14. Should You Break Up With Your Makeup?

Doctor Jacob here, and today's episode is entitled "Should you break up with your makeup?" The answer is it depends on what makeup you're using. Many cosmetics and makeups are designed without a thought about whether or not they clog pores or worsen acne, and the reason is that it's not quite direct. You can't pinpoint it on "Oh my gosh, six weeks ago I started this brand new makeup. Aha, that's why I'm breaking out!" There are so many things that can happen in the time between when you start using a makeup product and when you start a breakout flare, because it's not immediate. It's not quite "Oh my gosh, today I ate at the restaurant and then tonight I have a stomach ache. That's why I have a stomach ache, I know it."

Acne caused by cosmetic products has a special name, it's called acne cosmetica. It's estimated that about 30-40% of women, who are the main consumers of cosmetic products, eventually develop acne cosmetica. How does this happen? Well, obviously the pores are susceptible to whatever goes down them, causing inflammation within the pores. If that causes a greater degree of sludging up of the pores, which leads to clogging of the pores and inflammation, then acne results. There are ingredients which are called comedogenic ingredients or pore-clogging ingredients forming comedones, which are the blackheads or whiteheads of acne, and there are lists of ingredients that you can refer to (I'll put one on my website).

We can see what ingredients are comedogenic, meaning in a solution of just one ingredient, if we test only one ingredient - will it clog up the pores? And we can tell whether or not an ingredient is comedogenic, but it's hard to look at a full list of ingredients and figure out exactly whether or not that final product, that final makeup is comedogenic just by looking at the list; it really needs to be tested. Not all companies publish the ingredient lists, and some of them publish it but they're listed alphabetically, so we don't know how much of what ingredient is in the makeup, or the relative abundance of the ingredients in the makeup. So it's difficult to predict the comedogenicity of a makeup or a cosmetic product given the ingredient list, but you can sometimes get a good guess. For example, if one of the main ingredients is highly comedogenic - we can look it up on a table of comedogenic ingredients - then we can conclude that it's more than likely to be a comedogenic makeup, meaning a makeup that clogs the pores and causes acne.

Unfortunately many of the patients with acne have a sort of blind spot to their makeup. They like their makeup, they use it conceal their blemishes, they've spent a lot of money on their makeup and they don't want to think that there's any way in which their makeup could be causing their acne. So I encourage all patients who have acne who also wear makeup, to keep an open mind in thinking about "Could my makeup be causing or contributing to worsening my acne?"

Often times acne cosmetica doesn't manifest with the big, deep zits, but rather smaller whiteheads which are about one or two millimeters, located over the cheeks and chin, and maybe the forehead as well. It's rare for this type of acne to cause scarring, but it can take up to four months before the patient develops acne once they start using the offending cosmetic ingredient. So that's why it's really hard for patients to connect it, but it's really a true thing. So if you go to the website, you'll find a list of comedogenic ingredients, and you can take that with you - you should take that with you - when you go shopping for makeup.

One special category of persons so to speak, who often encounters acne cosmetica is people who need to wear makeup for being on the job, usually it's behind the camera. So people who are news reporters, or people who go on stage acting plays, that kind of thing, who are always on camera or in the spotlight, generally they tend to be taught or instructed to wear heavier and thicker makeup, and a lot of times these types of makeups do clog up the pores and result in acne.

One more final word, we'll talk more about oiliness and comedogenicity in the next episode, but just because something is oily doesn't necessarily make something comedogenic, meaning acne-causing. There are certain types of oils which bacteria can act upon and degrade in the pores and really cause inflammatory byproducts to be released, whereas other items, for example straight petroleum, although it's extremely oily, it cannot be broken down by the bacteria that live within the pores, and actually does not contribute to acne.

So with that we'll end for today. I'm Doctor Jacob, we'll see you next time.