Having had skin disease for most of my teenage and adult life, it is hard not to take it personally when I hear acne sufferers being criticized – oh it’s down to a bad diet, or laziness, being unhealthy or somehow slovenly or worse, that it’s catching!
These common myths are always variations on a theme and couldn’t be further from the truth. Nevertheless, they are all too familiar to me and anyone who has cystic acne, those deep, red painful bumps underneath the skin that can take weeks to heal and can leave pitted scars. Cystic acne should not define who a person is. Spots or no spots, we are all human beings, with feelings and emotions.
There’s still a great deal of misconception, stigma and misinformation about the causes of and treatments for cystic acne. It makes me only want to work harder to break down the myths that surround what is a medical skin condition.
Through my work as a dermatologist, it's alarming to see the amount of unsolicited advice being offered. I have no doubt that some of it comes from a good place with people genuinely thinking they're helping, but I can tell you now that celery juice, probiotics or major food restriction is not going to be the solution for most acne sufferers.
Here are 5 myths I’d like to bust now
Myth 1: Acne means you’re unhealthy
People think that having acne-prone skin a marker of internal health. There is a misconception that people are dirty with poor personal hygiene or have a diet filled with fatty foods and these lifestyle choices are being expressed outwardly in the skin.
Acne affects more than 80 per cent of the population at some point in our lives. People who escape unscathed are incredibly fortunate. It is a medical condition that occurs due to the complex interaction of genetics, hormones, bacteria, oil production, and sticky skin cells. People who are acne-prone have sticky skin cells which can block pores; the medical description for this is follicular hyperkeratinisation.
About 20 per cent of those who suffer from spots will go on to develop scarring. Acne doesn’t happen because you’re unhealthy, but it can impact your mental health. Having acne has been linked to mental health issues including low self-esteem, poor body image, social isolation, depression, and even suicide.
Yes certain lifestyle factors - dietary choices, stress, sleep, pollution, alcohol, makeup and skincare have a role to play in potentially triggering acne, they are seldom the single causative factor. Hormones and our genetics have a much more significant role to play in the maintenance of skin health.
We need to stop equating beauty with clear skin or seeing skin as an outward marker for health.
Myth 2: You have acne because your diet is bad or you're eating dairy
The link between diet and acne is weak. For a small group, reducing sugar or dairy may be of benefit but this is unlikely to help everyone. Food restriction to try to control acne can potentially lead to disordered eating patterns.
For the record, eating ‘healthily’ or following a vegan or gluten-free diet does not protect against acne development.
So what's the truth? There is potential emerging evidence that foods with a high glycemic index (GI) may be one of the multiple factors which may trigger or worsen acne. Foods with a high GI index cause a spike in blood sugar levels which in turn lead to a spike in insulin and insulin-like growth factor-1 (IGF-1). IGF-1 is suggested to have downstream effects which lead to an increase in androgen hormones which can drive acne. The association (and remember correlation does not necessarily equal causation) between high GI foods and acne is stronger than the link between acne and dairy in clinical studies we have to date.
I see many patients who decide to go ‘dairy-free’ for their skin. Many people switch to oat milk, however, oat milk is a high GI index food (69) that raises blood sugar levels rapidly, especially when compared to dairy (39) or almond milk (25). Many people are therefore cutting out dairy for their skin but potentially replacing it with something more problematic from a GI point of view. Now, if you do wish to have a dairy alternative, opting for non-sweetened soya milk or almond milk may be a better alternative than oat milk. Finally, food is never good or bad; oat milk is neither good or bad. It is about looking at whole dietary patterns over a sustained period of time. A splash of oat milk in your coffee if you are acne-prone is probably fine - acne is multifactorial and is rarely caused by diet alone. However, if you are consuming larger quantities eg in smoothies, you may want to think about an alternative.
Myth 3: You have spots because you're not washing properly
Acne is not due to poor hygiene or not washing your face properly. People with acne usually have oily or congested skin therefore they tend to over wash or over-exfoliate.
It is best to use a gentle, foaming cleanser with useful active ingredients such as salicylic acid or benzoyl peroxide if you are acne-prone. What about washing your pillowcases? There is no good quality data to suggest that this significantly reduces acne burden, but from a personal hygiene point of view, changing bedding once a week is sensible.
Myth 4: You’re infectious when you have acne
Acne is not due to infection. It’s not catching. People who are acne-prone have specific strains of a bacteria known as C.acnes which live on the skin. In the right circumstances (e.g. oily skin, blocked pores, hormonal drive) this is able to drive inflammation leading to spots.
Acne itself is not infectious and if you have spots you can’t pass them on to anyone else. However, if you pick spots, you damage the skin barrier which means that other microbes that live on the skin or in the environment can create a localized infection.
Myth 5: You’re just not using the right skincare
There is a common misconception that optimising your skincare routine can lead to both short and long-term clearance of cystic acne. For many of us who suffer with our skin, we hold onto the hope that using the right products for our skin in combination with eating healthily and drinking plenty of water will help sort out spots or acne. Sometimes that hope persists for weeks or months or even several years before help is sought in the right place.
Unfortunately, delaying the right treatment can lead to unnecessary skin scarring as well as a prolonged negative effect on our mental well-being. After six months of trying to stay on top of my own intermittent and largely pre-menstrual acne with skincare and chemical peels, a recent bout of spots has left me with some new, indented scarring. I accepted that I needed medication again and skincare was no longer going to cut it. The skincare industry can often lead you to believe that deep, cystic acne can be cleared with skincare and products.
One of the things that always makes me angry on social media is the sharing of poor-quality skin information. It has the ability to create hurt, shame and embarrassment for the sufferer of skin disease. It wastes a large amount of money and resources as people spend their hard-earned finances on treatments that inevitably won’t work. It drives worry and anxiety around food. It creates a culture of self-blame, self-loathing as well as other negative mental health impacts.
This is my why. This is why I do what I do. I was that person buying into any advice for sorting out my skin - over washing, food restricting, and all the while feeling “ugly” and “disgusting”. Ultimately it was medical attention that sorted out my skin. If I can even change one person’s mind about myths around acne then that’s a victory. We can all do our bit and the next time you hear someone offering ill-informed advice, then challenge them - nicely of course!
These common myths remain pervasive and need tackling. The next time you hear someone make an ill-judged or poorly informed statement about acne, please try to educate them so we can put an end to silly ideas.
Find Dr Anjali Mahto at her clinic, 55 Harley Street, London and dranjalimahto.co.uk