I’ve had a rash (collective noun for a group of dermatologically-challenged individuals) of female patients presenting in the post-Xmas period with more spots than usual. “Why, why, why?” they ask me. What’s changed? Why has their previously tamed complexion suddenly decided to misbehave and throw its toys out of the pram?
There’s no single explanation for this that fits all. But the reality is that anyone can breakout; even the most genetically blessed will get the odd acneic blip if they throw the right (wrong?) elements into the mix.
So here’s a list of practices which might influence the status quo; and when combined in a genetically-susceptible individual may just shift the balance towards Breakout City.
1) Changing contraceptive pill. Alas, they are not all equal, when it comes to the skin. Whilst the general trend with most combined pills (ones that contain an oestrogen and progestagen ) will be to reduce acne, certain ones have more complexion-clearing progestagens than others. Those which are most skin-friendly are: Yasmin, Cerazette, Femidene and Cilest. Avoid progestagen-only contraceptive methods (including the Mirena coil) like the plague.
2) Other medications can also push you towards your breakout threshold. Commonly prescribed agents like SSRIs, anticonvulsants and even certain supplements (like Vitamin B6 and B12) may promote acne in some, through poorly-understood mechanisms.
That’s not to say you should ever stop treatment without exploring the pros and cons or indeed alternatives with your prescribing physician. But it’s worth keeping in mind.
3) Stress. Research and my personal experience tells me that a fast-paced life undoubtedly contributes to higher levels of acne. Stress hormones behave like androgens, which increase sebaceous gland misbehavour. Ask any student approaching exam period – in fact one study from Stanford University did just that and guess what? Breakouts were more common and more severe in students during exam term.
4) Beauty experimentation. Certain trends do not favour the acne-prone. When a new patient comes to see me, I ask them to list what they’re currently using. And that list often encompasses a chaotic collection of more than a dozen products.
Elaborate cleansing rituals are a common culprit; facial oils, double cleansing, muslin cloths, over-used cleansing brushes….. all can be detrimental, aggravating acne by irritating the skin. Long-wear foundations can also be hazardous, as these can be extremely difficult to remove and are rarely non-comedogenic.
The bottom-line is acne is a fluctuant condition with good days and bad. Correct treatment and good beauty practices can minimize these ups and downs, but every so often the balance is disturbed; this shouldn’t cause despair. Stepping up treatment and banishing any provocateurs in order to regain control for a defined period of time usually re-establishes stability ….and pulls you back from the brink of your breakout threshold.