Acne vulgaris: a disease of Western civilization (2002)

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)

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.

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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).

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.

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-...

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

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

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.