Question. You read about a possible new acne treatment, how do you decide whether to try it or not? Maybe you are like most people and you go online to read user reviews and experiences? In this post I’ll share with you 3 reasons why you should take those reviews with a grain of salt.
This all started when a reader emailed me asking about urine therapy – he had read my About Me page where I listed it among the things I had unsuccessfully tried. I told him I think it’s useless, devoid of reality as science understands it, and that I don’t recommend anyone wasting time with it.
He then replied the following:
That’s unfortunate. I hope you don’t get upset if I ask, but were you doing it correctly? E.g., you’re supposed to use aged (about a week old) mid-stream morning urine, and you apply it after exfoliating your skin and you don’t rinse it off & leave it on overnight. Did you follow these steps? I whole heartily trust your info because you’re a skin guru and you’re intelligent, but urine therapy has gotten rave reviews that i can’t quite ignore.
Let’s take a moment to examine the underlying assumptions here. This person has read good reviews of urine therapy and takes them more or less at face value. The assumption is that because there are so many good reviews online they can’t all be wrong and therefore there must be something to urine therapy. Therefore me not getting good results with it means I didn’t do it correctly.
Note that I’m not writing this to mock the person. The assumptions he makes come naturally to humans, and I’ve been guilty of making the same countless times.
There’s no doubt that user reviews can be very helpful, but they can also be very misleading – especially if you don’t know how to read them. In this post we’ll go over 3 reasons to be skeptical of user reviews for exotic natural acne treatments.
People are often wrong
Yes, I know that’s a horribly arrogant thing to say. And I’m not pretending that I know better than the people writing the reviews.
Let me tell you a story of what happened to me a while back. I was convinced that sodium laureth sulfate (SLS) caused my scalp acne. Countless studies showed it’s a strong skin irritant – in fact, it’s used in studies to provoke skin irritation. And here I was like an idiot applying it on my scalp every day!
So I switched to a natural, SLS-free shampoo. And you know what happened? My scalp started getting better. It didn’t clear completely but I could see a definitive improvement. I even wrote a post blaming SLS.
Fast forward some time and my scalp acne came back – despite the definitive lack of SLS.
This is a good example of the confirmation bias fallacy. As humans we like to be right, and we tend to pay more attention to information that confirms what we already believe (or want to believe). We also tend to ignore and discount information that challenges our beliefs – i.e. shows we are not right.
That’s exactly what happened to me during the SLS fiasco. I was primed to believe SLS was the culprit and I saw everything through that lens.
Confirmation bias alone makes user reviews highly unreliable, and combining it with the next point makes things exponentially worse.
Reviews are just a snapshot in time
Many pro-athletes believe they will be jinxed, or cursed, if they appear on the Sports Illustrated cover. There’s even a name for this urban legend, The Sports Illustrated Cover jinx.
What really happens is that SI cover features athletes and teams who did exceptionally well, which, by definition, is an exception to their normal performance. The SI cover jinx shows a statistical phenomena known as regression to mean; plainly put things return to normal.
Acne, like most health problems, waxes and wanes over time – without any apparent reason. You can see how this could create tons of ‘false positive’ user reviews, especially when combined with the above discussed confirmation bias.
People often try new things when their acne is worse than normal. Confirmation bias ensures that improvements in acne are attributed to the new treatment – even if it’s just normal fluctuation. Seeing that the new, natural treatment is working, the person gets excited and shares the excitement with the world, i.e. a review/testimonial gets written.
I believe that this explains all those stories where a person complains that a treatment worked initially but then stopped working, they often claim that acne became resistant to it.
You can find positive reviews for anything
Keeping in mind what we have discussed so far it shouldn’t come as a surprise that you can find positive reviews for absolutely anything. Even for things that don’t do anything. Here are a few examples.
At the turn of the 20th Century American doctor Albert Adams was selling machines (called The Dynomizer). He claimed the machines diagnosed and treated almost any illness. His machines were widely used, with millions of people swearing by their effectiveness. After he died the machines were opened and found to contain random machine parts. In short, the machines did nothing and yet thousands of practitioners believed into them and used the machines to diagnose people.
And let’s not forget the radium craze in early 1900’s.
When Marie Curie discovered radium in 1898 no one was really aware of the dangers of radiation, in fact it was hailed as a miracle cure for any number of ailments from tuberculosis to sagging skin to impotence. It would only be many experiments later that the risk would become apparent. In the meanwhile, a radium craze that swept through France, America, Germany and Italy had people convinced that radium held miraculous health benefits. Just about every product, including chocolates, beauty creams and toothpaste, was made and marketed as radioactive.
Radium was added to drinking waters, one of which claimed that drinkers are guaranteed to “sparkle with energy”, while another brand claimed to be “the most radioactive water in the world!” Convinced that it’s a miracle cure, people couldn’t get enough of radium. Of course, it was later discovered that radium is extremely dangerous and countless people suffered horrific radiation poisoning. Yet, that didn’t prevent people from believing radium is the best thing ever.
For modern examples, you only need to look at acupuncture and homeopathy. Both of which have been conclusively shown to be no better than placebo, but this hasn’t prevented thousands of people swearing they are effective.
Question, how do you tell the difference between a positive review for a real treatment vs. one for an illusory treatment? You can’t, and that’s the real problem.
Now that we understand how unreliable user reviews can be, let’s look at a better way to evaluate new treatment options.
How to evaluate new acne treatment options
In medicine there’s a concept called biological plausibility. In simple terms it considers how well a treatment fits to our current understanding of how the human body works. Treatments that work through existing cellular pathways and mechanisms are considered plausible. Similarly, treatments that rely on unproven/undiscovered mechanisms (meridians, memory of water, etc.) are considered implausible.
Every effective treatment I’ve talked about on this site works through the established hormones/inflammation mechanism I talked about here. Eating less carbs and sugar works because they reduce insulin load on the body. Topical and supplemental antioxidants work because they counter oxidative stress.
Similarly, I was able to almost completely eliminate my scalp acne with supplements that balance gut bacteria and heal the gut. No study has ever shown those supplements work against acne, but knowing how they affect the gut I was able to make an educated guess they could also help my acne – and they did.
I dismissed urine therapy because of utter lack of biological plausibility. Nobody has ever shown that drinking or applying urine on your face affects the known mechanisms that lead to acne.
So when you look at the reviews for urine therapy you have to consider which is more plausible. That it works through some new and yet to be discovered pathway (highly unlikely), or that the reviews reflect known human cognitive biases (likely).
So next time you consider some new acne treatment, pay less attention to user reviews and more attention the ‘how it works’ section. Treatments that affect hormones (androgens, insulin, IGF-1), inflammation or the gut are at least plausible. Be very skeptical of treatments that supposedly work through some other way, and be especially vary of anything that claims to get rid of acne by detoxifying or purifying. Detoxification is nonsense and toxins don’t cause acne.
Conclusion
Learning from other people’s experience can be helpful but can just as well lead you astray. The human brain comes bundled with countless cognitive biases that make it difficult to assess complicated and emotionally-charged issues.
In the world of Harry Potter magic may be able to heal, but in the real world treatments must work through existing cellular mechanisms. When considering exotic and alternative treatments, pay attention to claims of how the treatment works.
Scientific research has linked hormones and inflammation to acne. Treatments that claim to affect the two are at least plausible. Be very skeptical of treatments that supposedly work through some other mechanisms.
What do you think? How do you approach new treatments you haven’t tried?
Hey seppo thanks again for that post; again i do have aquestions..
masturbation and acne.. what do you think? (https://www.herballove.com/guide/acne-caused-over-masturbation)
Greets
What do I think? *facepalm*, in a nutshell 🙂
But seriously, there’s no way to answer this question with data – there is none. My semi-educated guess is that there’s no link between sex/masturbation and acne. But without any reliable data I can’t say for sure.
The only data with regard to this I’ve seen shows that abstaining from ejaculation increases testosterone levels over time. If I recall correctly, they peak around day 7. After ejaculation (whether through masturbation or real sex) T levels drop significantly.
This kinda makes sense, as any guy knows, when the pressure builds guys become more active and aggressive.
This would suggest that masturbation prevents acne by preventing increase in T levels. But this is just speculation and without hard data I can’t say for sure.
I wouldn’t put much faith in the article you linked. They just rehash the old news of how acne is linked to male sex hormones, but haven’t actually established that masturbation would increase T levels. And elsewhere in the site they claim over masturbation reduces T and DHT levels.
haha thanks for your opinion.. 😀
and again another question.. your opinion on bone broth, drinking gelatin ..?
Sorry about the late reply. Long holiday here in Thailand.
I don’t have any good scientific data on bone broth. That said, there’s some evidence that beef gelatin could be helpful in gut issues. Apparently it lines the gut and repairs the protective lining on the gut wall. Other than that, it’s probably fairly nutritious, but whether it has any healing benefits I can’t say.
haha thanks for all the answers, i wonder how you can find the time for that to answer all the questions so dont stress! 😀
about masturbation: i found something that semen has approx.. 5mg of zinc.. could this be a reason behind people saying thay break out of it..
and also whats your opinion on eating oysters for zinc(and where do i get these? :D) and also eating liver?
And the last thing i wanted to ask is about scarring:
do you know what works best for reducing scars and reducing hyperpigmentation.. i do have a few of both and it seems that b3 does a good job at reducing hyperpigmentation.. any thoughts? 😀
thanks for the comments and as i said dont stress.. 🙂 as much as i like the site and all here i dont look it up every minute! 😉
Could ejaculation lead to zinc deficiency and that way contribute to acne? It’s not totally implausible idea.
Let’s do some math, cos math and sex always goes well together. So, scientist have taken a keen interest on the composition of human sperm. This paper reviewed studies on the subject:
https://onlinelibrary.wiley.com/doi/10.2164/jandrol.04104/abstract
From all the studies done, it seems that the average zinc concentration in human sperm is about 16mg/100mL. The average ejaculation volume is 3.4 mL. So there’s roughly 0.5 mg of zinc per ejaculation. The RDA for adult men is 11mg/day. So 1 load would burn about 5% of daily zinc needs. Not an insignificant amount. I suspect that there’s less zinc per load in repeated ejaculations.
Is that enough to cause acne? Nobody knows. There does seem to be a correlation between zinc levels in blood and acne severity. https://www.ncbi.nlm.nih.gov/pubmed/25157359
Perhaps it’s an issue for people who don’t get a lot of zinc from diet. Zinc does play a role in antioxidant pathways.
My opinion for eating oysters and liver for zinc? By all means if you enjoy them. Liver especially is very nutritious.
I have a page later on coming into the members-only area talking about various acne-related skin concerns. I’ve already written one for hyperpigmentation. From memory, vitamin C, B3 and retinol (or combination thereof) works reasonably well for hyperpigmentation. They are as effective as prescription hydroquinone. That said, expect slow going. It generally takes several months to get decent results with creams and lotions.
There’s nothing you can do to acne scars at home. As in scars that physically deform the skin.
The timing of this post couldn’t be more perfect! I recently read on another acne sight that wearing antiperspirant could possibly lead to breakouts. The theory was that antiperspirant doesn’t allow your body to sweat out toxins. I tried to research whether we actually do indeed sweat out toxins and could only find one actual study suggesting that it might be a mechanism by which we eliminate toxins. I couldn’t access the entire article, so I have no idea what toxins they were talking about. If toxins don’t cause acne then this doesn’t really make sense does it?
How are the gut healing supplements going? You mentioned that your scalp acne has been almost completely eliminated. That’s great news!
Glad to hear the post was useful. Yeah, alties have a lot of weird theories like that. I’ve come to realize that to them just about anything modern or man-made is automatically evil and unhealthy. It’s more about adhering to ideology than seeking out the truth.
Yes, my gut is doing much better! Can’t say my scalp is completely clear, but it’s 90% better than it was before. I’m even eating oatmeal and muesli in the mornings and both my gut and skin still hold up quite nicely. Really happy about that 🙂
Hi Ance Einstein, did you know the science about topical lotion probiotic? https://paleoforwomen.com/topical-probiotics-can-applying-bacteria-to-your-face-cure-your-acne/
As Stefani mentioned in her post, there’s some evidence to support topical probiotics. It’s certainly not a silly idea. I haven’t talked about them because I have no idea if applying ‘wrong’ bacteria to the skin could cause problems. I’m not sure that we know the ‘right’ strain or type of bacteria to apply to the skin. I’m hesitant to recommend these until we know more about the potential risks associated with topical probiotics. Perhaps there are none and they are completely safe. But it’s equally possible that wrong type of bacteria could cause serious skin infections.
Hello Seppo again a few questions?
https://www.ncbi.nlm.nih.gov/pubmed/20666829 what do you think of this study?
and a question regarding zinc how long do you think someone should try taking it?
The authors of that paper theorize that the bioavailability is the main factor determining how well zinc supplements work on acne. They claim that had the earlier studies used more bioavailable forms of zinc, they would have shown better results. Whether that’s true or not remains to be seen. They don’t provide any good evidence to support their theory.
It’s a moot point anyway. Most supplements contain highly bioavailable forms of zinc. So I don’t think there’s much room for improvement by trying different forms.
How long one should try zinc? At least a month, two would be better. If you haven’t seen any results in that time then it’s unlikely to work for you.
Hi seppo,you said that gut healing supplements helped your acne, is this a probiotic supplement? I have tried probiotics for like 2 weeks and broke out horribly! Im not sure if its just initial reaction but i dont want to risk it more so i stopped and my skin calmed down. At the same time, i also believe its my gut that causes my acne…im not sure though how to go about it thanks
No, I don’t take probiotics. I’ve tried several times but get constipated and break out badly soon after taking them. I suspect it’s not just initial reaction. SIBO often involves overgrowth of probiotics and in such case adding more could be detrimental.
I took herbal anti-microbials that kill bacterial in the small intestine. I’m just writing updates for the gut health chapter and will discuss there what to take in more detail. Unfortunately, I can’t say much now as I’m still in the middle of doing more research on it. Chris Kresser has more information about this on his website. I would suggest searching there to get you started.
Hi guys,
After having acne (12 years), seb derm (5 years), oily skin (don’t know since when), dry skin (occasionally) I finally cured them all 100%. How? By not doing ANYTHING. And by learning not to care. At all. Seriously. While the healing of all these did not occur overnight, one thing changed immediately – I was feeling a free happy man after I stopped giving a rat’s ass about such superficial problems; after I stopped looking myself in the mirror 5 times a day; after I started living without caring if I have a pimple if my face was peeling, if it felt oily or dry, or if it was hurting from a zyst, or however they call them big ones.
When did the healing happen? I have no idea. I just stopped paying attention to myself in the mirror so much. It went down pretty much like this – I was having a rough week in terms of everything – the result my face flamed with seb derm around my nose and all over my cheeks (I’ve never been so bad, usually it was just on the T-zone). It was itchy it was nasty – it was what AAAALLL the dermatologists called seb derm, or seborrhea (or even they don’t know what exactly it is). Anyway on top of that I had it on top of that – on my scalp too. But I managed to top even that – I had acne zysts on my chin. It was bad. The worst I’ve ever had for the last altogether 12 years. What did I do? One thing. I decided – OK. I’ve been to enough dermatologists (more than 10 during the years), I have tried enough medcs (can’t count them), I have tried enough diets (ANYTHING that was on the Internet I tried), so maybe it’s time I stopped caring? Stop stressing about these superficial problems? Hell, if I got diagnosed with something serious tomorrow, G-d forbid, what kind of man would that make me, the one who sweats over a pimple or red skin?! And I have read enough psychiatrists’ books saying it was the case with many cancer-stricken people, to say this a short while after being diagnosed – “cancer brought me back to life – I just stopped caring about meaningless stuff, and started living about the meaningful.” So that day, that awful skin and everything else day I carved it as my principle “It is key to one’s well-being to draw the line between the meaningful and the meaningless and live by it.” Is it meaningful that I pay attention to such trivial, superficial problems such as acne seb derm, oily skin?! Hell, no. So I stopped paying attention. It was tough. In the first few days my face was both itching and hurting from the seb derm and acne. But I noticed the less I care and pay attention, the less it was hurting and itching. This tendency kept on for the next days.
A week later my mother asked me – “What did you do? These creams you are using seem to really help. You have nothing.” I didn’t even know. I looked myself in the mirror – nothing. My face was clean. Literally. No acne, no seb derm. Of course I still had my small acne marks.
Now. Truth be told. Occasionally I still feel my face itch and hurt a little. (Today it’s 6 months after I stopped caring) But A) I still don’t care about it B) it’s normal – one does not heal their mind that quick after 12 years of paying too much attention to such bullshit and C) It’s just itching and hurting occasionally – when I look myself in the mirror I have nothing.
Main point – after stopped caring I started feeling great about myself.
The reason why I am writing all this is that I wish it could help somebody.
On an unrelated note a couple of months ago I got fungi on my penile head. I’ve had that a lot too over the years. Use condoms, people! Unless it’s the one you want to have kids with. This time – same drill. No doctors, no meds. I said to myself if it doesn’t heal in a week I will just put on one of the many creams I was prescribed with before. It was itchy and spreading, even more on the second day, a lot more on the third. Still I did not pay attention. On the forth – less itching. On the fifth – nothing. All clear.
I will leave my email address in case people have questions or are looking for advices for how to stop caring. Not that I am an authority in anything – I am just sharing my story here. One thing I will not do however – indulge into any arguments. I won’t. And I don’t care if you believe or not, so I will not bother with any such emails too. Here is the email – thesecretofnotcaring at gmail dot com (it’s lame, I know, but “dontcare” was taken and so were most of its derivatives. So many “non-carers”! Wohoo!)
Have a great day!
Thanks for sharing your experience ‘DontCare’. Stress is a huge factor in skin issues and if you can just let them be and not care it can certainly make you feel better and also help your skin.