Acne vulgaris: a disease of Western civilization (2002)

https://www.ncbi.nlm.nih.gov/m/pubmed/12472346/

by wallace_f • 8 years ago

69 58 8 years ago

ncbi.nlm.nih.gov

Tycho• 8 years ago

I used to get bad acne as a teenager. I remember thinking it was some kind of cruel joke that I’d look in the mirror on Sunday night and see a fresh spot emerging, just as the others had cleared up, just as the school week was about to begin. Looking back, I think I understand what was happening. On Fridays I’d always eat a lot of sweets. They were banned in the household except for Fridays, and so we’d gorge on confectionary and fizzy drinks. Then, like clockwork, I’d break out in spots a couple of days later. So the culprit would seem to be refined sugar or some other common ingredient, taken in high concentration.

I can’t believe I didn’t figure it out at the time.

jacobush• 8 years ago

Don't beat yourself up over it. There's a lot of shit going on at that age to correlate, even with a level head, which you are not generally possessing at that period of life.

AtticHacker• 8 years ago

It's interesting since I read a lot that food consumption doesn't affect acne. I used to have relatively bad acne as a teenager as well, but I don't think I consumed a lot of sugars.

As a grown up I grew out of it, but for some strange reason it came back (age 26-27) and I couldn't get rid of it for a year. I ate healthy foods, used face scrub every day, also did weight lifting exercises, but none of those things seemed to help. However at one point I picked up jumping rope, which I did almost daily for 20-30 minutes. After that I stopped having acne. I assume sweating is the core reason that cured (or I should say, prevent) my acne as an adult. Funnily enough I stopped jumping rope for a week or two and I already see some pimples coming back, guess I'm not allowed to stop anymore!

audunw• 8 years ago

Sugar and dairy products may be one of the problems. Lack of exercise could be one as well. There's some research on this, although some reviews seems to indicate that the evidence isn't 100% clear.

I think the other piece of puzzle, where there's a dire need of research, is on the microbiome of the skin. Having a healthy culture of good bacteria on your skin may be important. That's why washing with soap can cause as much damage as it helps -- if you overdo it, you don't just kill the bad bacterias, you kill the good ones too.

I've experimented a bit with Mother Dirt.. I can't say it's a cure for anything, but it does seem to help.

https://europepmc.org/abstract/med/29601613 https://europepmc.org/abstract/med/21916275 https://academic.oup.com/fampra/article/22/1/62/440463

wallace_f3• 8 years ago

That's a really interesting idea. Come to think of it, I've spent a lot of time on extended camping and hiking trips and cant come up with a memory or picture when my skin wasn't at its best then.

Also: that microbiome could be include yeasts, which also naturally live on the skin.

lustysocietyorg2• 8 years ago

What do you mean by "Mother Dirt" ?

lustysocietyorg2• 8 years ago

Eating sugar increases the sugar level in your body for some time.

Sugar is also food for bacteria and that leads to pus and inflammation and caries (the sugar in the saliva is converted to acid by bacteria).

There are also other bio-chemically active substances like certain fats and oils. Notably oils containing much Omega-6 acids (inflammation) like in sunflower seeds or sunflower oil.

Chocolate is bad not only because of the sugar.

juskrey• 8 years ago

Going paleo did a trick for me. Looking back, a was eating such amounts of shitty food, that I am very fortunate to end up being pretty healthy at all

EZ-E• 8 years ago

I read lots of research papers about acne and I tried many things including diets, removing dairy, removing sweets, changing pillow sheet daily, many kinds of anti acne treatments.

The only thing that worked was roaccutane. After the treatment it slowly comes back so I beat it permanently with low-dosing (a 10 or 20mg pill every now and then)

I realize there must be a reason deep down that caused it. Typically dermatologists first try to give a cleansing treatment with some kind of scrub cream (will solve it if hygiene was the issue). Then they try anti biotics (if bacteria is the issue) then finally use the nuclear option with roaccutane which works with practically every one (but relapse can happen)

raverbashing• 8 years ago

It's not permanent but once you are over with it the age of acne has "gone through" (though yeah some pop up eventually)

GolDDranks• 8 years ago

How long it takes? I'm 30 now and I would have breakouts if I didn't apply benzoyl peroxide twice a day.

InGodsName• 8 years ago

I am way above age of acne. I still get acne every now and often.

I am vegetarian, no sugar. I worked out 3 times a week

I consume dairy in form of curd and cheese. I am lactose tolerant.

Consuming balanced diet and deficient in nothing, according to the latest report but i still get acne.

I've good face cleansing routine involving walnut scrub, alovera gel.

masklinn2• 8 years ago

For most westerners, acne is a stage of puberty, but for a minority (1% of males, 5% of females) it's a part of their life well into their 40s. Persistence is more likely for people who "dodge" teenage acne but develop it in their early 20s.

speedracr• 8 years ago

+1 for Roaccutane/ Isotretinoin - worked really well for me with a one-time 3-month treatment and I wish I had tried it earlier.

hguhghuff• 8 years ago

Can you say more about your story please.

s9w5• 8 years ago

As long as it's only the face, BPO works, although tedious. For other body regions it becomes impractical. Isotretinoine is the big gun then - it works perfect, but has serious implications for the dopamine system. That is the huge problem.

Keto-ish diet works very often with the same effectiveness, but is also very hard to pull off.

barrow-rider• 8 years ago

I'll echo this. Keto did wonders for my skin.

But it's a hard diet to maintain, both in terms of managing cravings and consumption, and also because we put carbs (corn syrup, et al) into bloody everything. I found cheese/yougart, ketchup, and salad dressings to be the worst offenders.

mtgx• 8 years ago

What's your HbA1C level?

https://www.hindustantimes.com/columns/that-acne-could-be-a-...

https://jamanetwork.com/journals/jamadermatology/fullarticle...

https://www.ncbi.nlm.nih.gov/pubmed/26373866

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565837/

I would suggest you try a low-carb (and zero sugar) diet combined with a Zinc supplement, and even a 5,000 IU Vitamin D3 with 100 mcg Vitamin K2 (MK-7) and 200-400mg of Magnesium glycinate daily (high D3 depletes Magnesium) for six months.

It would help if you took a blood test to find out your HbA1C, blood glucose, and 25-OHD levels, just to know where you're at before you start that. Then retake the blood test.

If I'm right with my assumption, your problems are a lot worse than just getting acne, so you will solve a lot of other issues you may already have or are about to have if you follow those recommendations.

s9w5• 8 years ago

Some people here really seems to not like (and flag) anything related to diet. That's unfortunate. I did not know the linked studies!

nvarsj• 8 years ago

I've been on accutane 3 times in my life.

My family has a history of severe nodular acne. My grandfather, mother, and my siblings all suffered from it.

My brother had it the worst, but I still had it quite bad. I have facial scars from it.

It can be quite traumatic, psychologically. My parents and doctor were reluctant to offer me accutane - so I spent a couple years really suffering, trying all kinds of treatment that had little effect (I believe it was benzyl peroxide -> antibiotics -> some other stuff). I turned into a social recluse, I hated looking at myself in the mirror.

Accutane was the only thing that worked. It was truly a miracle drug for me. I ended up doing two courses as a teenager which knocked it into remission, through my university years.

It came back in my mid 20s moderately, so I tried the benzyl peroxide (the acne.org regimen). But it was a pain to apply regularly, costly, and it stained all my clothes. I could only wear white shirts. After a year of that, I went and did another treatment of accutane and it knocked it out.

I still suffer from mild acne to this day - in my late 30s. I keep it under control with salicylic acid pads, so it's very manageable. I also avoid touching my face/neck, which seems to exacerbate it.

Accutane can have a few reported permanent side effects. One is IBS. I was diagnosed w/ IBS after taking my last course of accutane. It's hard to know if it is the cause or not (my mother also suffers from IBS, so it may be genetic). It sucks, but the acne was far worse and I'll never regret taking accutane. The IBS is relatively mild - only gets bad when I'm stressed.

Treatment used to be much more draconian. In the 40s-70s, doctors would x-ray your face to eliminate severe acne. My high school physics teacher had this done, and unfortunately passed away in his early 50s due to throat cancer (having never smoked in his life).

s9w5• 8 years ago

Damn I had such a similar story.. antibiotics, BPO, Isotretinoin. I've taken Iso for 24 months total with 100-120mg per day. I'm still afraid of IBS-like problems from that, but so far so good.

random_kris• 8 years ago

roaccutane was the only thing that helped me aswell... but I think roaccutane had quite a negative effect on my mental state

beerlord• 8 years ago

Try some of the following:

Cold showers

Washing sheets in hot water every 5 days

Using a mattesss protector

Washing pillows and quilt every few months

Shaving with a disposable razor used once (bic hybrid)

Washing face with sensitive men’s face wash and washcloth washed after one use

Nidrozal anti fungal shampoo applied to face

Flossing nightly

Washing face with water and a washcloth before bed or waking up (depending on when you shower)

Eliminating sugar from diet and basic weights excerise (dumbbells)

lupinglade• 8 years ago

Shave with Philips one blade. It is the least irritating shave, helps a lot.

agurk• 8 years ago

Whilst living in hotels a few years back, I experimented with the provided moisturiser as aftershave. I soon noticed that rubbing any excess on my face reduced the number of spots I had, and now I apply it daily and get no spots.

Not applying it for a single day has a >50% chance of having spots appear. My hypothesis is it adds a mechanical barrier to my pores. The paper suggests various environmental factors might be behind it, so reduced exposure to anything airborne could be related.

Using moisturiser daily is certainly something that would have shocked my (more closed-minded) younger self - not being something that 'real men' would do.

rekshaw2• 8 years ago

Completely agree. The only post-shower routine I have is to put a pea-sized amount of whatever skin lotion is available (ideally not oily, the hotel ones are usually perfect), and just apply it on my face. If I don't do it, I feel my skin stretch and get very dry.

Another thing I've been trying is after shaving, put a first layer of high quality Aloe Vera gel. Then once it starts drying out and stretch the skin (usually 60-120 seconds), then put the moisturizing lotion. Good results so far.

Why? No idea, just felt right.

yaseer• 8 years ago

I think the microbiome on the skin and face is a large factor.

Controlling it is not as straightforward as a 'quick-fix', as it literally has a life of its own.

For me, the fix was wiping my face only with cotton face-wipes and water, and avoiding soap. (To be clear, I use soap everywhere else, but just use face-wipes on my face).

I actually came across this quite accidentally whilst camping. At the time, I thought it strange that an apparent lack of skin amenities made my skin better.

My theory is that disruption to the microbiome is a large factor, caused by detergents affecting the skin, and diet affecting the gut (which we know connects to other systems and microbiomes).

rekshaw2• 8 years ago

I avoid wiping my face at all, with any products. The only thing I do is rinse it with warm water whilst in the shower and follow up with a tiny amount of whatever moisturizer is available after the shower. Used to have acne as a kid, I don't anymore.

apatters• 8 years ago

Just to add another +1 to the anecdata points here, I had pretty bad acne well into my 20s, and experimented with a variety of measures for controlling it.

The biggest win was to stop using ordinary soap to clean my face. Once I switched to just rinsing it with plain water, 70% of my acne disappeared.

Some acne persisted around my nose and "T-zone" (the upper middle part of the face). I tried using a number of facial cleansers daily in the shower on just this area, and eventually found one that was far more effective than any other -- the brand is Aveeno and it has microbeads in it (which I heard are now illegal in the US).

I'm now typically acne free, but to this day if I binge eat greasy foods for a couple days (the biggest culprit is pizza, followed by burgers), my face will start to get oily and pimples will start to form around my nose/T-zone. Also if I'm out in the heat sweating a lot, a bit of acne forms after a few days. Aside from these extreme situations I have very little acne.

This all suggests to me that the face's microbiome plays a big role--too much soap or too much sweat are both capable of interfering with it, and too much oiliness probably blocks the pores. TL;DR more limited application of a milder cleanser seemed to be the biggest win for me.

This experience led me to be judicious with soaps and other cleansers on the rest of my body as well--the stinky bits like armpits get soaped up and cleaned daily, but I pretty much just rinse the rest of my body in the shower unless I've been doing hard physical labor or something. My skin's very healthy and people say I smell good so it seems to be working.

adventured2• 8 years ago

I have a similar reaction to excessively binging on greasy (also high sugar) foods like pizza.

A solution I found that almost always prevents the greasy food acne effect, is l-lysine. I'll take ~1,000mg or so if I eg eat a bunch of pizza. No idea why it works exactly, there's speculation that it aids the skin's defense against acne. Another option that also works but is more potent, is a low dose of vitamin A, which reduces oil production for some people.

rogerwilco1• 8 years ago

I have struggled with this for all my life (m/37). I have methodically tried all medications mentioned, and although most work they are just too invasive, like the benzozyl peroxide and facial antibiotics. Four weeks ago I started trying an enzyme solution to apply to your face by a Dutch/Swiss biotech startup. I have seen an immediate decrease and wold recommend it for everybody to try: https://www.gladskin.com/en/acne

snarfy• 8 years ago

I've had acne since I was a teen. I've tried every face cream and acne soap on the market. After 30 years of acne, I've finally found something that works - adapelene gel. It's a retinoid, a type of chemical related to vitamin A. My acne is a vitamin deficiency, but no amount of supplements would have fixed it as it's genetic deficiency in my skin. Benzoyl peroxide works well on red, inflamed acne but not on deep cystic acne. It's because they have different causes.

s9w5• 8 years ago

That retinoids (Vitamin A-like) work (be it isotrotinoine or topical creams) don't have to mean that a vitamin deficiency is the cause. Vitamin A and retinoids have very specific effects on skin.

Avalaxy• 8 years ago

It's funny that literally every comment in this thread claims to have solved the problem. But every single solution is different.

adventured2• 8 years ago

There are numerous responses in common focused on diet / lifestyle and retinoids.

antocv• 8 years ago

Except the ones who didnt solve it, but have tried every option so far mentioned, and not mentioned including eastern-european village-methods of egg yolk mixed with honey and special bark from some tree, and just yawn and keep on procastrinating.

ssvss• 8 years ago

Just raw honey helped for both me and my brother, after suffering for a decade with acne, came across this thread in reddit, and it helped.

https://www.reddit.com/r/pics/comments/16t0n4/bad_acne_befor...

tdsamardzhiev• 8 years ago

Avoiding stress and sugar was what solved the issue for me.

dade_2• 8 years ago

I think more effort is needed to understand the relationship with skin conditions and the families of bacteria, fungi, etc on our skin. Antifungal drugs, such as Ketoconazole are known to cause acne in some people. I suspect it isn't causing cysts, but that killing off fungus, makes for a huge opportunity for bacteria. For some reason certain fungi cause the skin to grow faster, clogging pores with dead skin. Similar stories here about killing off bacteria to help with infected pores.

wallace_f3• 8 years ago

Someone else mentioned this here. Like I said there, I really think the same way. Not just for acne, but other dermatitis conditions are really not understood.

So how do you get back a good balance of healthy bacteria/fungus on your skin? Rub some dirt on your face?

dade_2• 8 years ago

Other people, preferably without skin conditions. I used the traditional approach. It's anecdotal, but I've noticed a correlation over the years.

crehn• 8 years ago

Had persistent mild acne for a long time. Had chemical peels, used antibiotics, BP, SA, removed dairy, didn't touch my face, fasted, used cleanser and oil-free moisturizer, etc. Kinda helped, but not really.

So I stopped using all products. Only water. Face got better over the next few weeks. I also stopped caring too much. About anything in life. Long story short, it was a multi-year self-development process that culminated that summer, but essentially I became much more relaxed and secure with myself.

Have had clear skin ever since, and I feel great.

8bitsrule2• 8 years ago

Over time, in my case, I've seen that there's a certain threshold for eating (refined) sugar. Once I go past that, flare-ups start.

After years of trying this/that (including UV), tetracycline was the first thing that helped -a lot-. So there's an infectious component. Sebacious blockage (humidity is one factor) followed by infection seems a likely culprit.

I've also noticed something I've never seen mentiond: facial eruptions are often symmetrical on the horizontal. Maybe that's hygiene-related.

Acne sells a lot of product; maybe that's why there's been little resolution (apart from treating the symptoms instead of the cause) in decades.

s9w5• 8 years ago

antibiotics usually help - once. They also nuke a lot of things with them. And I recall a study showing they literally make you dumber - although I'm not certain on that.

I think acne has been 'solved' with isotretinoin mostly

sebastianavina• 8 years ago

Antibiotics make you dumber?

I think I need a source for that.

8bitsrule2• 8 years ago

Not once, but an improvement lasting years after years of trying every cure in the book.

I shared some some etiological observations, not suggesting any 'solutions'. And no, son, it hasn't been 'solved', nor has cupidity (or lameness). Treating symptoms is not a 'solution' but it is quite profitable.

bjourne• 8 years ago

This study by Loren Cordain, the antropoligist founder of the paleo-diet, is flawed in several ways. Isolated tribes lead completely different lives from Westernerns. They also often share very little genetic material with us. E.g two neighbouring African tribes can be genetically more separated than all white people in the whole world.

Regarding acne and diet, here are two quotes from two meta studies:

"We did not realize how daunting it would be to write an article dedicated to making sense of the relationship of acne to foods. It turns out that there are no meta-analyses, randomized controlled clinical studies, or well-designed scientific trials that follow evidence-based guidelines for providing solid proof in dealing with this issue." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/

"Despite the inundation of epidemiologic studies, mostly of unsatisfactory quality, and the abundance of beliefs and perceptions among acne patients about the role of diet in the pathogenesis of acne, there is a paucity of reliable information. In the few studies that have been undertaken, no specific foods (including fatty foods and chocolate) have been identified as causative factors. Yet, the question of whether common perceptions and beliefs prove to be fact or misconception is more than an academic issue. It is of importance due to the practical implications of these beliefs for acne management.

Alas, after reviewing the relevant published data, we can conclude that insufficient serious effort has been invested in investigating these questions, which are prevalent and consistent across different cultures. At present, we are bereft of reliable answers based on scientific evidence. We hope that the day when we will be able to knowledgeably advise our acne patients on the role of nutrition in relation to acne etiology is not too far away." http://centrespringmd.com/wp-content/uploads/2013/05/The-Rol...

Both mention Cordain's study and explains why it is no good. If you believe diet is causing acne, you might as well believe in homeopathy and healing too. All the anecdata in the world cannot change that.

If you think X (eating "bad" food) causes Y (acne), then observing (not X)and(not Y) doesn't prove anything because there is no PREDICTION involved. However, there is an obvious way to try and test the causality; DO X and observe Y. Eat as much pizza and chocolate and drink as much milk and soda you want. If you after t days have a face full of acne then CONGRATULATIONS! You have done something thousands of dermatologists have been unable to - namely demonstrated a causative link between diet and acne. It would truly be a huge breakthrough and you would have revolutionized the science of dermatology.

I find it very odd that, despite all the anecdotes, not a single person has conducted any such experiment.

geden• 8 years ago

I had moderate / server acne in my late teens (25 years ago now)

Benzyl Peroxide - no effect apart from making skin on face very dry

Daily Erythromycin (oral antibiotic) for months and months - no effect. (I dread to think what havoc that pointlessly wreaked on my microbiome at the time)

Roaccutane - complete cure within weeks HOWEVER in hindsight this coincided with an unusual period of depression, so was quite alarmed to see the reports of suicide risk more recently. That was not mentioned when prescribed, probably before there was evidence.

One thing that's guaranteed to make me a bit spotty, even in my mid forties is a sugar/chocolate binge, so for me the finger definitely points at sugar.

dingaling• 8 years ago

Similarly in my mid-40s any substantial amount of 'milk' or white chocolate, or cocoa-based drinks and cakes, will retrigger.

Proper dark chocolate is fine, though possibly because it is eaten in smaller quantities.

camelNotation• 8 years ago

I had severe acne for many years. I tried a lot of different things, but I discovered that I had a personal trigger - if I ate a lot of carbs and fats together combined with irregularity of my bowel movements, I would break out. So I basically cut out sugar and took steps to make myself as regular as possible. Acne completely disappeared. I didn't really lose weight (I was never fat) and I didn't really get too much healthier since I still eat a lot of "non-sugary" junk food.

But even now, around the holidays when there is lots of candy and unhealthy food, if I eat too much sugar and don't have regular bowel movements, the acne comes back like it was never gone. It's crazy, but I'm approaching middle age and this is still a thing.

And this isn't something that applies to other acne sufferers I've met, either. This is my trigger, they have theirs.

t0mbstone• 8 years ago

I had chronic acne for the entirety of my teen years and even into my 20's. I tried all sorts of things. Benzoyl Peroxide, Salicylic Acid, various mail-order subscription kits (you know the ones). Nothing worked.

I ended up getting rid of it after I went to a dermatologist that recommended I wash my face daily with Cetaphil face wash (available at just about any grocery or drug store). I also completely stopped using any and all hair products.

No hair gel. No hair spray. Nothing. Just washed my hair every morning with Head and Shoulders shampoo and rinsed, lathered up the cetaphil and applied all over my face. Let it sit for half a minute or so, then rinse. Blow dry and water for styling.

Acne solved.

Since then, I have shared this technique with a number of other people, and they were all able to solve their acne issues the same way.

I still get the occasional flare up every once in a blue moon, and I've noticed a direct correlation to whenever I eat a lot of ice cream or drink milk (even though I have been tested and don't have milk allergies). I'm not sure how it's possible, but if I drink a glass of whole milk, I can reliably count on getting at least 3 zits in the next week, after months of absolutely zero skin problems. So there is definitely something going on there.

yboris2• 8 years ago

Milk and acne have a relationship: https://nutritionfacts.org/video/the-acne-promoting-effects-...

yboris2• 8 years ago

My understanding is that acne is correlated with milk consumption - after all, milk is meant to grow a calf at an inhuman rate (quickly doubling its mass).

Relevant video: https://nutritionfacts.org/video/the-acne-promoting-effects-...

Acne vulgaris: a disease of Western civilization (2002)

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