Okay, honesty time: Everyone, at one time or another, has had a freak out over a pimple. You’re going about your day, minding your own business, when suddenly you look in the mirror and see a large, protruding welt that has formed on your face. Usually, it’s in a place that is so prominent you can’t ignore it; the tip of the nose, between the eyes or right on the chin. And oftentimes, it’s not just red and inflamed, but has a nice, big white head on it too. Fantastic.

As an esthetician, acne and breakouts are a large part of our practice. Some people are rushing to fix a stress breakout before a big event, while others are trying to find solutions to a chronic condition. It’s a condition that haunts teens to adults, men and women, and all different types of ethnicity, and anyone who has suffered with acne can tell you that it can damage your self-esteem so very quickly. As an educator, I’ve seen many future estheticians come to school because they had acne and working with an esthetician is finally what cleared their skin up, even after years of dermatologist visits and prescriptions and lots of Cetaphil.

There is SO much information about acne that I couldn’t put it all in one post without writing a novel, but I wanted to start with how acne is formed and the causes of acne.

So first, the science lesson.

First, I want to address the fact that YOUR SKIN NEEDS OILS. Your skin protects itself from the muck and gunk in the air, water loss, aging and environmental inflammation by producing sebum, or oil.  Your skin cells are held together by this oily soup, and you can think of it as the mortar in between bricks. Too much oil will obviously cause breakouts, but if you strip your skin of oils, you will have problems, such as sensitivity, cell damage and premature aging. But I’ll get into that more later.

Acne is caused by blockages in the follicles on your skin. Anytime a follicle is clogged or blocked, bacteria can grow because there is no oxygen getting down into the follicle anymore. The oil gland is still productive and dead skin cells are still accumulating in the follicle, increasing the debris and bacteria continues to form. When this happens, you’ll start to see the beginning of inflammation. Pretty soon, the walls of the follicle will burst, bacteria will spread under the skin, and you’ll see marked inflammation and the chance of scarring increases. So now that we have an understanding of how acne is formed, we have to look at what the many and varied causes of acne are.

Stress

We’ve all experienced the stress breakout. It usually happens right before an important event that you’ve been slaving over for weeks to get all the details perfectly in place, or after an extremely taxing week at work. We already know that stress does nasty things to our bodies, like increase your risk for heart disease, obesity, and cause or worsen anxiety and depression, but it also wreaks havoc on your skin. As your stress level rises, your adrenal glands start to go into overdrive, spiking your androgen hormones, which raises the level of testosterone in your body. An increase in testosterone will stimulate your oil glands, leading to an increase in acne.

Hormones

This one is one that most of us are already aware of, especially if you went through teenage acne. Puberty=Hormones=Acne. But adults suffer from hormonal acne and breakouts all the time. Not only do women suffer from hormonal breakouts once a month when Mother Nature comes to visit, but any kind of hormonal inbalance can have chronic skin symptoms.

Hormonal acne is due to a spike in androgen. If you are female, your worst skin days are usually days 21-26 of a 28 day cycle. Day 22 is typically the worst. Your clearest skin days are days 15-20, right before you start to PMS and crave insane amounts of chocolate.

Teen acne is also hormonal, but affects the skin differently than hormonal adult acne. Teen acne is still fueled by androgens and testosterone, and starts on the nose and travels up to the forehead, to the cheeks, and lastly to the chin. 85% of teens will be affected by acne, and boys experience it more severely than girls because their testosterone is surging, while a girls is leveling out and her estrogen and progesterone are increasing.

Adults experiencing hormonal acne do not see it in the same places as teens do. Hormonal acne in adults is usually regulated to the lower jaw, chin and neck, and is fueled by estrogen and progesterone. Because it is caused by those hormones, it is more commonly seen in women. Unfortunately, if someone is experiencing hormonal acne, they will need to get their hormones regulated first before they will see marked, lasting improvement in their skin. Birth control can help, but it’s not a fail-safe method and some people see their skin worsen.

Smoking

We’re told time and time again how bad smoking is for our insides, but it also affects our skin too. Not only does smoking asphyxiate the skin, giving it a yellow, sallow look, it weakens capillary walls and damages blood vessels which can be seen one the skin around the cheeks and nose. Smokers are 4 times more likely to experience cysts and whiteheads, because nicotine increases testosterone and stimulates oil glands. (P.S. if you haven’t started a drinking game by taking a shot every time I mention “testosterone”, you may want to. It will make your day a lot more enjoyable.) Smokers have a higher response to insulin in their blood, which leads to free radical damage through glycation (I’ll talk about glycation and aging another time). Nicotine can stay in the body for up to 8 years, so it’s best to never start if you can help it, since the effects can be especially long term and damaging.

Tanning

Ugh, the myth that tanning helps acne is one that just won’t die. It astounds me that dermatologists actually recommend tanning to clients, simply based on the fact that tanning beds are so bad for your health. They have the same carcinogen rating as cigarettes, for crying out loud. And while you may see an initial improvement in acne from tanning because it is temporarily drying out your oil glands, it isn’t a long term solution because it actually slows down the cell turnover rate in your skin, causing increased cell buildup in the follicles.

Improper Home Care

Using the wrong skincare products will not necessarily cause acne, but it can worsen it. Remember earlier when I mentioned that the skin needs oil? If you are overdrying your skin, your skin will find a way to produce more oil to protect itself, and it isn’t going to be healthy oils either. Acne products are notoriously drying, so make sure you are using a great hydrator and a broad-spectrum SPF every day! Exfoliation is a must for acne client’s but be careful what you are using. Abrasive scrubs that use nuts as their mechanical exfoliants are not good for the skin, because they can not be ground down to smooth beads. The harsh, jagged edges then create microscopic tears in the skin, which will spread the acne bacteria to uninfected parts of the skin, thus creating more acne. Stick with a chemical based exfoliator with AHA’s and BHA’s. Salicylic acid is an acne client’s best friend.

Cosmetics are a big factor in acne. Make sure the products that you are using are using noncomedogenic (known to not cause acne). Oil-free doesn’t mean oil free, it only means that it’s not using mineral or petroleum-based oils. Know the lingo when purchasing, because there are so many cheat words out there to mislead consumers. My favorite makeup is made with skincare in mind, as are many other mineral makeups. Jane Iredale and Glo Minerals are two really great skincare makeup brands. And make sure you are cleaning your makeup brushes! Bacteria thrives on dirty brushes, so make sure you are being sanitary.

Other Causes

Frangrance and dyes are another big factor in acne, especially in body acne. Detergents, fabric softeners, shampoos and conditioners are all huge causes for body acne. I had to switch my shampoo and conditioner 3 times before I finally found something that wouldn’t break my back out, and this was after I cut 10 inches off my hair to try to rid myself of the problem. Avoid liquid fabric softener and scented detergents. Tide is a no-go. Try to use white sheets, towels and pillowcases if possible to avoid irritation from colorants, and tie your hair back when you sleep. Wash your hats and ball caps often. As I said above, sanitation is a huge thing, so keep anything that is touching your face clean.

Phew! There’s a lot of information for you, and hopefully some of it will be helpful. On the next post, I’ll delve into the ways to treat acne, so that you can understand how to make lifestyle changes on the inside and on the outside that will clear your skin.