
Acne vulgaris: a disease of Western civilization (2002) - wallace_f
https://www.ncbi.nlm.nih.gov/m/pubmed/12472346/
======
EZ-E
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)

~~~
raverbashing
It's not permanent but once you are over with it the age of acne has "gone
through" (though yeah some pop up eventually)

~~~
GolDDranks
How long it takes? I'm 30 now and I would have breakouts if I didn't apply
benzoyl peroxide twice a day.

~~~
cylinder
That stuff is the devil. Thought I had oily skin. I didn't. It was a reaction
to benzoyl. Switched to Cetaphil which I add pure tea tree oil to.

------
Tycho
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.

~~~
audunw
Sugar and dairy products may be one of the problems. Lack of exercise could be
one as well. There's some research on this, although some reviews seems to
indicate that the evidence isn't 100% clear.

I think the other piece of puzzle, where there's a dire need of research, is
on the microbiome of the skin. Having a healthy culture of good bacteria on
your skin may be important. That's why washing with soap can cause as much
damage as it helps -- if you overdo it, you don't just kill the bad bacterias,
you kill the good ones too.

I've experimented a bit with Mother Dirt.. I can't say it's a cure for
anything, but it does seem to help.

[https://europepmc.org/abstract/med/29601613](https://europepmc.org/abstract/med/29601613)
[https://europepmc.org/abstract/med/21916275](https://europepmc.org/abstract/med/21916275)
[https://academic.oup.com/fampra/article/22/1/62/440463](https://academic.oup.com/fampra/article/22/1/62/440463)

~~~
wallace_f
That's a really interesting idea. Come to think of it, I've spent a lot of
time on extended camping and hiking trips and cant come up with a memory or
picture when my skin wasn't at its best then.

Also: that microbiome could be include yeasts, which also naturally live on
the skin.

------
dade_
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.

~~~
wallace_f
Someone else mentioned this here. Like I said there, I really think the same
way. Not just for acne, but other dermatitis conditions are really not
understood.

So how do you get back a good balance of healthy bacteria/fungus on your skin?
Rub some dirt on your face?

~~~
dade_
Other people, preferably without skin conditions. I used the traditional
approach. It's anecdotal, but I've noticed a correlation over the years.

~~~
wallace_f
You know what's interesting, and perhaps a cruel fate, is that teenagers, and
maybe even children, with worse skin likely get less skin-to-skin contact with
other teenagers, family, etc., and perhaps further inhibiting their healthy
biome/immune system later in life in a phenomenon that is not dissimilar to
how Amish children's increased exposure to bacteria positively develops their
immune systems. Someone should publish research on this.

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

~~~
antocv
Except the ones who didnt solve it, but have tried every option so far
mentioned, and not mentioned including eastern-european village-methods of egg
yolk mixed with honey and special bark from some tree, and just yawn and keep
on procastrinating.

~~~
ssvss
Just raw honey helped for both me and my brother, after suffering for a decade
with acne, came across this thread in reddit, and it helped.

[https://www.reddit.com/r/pics/comments/16t0n4/bad_acne_befor...](https://www.reddit.com/r/pics/comments/16t0n4/bad_acne_before_and_after_i_put_raw_honey_on_my/)

~~~
AstralStorm
Specifically propolis, which is pretty good for feeding specific kinds of skin
bacteria.

------
crehn
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.

------
t0mbstone
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.

~~~
yboris
Milk and acne have a relationship: [https://nutritionfacts.org/video/the-acne-
promoting-effects-...](https://nutritionfacts.org/video/the-acne-promoting-
effects-of-milk/)

------
juskrey
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

------
camelNotation
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.

------
apatters
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.

~~~
adventured
I have a similar reaction to excessively binging on greasy (also high sugar)
foods like pizza.

A solution I found that almost always prevents the greasy food acne effect, is
l-lysine. I'll take ~1,000mg or so if I eg eat a bunch of pizza. No idea why
it works exactly, there's speculation that it aids the skin's defense against
acne. Another option that also works but is more potent, is a low dose of
vitamin A, which reduces oil production for some people.

------
geden
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.

~~~
dingaling
Similarly in my mid-40s any substantial amount of 'milk' or white chocolate,
or cocoa-based drinks and cakes, will retrigger.

Proper dark chocolate is fine, though possibly because it is eaten in smaller
quantities.

------
8bitsrule
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.

~~~
s9w
antibiotics usually help - once. They also nuke a lot of things with them. And
I recall a study showing they literally make you dumber - although I'm not
certain on that.

I think acne has been 'solved' with isotretinoin mostly

~~~
sebastianavina
Antibiotics make you dumber?

I think I need a source for that.

------
agurk
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.

~~~
rekshaw
Completely agree. The only post-shower routine I have is to put a pea-sized
amount of _whatever_ skin lotion is available (ideally not oily, the hotel
ones are usually perfect), and just apply it on my face. If I don't do it, I
feel my skin stretch and get very dry.

Another thing I've been trying is after shaving, put a first layer of high
quality Aloe Vera gel. Then once it starts drying out and stretch the skin
(usually 60-120 seconds), then put the moisturizing lotion. Good results so
far.

Why? No idea, just felt right.

------
yaseer
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).

~~~
rekshaw
I avoid wiping my face at all, with any products. The only thing I do is rinse
it with warm water whilst in the shower and follow up with a tiny amount of
whatever moisturizer is available after the shower. Used to have acne as a
kid, I don't anymore.

------
snarfy
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.

~~~
s9w
That retinoids (Vitamin A-like) work (be it isotrotinoine or topical creams)
don't have to mean that a vitamin deficiency is the cause. Vitamin A and
retinoids have very specific effects on skin.

------
yboris
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-...](https://nutritionfacts.org/video/the-acne-promoting-effects-of-
milk/)

------
rogerwilco1
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](https://www.gladskin.com/en/acne)

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

------
bjourne
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/](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...](http://centrespringmd.com/wp-content/uploads/2013/05/The-Role-of-Diet-
in-Acne.pdf)

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.

