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Avoiding Exacerbators of Acne

Much of the tendency to get acne is genetic, but the way that you interact with the world around you can influence the severity of acne’s breakouts.
One of the most common causes of acne flare-ups that I see in my clinic is stress from final exams. Usually, the acne won’t clear up until a few weeks after finals. Finding good stress relief outlets, such as exercise or yoga, can help.
Lack of Sleep
If you can’t get any sleep, or if you work the night shift or irregular shift hours, your body will be stressed. Often, this worsens breakouts.
Shampoo and conditioner
Haircare products were not meant to be skin care products. For patients with acne on the forehead or the temples, I recommend to carefully avoid applying haircare products including shampoo, conditioner, and hair gels to the skin of the face; they should be constrained to the hair-bearing scalp.
Acne can be worsened by sunscreens, not because of the active ingredients in the sunscreens, but because of the oils and other chemicals that are needed to dissolve and emulsify the active ingredients. Even sunscreens which are labeled as non-comedogenic can cause problems in acne-prone individuals. Comedogenicity testing is done using back skin of healthy volunteers, which not very sensitive. By using one of the Acneologist’s recommended sunscreens, you can minimize your risk of sunscreen worsening your acne.
Hats, visors, and baseball caps rubbing on forehead skin can certainly trigger acne. Construction workers wearing hard hats, motorcyclists or bicyclists wearing helmets, and sport enthusiasts wearing helmets or facemasks are affected as well. Patients with back acne may report worsening around the belt line. Young men and women with facial acne who prop themselves up in bed while reading by placing one hand on the chin or cheek often experience a flareup in just that location.
Acne can flare up if there is moisture or sweat trapped in contact with the skin by clothing, for example, after working out. Additionally, back acne can be triggered by sitting in a sweaty shirt with your back against a chair, for example, if you were taking a long car ride in a hot car without air conditioning.
Picking pimples
The quickest way to get your acne to worsen is to pick the pimples. A much healthier alternative would be to apply at bedtime the Acneologist’s recommended pimple spot treatment.
Diet and acne are two words which paired together yield controversy. From my experience, five main items can worsen acne:

1) milk, with skim milk being worse than whole milk
Almond milk is a good alternative.

2) peanuts and peanut butter
Almond butter or other nut butters are good alternatives.

3) whey protein, found in protein supplements and nutrition snack bars
Other proteins such as egg protein, hemp protein, and pea protein are good alternatives.

4) iodide, particularly iodized salt and seaweed
Sea salt is a good alternative.

5) sweets, such as candy, cookies, cakes, etc.
Things sweetened with Stevia instead of sugar are a good alternative.
Most companies selling facial makeup have little or no incentive to ensure their products don’t break out people’s faces. When makeup causes acne, it usually takes 6 to 8 weeks before the breakouts are seen. Thus, the average consumer will simply apply more makeup to cover up the breakouts. This in turn causes more acne, and a feedback loop has been created.

Like mentioned above in the sunscreen section, even when a product is labeled as non-comedogenic, it doesn’t mean that it has been tested on facial skin. Nevertheless, there are extremely few makeup products which are labeled as non-comedogenic. Even the words “oil free” don’t mean much, because it really depends on how one defines “oil.”

Foundation and blush are the two most common offending products. Loose powder foundations are the safest of the bunch, and blush without artificial red dyes is a must.
Hormonal contraception
It’s very frustrating when birth control ends up causing or exacerbating hormonal acne. There are many options for hormonal contraception, including birth control pills, the patch, implantable rods, a hormone-releasing intrauterine device (IUD), a delayed release hormone shot, and a hormone-releasing intravaginal ring. Of all these, only certain types of birth control pills are acne friendly. So for patients with acne, consider switching to one of these acne friendly birth control pills.
Bodybuilding drugs
Drugs such as testosterone, human growth hormone, and insulin like growth factor one (IGF-1) increase the output of the oil glands, inevitably leading to clogged pores and acne. Even when testosterone is taken in small doses for conditions such as lowered libido, acne typically will result. In these cases, the only solution is either discontinuation of the offending drug, or ongoing treatment with isotretinoin.
Drugs for other medical conditions
There is a very long list of drugs for medical conditions, some of which are serious, which may cause acne. Fortunately, in many cases, there are alternatives which do not.

1) prednisone – this drug is used for many conditions to reduce inflammation in the body. For short-term usage, such as one to two weeks, it can actually clear up acne, but when used for the long term, it will definitely lead to breakouts typically on the trunk and possibly on the face as well. Other types of corticosteroids such as dexamethasone and prednisolone cause the same exact problem as prednisone.

2) topical cortisone – there are many topical creams and ointments used to treat eczema, psoriasis, or other inflammatory skin disorders which are derivatives of hydrocortisone. When used for a long duration, these will undoubtedly trigger acne in sensitive individuals.

3) lithium – this drug is useful for the treatment of bipolar disorder. If a patient develops acne while taking this drug, their psychiatrist might choose to switch to different medications for the treatment of bipolar disorder.

4) phenytoin (Dilantin) – for the treatment of seizures, this drug is commonly used. Fortunately, there are many alternatives on the market today that do not cause acne. If you are taking this drug and acne is bothering you, be sure to discuss it with your neurologist.

5) testosterone – whether taken for bodybuilding for use in a gel form as a medical treatment for low testosterone levels that occur with aging, this drug is the king of all stimulators of the oil glands.

6) potassium iodide – a liquid medication called supersaturated solution of potassium iodide was once more commonly used as a drug, but now it is rarely used.

7) certain chemotherapy drugs can cause acne, but that is not a reason to change the chemotherapy. In these cases, we simply treat the acne.

There are others, but these are the most common.
Whether taken for recreational or therapeutic purposes, marijuana often causes acne flareups. The acne may respond to standard therapy, but discontinuation of marijuana use speeds up the clearing of the skin.