps identify false-positives e.g. the donut you ate Friday lunchtime may not be responsible for Saturdays flare up, it might be a monthly fluctuation of your hormones, simply that a pimple takes 7 to 10 days to form or one of the many other dominoes that can trigger the acne formation chain.
There are numerous studies demonstrating stress positively correlates with acne severity. Stress releases a number of hormones, chief among them the stress hormone cortisol. Studies have shown that stress can increase our cortisol hormone 2 to 5 times. Cortisol in turn affects the release of other hormones more directly related to acne.
Its a two pronged attack, not only does cortisol cause a hormone storm it also triggers and inflames the sebaceous glands. Over go the dominoes and the result, breakouts.
Its a non brainier that managing our stress levels can help prevent acne flare ups but obviously we can't all just stop engaging in stressful situations. The key is to plan in time to de-stress and do whatever relaxes you - whether its walks, runs, meditation, mindfulness, yoga, soundbaths or even just plain old cleaning the most important thing is to plan it and stick to it. You are your biggest priority.
No time? Even just taking time to breath can reduce cortisol. A clinical study of 50 people found cortisol levels were significantly lower in subjects who practiced slow breathing over a 4 week period. So effective was this study that similar studies since have used cortisol levels as markers to test the efficacy of practices like mindfulness.
The Climate & pollution
Its not just what is going on inside us that can cause the acne chain to cascade. Heat and humidity can cause acne flare ups by the body simply producing more sebum.
A study of 452 patients with acne found that acne severity increased in summer (80.62% of patents reported increases in aggravation) due increased temperature, marked humidity and sweating. (BTW its a myth that heat 'opens pores'. Pores don't have any mechanism to open or close - they're just little tunnels in our skin.)
An increasing number of studies indicate a link between skin problems and exposure to airborne pollutants - the mechanism for this is (unsurprisingly) complex but in short its believed air pollutants change the chemical nature of sebum when the two meet, creating an inflammatory response in our skin which can result in acne.
What we put on our skin
Perhaps one of the most widely accepted but misreported causes of acne comes from what we use on our skin.
The internet is awash with comedogenic tables of almost every ingredient a formulating chemist might use with a handy rating (typically 0 to 5) of how bad these are for acne.
This scale is both simple, easy to understand and almost always wrong. The comedogenicity of an ingredient in a compound (such as a moisturiser) is not solely dependant on that ingredient, but on the other ingredients its with and how much of that ingredient is there. The comedogenic scale was originally developed by applying 100% concentrations of ingredients to ultrasensitive rabbit ears. Unless you have rabbit ears its unlikely you'll obtain the same results. Unfortunately the comedogenic myth isn't solely the result of armchair skin experts dispensing advice its also endemic in the marketing of many cosmetic companies (everything can be comedogenic under the right conditions and there is no comedogenic free cream for everyone).
"But hang on!" I hear you say "coconut oil breaks me out". Quite right. The ingredients of topical products can result in our pores getting clogged by altering the chemical composition of sebum, increasing skin shredding or by simply blocking our pores directly due to their viscosity. They also can damage the fragile skin barrier (an 'acid mantle' layer of lipids (fats) which protect our skin from bacteria, pollutants and prevent water loss) if they are formulated badly (for example are at a different acidity level to the acid mantle).
Studies have shown people who are prone to acne typically have a weakened skin barrier (those genetics again) and the application of product which further weakens it can result in an inflammation response and an acne breakout. Likewise, even if a person is not genetically likely to have acne - if they continuously damage the skin barrier with their skin care routine the skin will eventually sensitise and have an inflammatory response.