Chapter 4
Living with Acne

People with acne face a number of challenges that affect their daily lives. Acne care involves taking careful steps to improve, rather than worsen, acne symptoms as well as avoiding activities that can harm the skin. At the same time, people with acne must deal with emotional issues that acne can cause. Meeting these challenges helps people with acne lead happy lives.

Practicing Good Health Habits

One important thing people with acne must do in order to reduce their acne symptoms and lead happier lives is to practice good health habits. Although this is an important step for everyone to take, it is especially important for people with acne. For people with acne, practicing good health habits can keep bacteria from spreading, increase circulation and oxygen to the skin, help balance hormone levels, and reduce inflammation and infection.

Keeping the Skin Clean

Perhaps the most important good health habit that people with acne can practice is keeping their skin clean. Having clean skin keeps bacteria from spreading, reduces excess oil, and helps the skin shed dead cells. For acne patients this involves maintaining a delicate balance between cleansing the skin without irritating acne lesions, drying the skin, or spreading bacteria. This is accomplished through a carefully prescribed regimen that begins with gently washing the face no more than two to three times a day.

Although many people think that frequently scrubbing acne-infected areas stops acne outbreaks, this is not true. In fact, washing too often or using ordinary soaps can make the skin dry and sore, which worsens acne symptoms. Instead, acne patients use mild facial cleansers, which are specially formulated not to irritate the skin. Ordinary soaps, on the other hand, contain harsh ingredients that can irritate inflamed acne lesions and dry out the skin. If the skin becomes too dry, the sebum glands overcompensate by producing even more oil, which exacerbates acne outbreaks.

Not only do acne patients use gentle soaps, they also use disposable washing pads or their fingers rather than a washcloth or loofah to cleanse acne-prone areas. The reason for this is that when a washcloth or loofah is used more than one time, it can trap and spread bacteria. In addition, washcloths and loofahs made from scratchy fabrics can irritate acne lesions and worsen inflammation. For the same reasons, acne patients use a fresh, clean, soft towel to gently pat, rather than rub, their skin dry once they are finished cleansing. Then, once acne patients have cleaned and dried their face, they can apply topical treatment. An acne patient recalls:

When I first started breaking out, I scrubbed my face all the time with the same washcloth that hung in my bathroom for weeks, and the same soap that I scrubbed my hands with after I worked on my truck. Then I rubbed my face dry with the same towel I used on my hands. The only thing all that cleaning did was turn my blackheads into pusy red zits. Once the dermatologist straightened me out, I stopped using all that stuff, and my skin started to improve right away.⁴³

Showers and Shampoo

People with acne must maintain the same delicate balance when they shower and shampoo their hair as they do in cleansing their faces. As with facial cleansers, acne patients use a specially formulated, gentle body cleanser when they shower, such as Dove or Oil of Olay body wash. This helps protect sensitive acne-prone areas of the body like the chest, back, and shoulders from being irritated.

Moreover, since many people with acne have oily hair, in order to keep oil from the hair from being transferred onto the forehead, neck, and back, where it can clog the pores and worsen acne outbreaks, people with acne must shampoo their hair every day. In addition, they must take special care to rinse their hair thoroughly. Otherwise, residue from shampoos or conditioners can clog the pores on a person's back and forehead. A young woman with acne explains how she solves this problem: "I have figured out how to keep my back and chest clear of zits: when you're in the shower, wash these areas with a gentle soap after you have rinsed the conditioner out of your hair. I know this can be a problem especially for girls with long hair; the conditioner goes down your back and leaves this nice zit-causing film that water doesn't wash off."⁴⁴

Drinking Plenty of Water

In addition to using water to keep their skin clean, people with acne are advised to drink at least half their body weight in ounces of water each day. This means a one-hundred-pound individual should drink fifty ounces, or about seven glasses, of water a day.

Water carries waste material out of the body. This includes harmful chemicals, fats, and excess hormones. Without adequate water, the kidneys cannot produce enough urine to flush out wastes. Therefore, impurities that cannot be eliminated through urination are eliminated through the skin. This can cause toxins to build up in the pores, worsening acne outbreaks. In addition, without adequate water the liver, whose job it is to clear excess hormones out of the body, cannot function properly. As a result, excess hormones remain inside the body, where they stimulate the production of sebum and worsen acne. According to author and skin care expert Jennifer Thoden:

Water… is quite possibly the single most important contributor to healing and preventing acne flare-ups.… If not enough water is consumed, toxins can build up causing breakouts. Water flushes these toxins out.… By drinking at least 8 glasses of water a day, you are flushing out the toxins that would normally escape through the pores of your skin… thus preventing acne breakouts.⁴⁵

Getting Adequate Sleep

Another good health habit that is especially important for people with acne is getting adequate sleep. Sleep strengthens the body by allowing the body to rest, which in turn strengthens the immune system's ability to fight off acne-causing bacteria. It also helps regulate hormone production. A 1999 study at the University of Chicago Medical Center showed that cortisol production increases when people do not get adequate sleep. Since excess cortisol leads to increased sebum production, getting plenty of sleep keeps cortisol levels low and thus helps control acne.

In addition, a 2003 study conducted by the Endocrine Society in Chevy Chase, Maryland, found that a loss of just two hours of sleep per week increases the body's production of inflammation-causing chemicals by 60 percent. The result is a worsening of inflammatory acne. A former acne patient describes how lack of sleep affected his skin: "When I pulled an all-nighter my face erupted like a volcano; and not with little blackheads either, but with big red welts. As a teenager with acne I needed to get at least eight hours of sleep a night."⁴⁶

While getting adequate sleep is important, acne outbreaks can be exacerbated if the bedding on which acne patients sleep is not changed often. When people sleep, oil, bacteria, and dead skin cells rub off their skin and accumulate on their bedding. The bedding absorbs these items, which then find their way back onto the skin, clogging the pores and causing new acne outbreaks. Therefore, it is important that people with acne change their sheets and pillowcases often. An acne patients explains: "I have found that changing my bedding, especially my pillowcase, every few days has helped my skin stay clear."⁴⁷

Exercise

Exercise is another good health habit that helps improve acne symptoms. Besides being good for a person's overall health, exercise causes the body to release endorphins, natural chemicals that give exercisers a feeling of well-being. This reduces stress and stress-induced acne outbreaks. For these reasons, it is important that people with acne get plenty of exercise.

As beneficial as exercise is, people with acne must take special care after they exercise to remove excess perspiration from their skin in order to prevent acne outbreaks. The reason for this is that perspiration can trap bacteria on the skin. If it is not washed off, the bacteria will eventually get trapped in hair follicles and aggravate acne symptoms. Tight-fitting athletic clothing can trap perspiration and rub and chafe the skin, which irritates and inflames acne lesions. Such garments as sweatbands, bicycle shorts, chin guards, and shoulder pads, to name a few, can exacerbate acne symptoms. Therefore, people with acne must take special care when they wear these types of garments and shower immediately after exercising to remove perspiration from their bodies.

Eating a Healthy Diet

Another good health habit that many people with acne practice is eating a healthy diet. Good nutrition helps the body to work properly. This is important in maintaining healthy skin. Eating a balanced diet high in vitamins, minerals, and fiber helps support the immune system and the body's ability to fight infection, including the bacteria that causes acne. Fiber found in fruits, vegetables, and cereal, in particular, helps the digestive system effectively eliminate waste. This keeps the body from eliminating waste through the skin, which can clog hair follicles.

Although specific foods have not been proven to cause acne, many scientists believe that certain foods may worsen acne symptoms. For instance, eating a diet high in linoleic acid, a fatty acid found in many fast foods and processed foods such as potato chips and donuts, may trigger the production of chemicals in the body that worsen inflammation. For this reason, people with acne are urged to limit their consumption of foods high in linoleic acid.

In addition, scientists have also linked foods high in iodine with increased acne outbreaks. For reasons that are yet unknown, the body cannot use excess iodine for energy. Nor can iodine be broken down effectively by the liver. Instead, it is excreted through the pores, where it can block hair follicles and cause irritation, inflammation, and worsening of acne symptoms.

Foods high in iodine include iodized salt, shellfish, and milk. In fact, a liter of milk contains anywhere from 450 to 1,000 micrograms of iodine, which gets into the milk through milking equipment and medication given to cows. According to Dr. James Fulton, the head of the Acne Research Institute in Newport Beach, California, "In some who are acne-prone, I'd say 1,000 micrograms or 1 milligram of iodine a day could be a problem."⁴⁸ Therefore, in order to reduce acne outbreaks, many people with acne avoid foods rich in iodine.

Avoiding Activities That Worsen Acne

Even when acne patients carefully practice good health habits, certain activities can worsen acne symptoms and should therefore be avoided. One such activity is squeezing acne lesions. Because acne lesions are filled with oil or pus, many acne patients think that they can reduce the size of a lesion and clear their skin by squeezing the oil and pus out of the lesion. However, this is not the case.

When acne lesions are squeezed, some oil and pus can be squeezed out. But at the same time, squeezing an acne lesion puts pressure on both the surface of the skin and the underlying layers. This pressure forces oil and bacteria deeper into the skin, leading to the formation of painful cysts. Moreover, squeezing the skin causes the skin to swell. Swelling puts pressure on the upper part of the hair follicles, which leads to the follicle becoming inflamed and the formation of new acne lesions.

Worse still, squeezing acne lesions damages skin tissue, and in the case of cysts, causes them to break and bleed. The result is a scar that forms where the skin tissue was damaged or the cyst was broken. Los Angeles skin care expert Arcona Devan warns her clients: "Don't pick at your skin. It's one of the worst things you can do. Squeezing blemishes injures your skin and can create scars."⁴⁹

Keeping the Hands off the Face

Even when individuals with acne refrain from squeezing acne lesions, unless they are careful to keep their hands off their faces, acne symptoms can worsen. Unwashed hands hold bacteria that can easily spread from the hands to the face. Even clean hands can spread bacteria when they touch bacteria-infected acne lesions. The bacteria is transferred onto the hands and then onto the face or body. Because many people habitually rest their chins on their hands, people with acne must make a conscious effort to avoid doing this. A young man explains: "When the dermatologist told me to keep my hands off my face, I had to work at it. I was surprised how often I touched my face. It's not something you think about until the doctor tells you to. It's not easy to stop either. But I don't want new zits all over my face, so I really watch myself."⁵⁰

Avoiding Oil-Based Cosmetics

Just as touching the face can worsen acne symptoms, so can using makeup that contains oil. Lanolin, petroleum jelly, and other oils in oil-based makeup can clog the pores, causing acne outbreaks. Even lipsticks with moisturizers and hair products such as gel and mousse can clog the pores along the lip line and forehead, respectively. Since many people with acne use cosmetics to conceal acne lesions, the oil in these products can be a problem. Therefore, in an effort to hide acne blemishes without worsening their acne, many acne patients use specially labeled, water-based, noncomedogenic makeup. Unlike oil-based makeup, such makeup does not clog the pores. And, in order to keep from spreading oil and bacteria, acne patients should wash their makeup brushes and sponges often.

Unfortunately, even noncomedogenic products sometimes contain a small amount of oil that makes the product easier to apply. This can aggravate acne outbreaks in some patients. In order to test how much oil is in a product, many acne patients place a dab of makeup on a piece of white paper and wait to see if an oil ring forms. The larger the oil ring, the more oil in the product. Many acne patients report being surprised by the size of the oil ring that many popular cosmetics form. But by doing the test, acne patients learn which products they should avoid.

When patients switch from oil-based cosmetics to water-based products, they are usually quite happy with the results. They report water-based cosmetics work well at concealing their complexion flaws and cause fewer acne outbreaks. Beauty and skin care expert Bobbi Brown agrees. "Don't even think of wearing anything except an oil-free [makeup] formula,"⁵¹ she advises her clients with acne.

Taking Special Care When Shaving

Shaving can also worsen acne. Razors can cut acne lesions, causing pustules and cysts to rupture. If the cutting edge of the razor is not clean, it can spread bacteria and oil. If it is not sharp, it can irritate the skin and cause a razor burn, which makes the skin appear redder than usual.

In particular, shaving with a dry razor causes problems. Washing the face before shaving softens the skin and beard. Conversely, when the face is dry, the shaver's skin and beard are tough. Therefore, the shaver must apply more pressure to the razor in order to remove facial hair. This irritates the skin and leads to razor burn. Consequently, most men with acne use a wet razor or an electric razor, which requires even less pressure than a wet razor and is thus gentler on the skin.

Shaving lotions can also cause problems. Lotions that are not noncomedogenic can clog pores just as cosmetics can, and after-shave lotions that contain alcohol can dry out the skin and cause an increase in sebum production. In fact, because shaving and shaving products present so many problems for men with acne, many male acne patients try to avoid shaving whenever they can. A former acne patient explains: "I've had some bad experiences shaving, like burning my face and turning it bright red, and slicing open my pimples. Some of the scars I have are from pimples I destroyed shaving. Even now, I try not to shave every day. I still get little pimples, and shaving is hard on my skin. When I do shave, I use an electric razor, and I don't press hard."⁵²

Avoiding Unhealthy Environments

Just as people with acne avoid shaving with a dry razor, they also often avoid certain environments that can worsen acne symptoms. Oil in the air in the kitchen of a fast-food restaurant or in a gas station, for example, can settle on the skin of acne patients and clog hair follicles, causing acne outbreaks. For this reason, many people with acne avoid working where they come in contact with oil in the air.

Hot, humid environments, which cause people to perspire excessively, also exacerbate acne symptoms by causing perspiration that traps bacteria on the skin. Indeed, many acne patients report increased acne outbreaks when they travel to hot, humid places on vacation. Consequently, they often choose to vacation in cooler, drier environments. Many people with acne who live in hot, humid environments try to stay indoors in an air-conditioned environment as much as possible. When they do go outdoors, they take special care to remove excess perspiration from their skin as quickly as possible.

Sunlight can also cause problems for people with acne. Although sunlight helps dry out oily skin, for patients who are using Accutane, antibiotics, or retinoids, exposure to sunlight can be dangerous. Many acne medicines cause photosensitivity, which makes the skin burn easily when it is exposed to sunlight. Therefore, many people with acne avoid exposure to sunlight.

Coping with Emotional Issues

While people with acne should avoid certain activities and environments and practice good health habits to improve the physical symptoms of acne, they also must deal with the emotional issues caused by acne in order to lead happier lives. One such issue is low self-esteem. Talking with a counselor or a psychologist helps acne patients recognize why they suffer from low self-esteem and investigate ways to change or avoid these feelings. An acne patient describes how talking to a counselor helped her. "Before I started seeing him [the counselor], I hated the person I saw in the mirror. He helped me realize that there is more to me than my appearance. I'm smart and funny. I realize the person in the mirror isn't all I am. Because of what I learned in counseling, I'm a happier person, and I feel better about myself."⁵³

Staying Active

Another way acne patients deal with emotional issues is by staying active. Getting involved in activities that are fun and that focus on others helps people with acne to forget about their appearance while raising their self-esteem. Supporting a cause, joining a club or church group, or doing volunteer work are a few of the ways people with acne stay active and raise their self-esteem in the process. A former acne patient explains:

Being a teenager with pimples, that was bad. I knew I wasn't popular. I knew I wasn't attractive to girls. There was a lot of anger and humiliation. I wanted to avoid social activities and stay home and hide. But I went out anyway. I had to get over myself. I had to put myself out there, pimples and all. One of the things I did was volunteer at the animal shelter. The animals didn't care how I looked. They licked my face, welts and all. After a while I didn't care either. I was doing something that made me feel good inside. That made me look better outside.⁵⁴

It is clear that people with acne face many challenges. But by dealing with emotional issues and carefully protecting and caring for their skin, they can meet these challenges and live happy, productive lives.