“Exfoliation heals acne and eating chocolate makes spots worse”

Seeing as 80 per cent of us are affected by acne at some point during the course of our lifetimes, you’d think that some of the hogwash circulating on the topic of spots might have been rinsed down the sink alongside the Clearasil, and yet, for such a prolific and growing area of skin concern, the causes, aggravators and remedies for acne remain much misunderstood. With acne accounting for 3.5 million GP appointments in the UK every year, and 20 per cent of women experiencing late onset (adult) acne , compared to 8 per cent of men, many of us are clearly in search of answers, a fact confirmed by online beauty retailer Cult Beauty , which reports that acne accounts for 35-40 per cent of all beauty and wellbeing queries onsite. As such, we turned to the experts to address some acne enigmas, from whether your cleansing routine could be exacerbating blemishes to the current evidence on spots as a signal of underlying health problems and intolerances. BS radar at the ready.

Acne is contagious

Consultant dermatologist  Dr Anjali Mahto  is having none of this myth:

“Acne is not contagious and cannot spread from person to person. While acne bacteria has a role to play in its development, it cannot be transmitted like most bacterial infections. It is, however, not a good idea to share towels or pillows with someone else for general hygiene reasons.”

Speaking of cleanliness, of course washing your skin is vital, but don’t believe for a minute that because you’re suffering with acne that you’ve not scrubbed your skin sufficiently or the fact that your skin is ‘dirty’...

Acne is caused by poor cleansing

Dr Mahto debunks the dirt delusion:

“Acne isn’t linked to being “dirty”, and excessive cleansing won’t get rid of spots. The dirt myth plays a huge part in the stigma surrounding the condition and the perception of it by non-sufferers, so it’s time we stamped it out.

“Acne is a disorder of the pilosebaceous unit in skin, which is composed of a sebaceous gland (oil producing gland), hair follicle, and hair.  Acne develops due to a complex interaction between excess oil production, bacterial proliferation, and “sticky” skin cells lining the hair follicle, which leads to inflammation.”

Former acne sufferer and  Allies of Skin  founder Nicolas Travis, whose brand only tests its formulas on acnegenic skin, seconds Anjali’s sentiment that perceiving skin as dirty, and obsessively cleansing as a result, is bad news for both skin and mind:

“Whatever you do, please don’t wage war on skin. It’s easier said than done, but treating skin with love and having a gentle approach will go far. Acne is an inflammatory disease and hence, reducing inflammation is the number one way to treat it- not by stripping the skin with harsh products nor layering on multiple antibacterial products. Less is often more when it comes to acne.”

Avoid foaming cleansers and products containing high levels of alcohol and opt instead for gentle gels and natural plant oils (with a few exceptions below). From a mental health perspective, given that 62 per cent of acne sufferers aged between 10-18 years old report being bullied by friends, family members or a person they know on account of their skin according to  The British Skin Foundation , we can’t act soon enough to reverse the damaging associations often made between having acne and being ‘dirty’ or ‘disgusting’. Dr Mahto, also a former cystic acne sufferer, supports the #skinpositivity  movement on social media, which aims to shatter stereotypes and provide a supportive community for those suffering with acne and other skin conditions, while  talkhealth  provides online information and forums for acne sufferers. The charity Mind and Skin  also provides psychodermatological support to anyone with a skin condition experiencing mental health difficulties and low self-esteem.

Exfoliators can fix acne

On the subject of ‘purging’ skin, continually clearing the decks, even with beneficial bacteria beating BHAs  such as salicylic acid, isn’t the answer to calmer, more balanced skin according to Skin Owl  founder Annie Tevelin, who has a postgraduate degree in cosmetic chemistry and was also hit by “a cystic acne mega truck” at the age of 29:

“Exfoliators will not heal your acne. I always tell my acneic clients to steer clear from products with the following words in their description: brightening, resurfacing, and exfoliating. There is a misconception that by scrubbing your skin, acne will “shed” and skin will appear brighter. While occasional exfoliation (twice a week) can lead to healthy cellular renewal, effective product penetration and restored radiance, daily exfoliation trains the skin never to turn over new cells on its own. As a result, skin can become extremely sensitive, red, and dry, wherein the skin will produce sebum in excess to protect itself, often leading to more spots, oil and reactivity. Stick to gentle exfoliation once a week for best results.”

If you’re in any doubt as to how to best exfoliate, consult our  ‘dos and don’ts’ of exfoliation , and bear in mind that while weekly exfoliation can be helpful for those suffering with acne, particularly for addressing blackheads , monitoring how your skin responds and cooling off if irritation occurs is essential to keeping the skin barrier  protected and acne at bay.

“Oh well, you’re just one of those people”

This is one of Annie’s pet peeves, and given that 52 per cent of 10-18 year olds have already tried five or more treatments to try to alleviate their acne according to The British Skin Foundation, it’s understandable that a lack of hope and a dismissal of the condition would only lead to more despair. While Dr Mahto acknowledges there is a genetic link at play in the development of acne, with studies suggesting that nearly 80 per cent of acne cases can be linked to the presence of certain inherited genes, it’s high time we took the physical and mental implication of acne seriously, rather than writing it off as a teenage phase or ‘time of the month’ blip:

“Acne, for the majority of people is a treatable skin disorder, and having suffered with it myself, I really do feel that no one should just have to live with it. A good dermatologist can offer a large number of potential treatments that can be tailored to the individual. Unfortunately, the skin is such a visible organ, that it's only natural that self-esteem is so closely tied to it.

“People do underestimate acne and the impact it has on those suffering with it. It is important to seek help and advice early before scarring (be that mental or physical) develops and request referral to a dermatologist if treatments aren't working. We also need to investigate the psychological burden of this further.”

All natural plant oils are good for acne

This is almost a double bluff where acne treatment is concerned: it’s a myth that oil triggers the production of more oil, as many skin experts believe that  high quality plant oils  that have a natural affinity with the skin can help to rebalance sebum levels and reduce angry breakouts, but not every oil is conducive to clear skin, as Nicolas highlights:

“Oil is not your enemy, but not all oils are created equal. As acne is an inflammatory disease, anti-inflammatory fatty acids help to repair and restore your skin. Look out for non-comedogenic oils such as hemp seed oil, tamanu oil and rosehip oil to balance and nourish acne-prone skin.”

As for oils to avoid, Annie isn’t nuts about a certain tropical fat often marketed as an all-over skin salve:

“Using  coconut oil  to “cure” breakouts is one of the most common acne myths I’m coming across at the moment. Contrary to popular belief, coconut oil is more of a wax than an oil, much like jojoba oil. It is highly comedogenic, meaning that it completely clogs the pores. Due to the fact that it doesn’t penetrate the skin in the way that lighter plant oils can, it sits on the surface of your skin, never giving it the moisture that it needs. Despite its high level of antioxidants and fatty acids, in not being able to penetrate the pore, any benefits that these might bring go straight out of the door. I would never recommend coconut oil to anyone as a facial moisturiser or cleanser, but especially not to those suffering with either chronic acne or dryness. Be it extra virgin or fractionated coconut oil, both will clog and irritate the pore. It doesn’t matter how “pure" it is”.

Wearing makeup makes spots worse

Another acneic double edged sword, while comedogenic longwear foundation can cause serious problems for acne sufferers, as explained in no uncertain terms by dermatologist Dr Sam Bunting , that doesn’t tar all base with the same brush. Dr Mahto has some camouflage options up her sleeve:

“There is no need to avoid makeup if you have acne, but if you do wear it, opt for  oil-free foundations , light tinted moisturisers or BB creams that will provide the coverage you need.”

Dr Bunting is a big fan of these  stick foundations  for taking blemishes down a peg or two and evening out skin tone while being non-pore clogging and easy to remove at the end of the day.

Acne is an indicator of a food intolerance or underlying health issue

As if acne alone weren’t bad enough, the location of a crop of spots is believed by some to be indicative of poor health elsewhere in the body. Annie reckons that this is categorically unhelpful for cases of cystic acne, and Dr Mahto advocates taking such suggestions with a pinch of salt:

“There is little evidence to suggest that facial mapping for acne is effective. It’s often referred to as showing that someone is intolerant to gluten or has bad digestion. That said, acne in certain areas of the face may be caused by specific factors.

“Acne on the forehead can be caused by certain hair styling products such as waxes and oils, which block the pores. It can also occur if you have a fringe, as hair can rub against the forehead skin causing irritation and potentially contributing to breakouts. The same applies for regularly wearing hats, caps, and helmets.

“Cheek and jawline acne can result from phone use. Touchscreens contain large numbers of bacteria on their surface and placing your phone against your cheek creates pressure that may activate your oil-producing or sebaceous glands. This effect can be worsened by the heat generated by using your phone.

“Acne along the jawline and around the mouth, or acne affecting the lower half of the face in general, has often been linked to hormonal fluctuations, particularly in women that develop spots at a later age. These can often manifest as deep, red painful cysts under the skin rather than blackheads or whiteheads.”

If you suspect that your acne trigger could be oscillating hormones , see our five point guide to getting to the bottom of it, and never blame yourself for consistent breakouts, as Nicolas emphasises that it’s vital to bear in mind that “acne doesn’t discriminate”:

“It can happen to the best of us, even those with a meticulous ten step regimen. Late onset acne is becoming a reality for more and more of us, and while treating adult acne requires more finesse because, unlike teenagers, adults have to field collagen and elastin breakdown (alongside the legit stress of “adulting”!), tailored intervention and treating breakouts holistically is key.”

A 360º treatment plan could incorporate everything from swapping to a non-comedogenic moisturiser  to seeking out stress-relief techniques , but if you had giving up chocolate in the name of clear skin on your list, Dr Mahto hints that perhaps holding that thought wouldn’t be such a bad move…

“The role of chocolate and its effects on acne remains controversial. A recent laboratory study showed that chocolate consumption in the presence of P. acnes bacteria resulted in the increased release of chemicals that cause inflammation. However, the link remains tenuous and it may be a specific constituent in chocolate itself that may have a role to play for example cow’s milk, which is known to contain hormones and sugar. Well-designed clinical studies in the future will establish the real role of diet as a causative factor for acne but currently I recommend everything in moderation.”

Don’t cancel Easter, and definitely don’t suffer in silence.

How to cope when your skin condition is crushing your self-confidence

Follow Anna on Instagram  @annyhunter , Dr Mahto  @anjalimahto , Skin Owl  @skinowl  and Nicolas  @nicolastravis_