Acne Types – Why Nothing Works For Your Acne

Does it feel acne treatments are like a box of chocolates? You never know whether you’ll end up happy or disappointed.

You read a gushing story of how someone got over acne with a particular treatment. As you read more, you find other people who swear by the treatment. The excitement builds up, and you rush to order it. Only to have your hopes dashed – once again – because the treatment had no effect on your acne.

What if I told you the reason the treatment didn’t work is that you were treating the wrong problem?

What do you mean, you ask, we both have acne, right?

Yes and no. Yes, you both have a skin problem called acne. No, because there are different types of acne.

After reading a well over 1000 studies and talking with acne sufferers for over five years, I’ve come to realize we don’t all suffer from ‘the same acne.’ On the surface, they look more or less the same, but the internal causes that cause acne for one person can be wildly different from the internal causes for another.

So, in a very real way, acne for one person is an entirely different problem than it is for another. And yet, both are lumped into the same ‘acne’ group and treated the same way – is it any wonder that people struggle to get clear?

Different acne types

Here are the distinct acne types I’ve identified:

  • Hormonal – linked to an imbalance between male and female sex hormones (androgens and estrogens). Androgens stimulate the skin cells to produce more oil, which leads to clogged pores, inflammation and acne. Usually aggravated by carbohydrates, dairy products and other foods that spike insulin levels. The most common acne type for adult women.
  • Inflammatory – Excessive inflammation depletes antioxidant stores and leaves the skin vulnerable to inflammatory damage from UV radiation, air pollution, and other sources. Read more about the link between inflammation and acne. The trick in inflammatory-type acne is to nail down the cause of inflammation, which can be gut problems, histamine intolerance, food allergies, etc.
  • Stress/emotional – People with emotional-type acne feel like acne has taken over their lives. They are anxious and stressed because of it and spend a lot of time and money researching and trying different things. Stress and anxiety often aggravate acne, which causes even more stress and anxiety. The priority in emotional-type acne is to stop the vicious stress-acne-stress cycle.
  • Irritant – Sometimes acne is just a skin problem, like in irritant-type acne. Physical rubbing and harsh or comedogenic chemicals can irritate the skin and cause acne.
  • Infectious – Not technically acne but frequently mistaken for it. Certain pathogens can cause skin infections that look like acne. One example is a yeast called Malassezia, which causes Malassezia folliculitis that looks very similar to acne. One characteristic of infectious-type acne is that it usually doesn’t respond to or gets worse with antibiotics used treat acne. The antibiotics kill off the skin bacteria that hold off the yeast.
  • Acneiform – An acne-like drug reaction. Potential causes include halogens (chlorine, iodine, fluoride), immune system suppressors, some chemotherapy drugs, and corticosteroids. Vitamin B12 can also trigger acneiform.

This list is not necessarily comprehensive, and you should consider it as work in progress. As scientists learn more about acne, it’s likely they will also identify other causes.

You can have more than one acne type

Real life is messy and doesn’t fall into neatly separated boxes. And so it is also with acne. Your acne can be 100% one type, but more likely it’s a mixture of two or more types. In the private Clear for Life Facebook group, many women say their acne is a combination of hormonal and inflammatory types (usually linked to gut problems).

Take this quiz to identify your acne type

So how do you know what your acne type is? By taking this quiz I created. Just answer a series of questions about areas linked to acne, and you’ll get a personalized acne type report to your email that explains your acne type(s) and what you can do get over acne.

The quiz only takes a couple of minutes.

You can take the quiz here.

How to use acne types to get clear – for good

The main benefit of knowing your acne type is that it helps you to focus on treatments that are the most likely to work for you.

Before this, you might have clicked your way to an acne forum – only to find a contradicting mix of “this worked for me” and “no, that doesn’t work” opinions.

Let’s say your acne is at least partially hormonal. We know that hormonal-type acne is linked to insulin and treatments that reduce insulin levels often also reduce acne. There’s one group of people who knows a lot about insulin – diabetics. Check diabetic forums for diet information.

Or let’s say you have inflammatory-type acne that’s linked to gut problems. Ask people with irritable bowel syndrome what to eat.

I guarantee you’ll get better answers than asking other people with acne.

Don’t do everything that’s supposed to cure acne

Many with acne get overwhelmed with the sheer number of causes and treatments for acne. Maybe they feel like they can’t keep up with everything they are supposed to do.

You don’t have to do everything just because someone said it helped their acne. Focus on the treatments that are relevant to your acne type.

Let’s say you have stress/emotional-type acne and none of the diet changes you’ve tried have helped. You don’t have to keep doing them just because they are supposed to reduce acne. For someone with stress/emotional-type, a diet shouldn’t be a priority number one. You can’t fix emotional problems with a knife and fork.

Take-away

Here are the three points you should take away from this:

  1. Use your understanding of acne types to understand the problems that cause your acne.
  2. Look for solutions to those problems – instead of acne.
  3. Tackle each problem one by one.

Do this, and you can expect your acne to go away or reduce significantly.

About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

References

46 thoughts on “Acne Types – Why Nothing Works For Your Acne”

  1. This is a wonderful summary! I especially like how you tied emotional acne to BDD – which is a pretty concerning issue in today’s time.

    One thing that I would add to the list is acne that’s not really acne. This is pretty rare, but sometimes people confuse a skin staph infection with acne. It looks almost the same, but pretty much none of the acne solutions will work. In that case, an old-fashioned visit to the doctor and antibiotics is the way to go. For anyone who’s been suffering with skin problems and nothing seems to work, it’s worth looking into.

    Same thing happens with rosacea, but many of the treatments that work for acne keep rosacea at bay too, so it’s a little easier to take care of even when improperly diagnosed.

    • Glad to hear you liked it!

      There are also some other infections that look somewhat like acne, I think I even wrote about one of them on this site. But yeah, you need to be sure that you actually have acne instead of something that just resembles it.

  2. Another good article!
    Do you think it’s possible that different triggers cause acne at different parts of the face? I have noticed that gluten makes my forehead have terrible cysts. When I don’t eat gluten, my forehead is clear but I still get hormonal acne on my cheeks and chin. But yogurt and feta cheese don’t seem to affect it. Lack of sleep and emotional pain cause me to break out on my cheeks as well but even then my forehead is clear as long as I don’t eat gluten. For some reason, lemons cause me pimples similar to the hormonal acne.
    However, after following your great advice on lifestyle changes and external care my acne is almost gone and practically unnoticeable with makeup. If I do get a pimple, I know the reason for it, I don’t panic, I don’t start hating myself. I just see it rationally as the result of my actions and take mental notes how to avoid it next time. It also helps that now the pimples are rather small and few. It’s great to feel in control and to receive compliments on your looks (shallow as it sounds). It’s also great not to worry about your skin.
    BTW, have you read ‘Feeling good’? I’m reading it now, it looks like there are many great techniques there too (it’s also cognitive behavioural therapy).

    • That’s an interesting point. At this point we have no data to support of refute that. My ‘gut reaction’ would be to say that there’s no mechanism that connects different body parts to different parts of the face. But my gut reaction has been wrong many times. At the moment the best I can say is that it sounds weird, but not totally implausible. I’m assuming you’ve noticed this several times?

      Really happy to hear that you’ve managed to get your skin under control and don’t freak out about acne anymore. That’s really the best anyone can expect.

      Nope, I haven’t read that book. Something I should add to my reading list?

      • Hey, Seppo, it’s been a while, still a good post! I would like to say again that I really, really recommend Dr David Burns’ book “Feeling good”. He builds on REBT, it’s a more detailed and developed version with a good list of many more cognitive distortions. His other book “Feeling good together” is amazing, too, not directly related to acne treatment but can really help with improving your relationships which is the key to being happy and feeling less stress. And they’re all scientific, based on years of research.

  3. Seppo,

    Another good summary considering how complex a disease acne is.

    I personally have a “thing” nowadays about the immune system. Why is it that some people may only get some whiteheads, small spots while others get raging pus filled mountain spots? Also, some people get very greasy skin but no spots. The immune system and the sensitivity of the sebaceous glands all play their part in the story. Both aspects are probably a genetic disposition leading to hyperkeratinisation etc.

    I’m still not that convinced about the stress or poor self-image being a cause of acne. Yes,I think it may aggravate it but not cause it. I definitely believe acne leads to poor self-image but not the other way round. When you get acne under control and keep it under control, I think better self-esteem will follow. It is the feeling that you know you can avoid major flare ups or at least reduce their likelihood in the future. In my opinion, trying to control your thoughts is a never ending, maybe pointless battle. Look at the cases that Oliver Sack’s has documented. Hallucinations, damage to memory and so on. I think I’m trying to say the brain is not that easy to control and many aspects of it trundle along without you even being that conscious of it.
    It may even be that people with a positive outlook on life just have lucky genes. For example I wouldn’t advocate treating manic depression with CBT. There are plenty of people out there with negative attitudes who have flawless skin. There is always the danger that as well as having acne, you get told it’s your fault you have have acne because you have a negative personality. That can lead to further damage to your confidence.

    At the end of the day, people just want to clear up their acne. Your articles and advice play a vital role ih helping people to achive that.

    MichaelC

    • Glad to hear from you again, Michael!

      I think most people with acne to some degree realize that what works for one person may not work for another. In this post I wanted to expand on that. In some cases it makes sense to think of different acne cases as completely different diseases. This might help them to make sense of all the conflicting recommendations and user stories out there.

      I would add different bacteria strains to your comment about the immune system. It’s likely that some strains of the P. Acnes bacteria trigger a stronger immune reaction than other strains. This, combined with variations in degree of sensitivity of the immune system and sebaceous glands, makes for a grand mess that we aren’t likely to untangle anytime soon.

      I hear your points about self-esteem and acne, and I raise my own points for you to consider. First, let’s start with what we agree on. I do agree that poor self-image doesn’t cause acne as such. I mean the new age view, one that I used to subscribe to, that self-image problems would somehow manifest on the skin. Like your body would try to ‘communicate the truth about yourself’.

      That said, I think we both can agree on these 2 points: 1) acne can cause enormous stress to some people, 2) stress can trigger/aggravate acne (when the individual is predisposed to it). There’s even reasonable scientific evidence to support the #2.

      I see stress (and I include feelings of anxiety, depression, etc. to the definition of stress) like sugar or dairy – something that triggers acne in susceptible people. People with low self-esteem or BDD are much more likely to stress over acne than people who are happier about themselves.

      So I don’t think it’s unreasonable to argue that in this roundabout way self-esteem problems do cause acne.

      When you get acne under control and keep it under control, I think better self-esteem will follow. It is the feeling that you know you can avoid major flare ups or at least reduce their likelihood in the future.

      This is probably true for people who don’t suffer from emotional acne or BDD. It’s perfectly normal for people to feel better about themselves when they get rid of an obvious blemish.

      I do think that in people with emotional acne it goes the other way, though. I say this for 2 reasons. The degree of stress people experience doesn’t correlate with how severe their acne is. Some people get badly stressed out when they get a small pimple whereas others can be fairly comfortable even with moderate acne.

      Obviously, there’s a psychological difference in these people that explains the different reactions. This lines very well with what we know of the human psychology. This was expressed over 2000 years ago by the Greek philosopher Epictetus when he said: “People are not disturbed by things, but by the view they take of them.”

      My 2nd point. Like the research I cited pointed out, people don’t necessarily get emotionally healthier once they get over acne. In the study 21% of people with practically no acne still said their skin causes a lot of stress and worry for them. The same figure was 40% for people who had taken Accutane, i.e. people who used to suffer from severe acne.

      Again, this is consistent with the idea that these people see themselves as flawed and this drives them to pay attention their perceived flaws. Perhaps they don’t worry about existing acne but they may spend time worrying that acne comes back and looking at signs of it.

      In my opinion, trying to control your thoughts is a never ending, maybe pointless battle.

      Agreed, and I wouldn’t ever advocate The Secret-style controlling of your own thoughts. Well, not anymore as I used to be into that thing, but have since grown out of it.

      Neither REBT nor other forms of cognitive behavior therapy ask you to control your thoughts. They aim at a deeper change, at the level of beliefs, or cognitive filters, that drive what you focus and think about. There’s probably a limit to what these techniques can do. A part of the problem may indeed be in the genetic hardwiring or chemistry of the brain – we just don’t know yet. But there is evidence to show these techniques are effective in reducing anxiety, depression and other negative emotions. Same with meditation techniques. In some cases they are just as effective as antidepressants.

      There is always the danger that as well as having acne, you get told it’s your fault you have have acne because you have a negative personality. That can lead to further damage to your confidence.

      This is a difficult thing to tackle. If someone gets acne because they drink milk, I don’t think it’s wrong to point this out to them. The person is clearly responsible for their own dietary choices and those choices happen to cause acne for them.

      I don’t think that the situation is THAT different when it comes to self-esteem and stress. Yes, these things are harder to change and not a result of a personal choice. To some degree they are still under your control and you are the only one who can change them.

      Are we putting the blame on the victim by pointing out that the stress and anxiety they experience aggravates acne? I don’t know, but I also don’t see what we can achieve by hiding the issue. Stress does aggravate acne, and may even be the main cause for some people. Is the person really better off not knowing this?

      I just see people spending years and countless dollars on strict diets, cleansing imaginary toxins, isolating themselves because they believe going out with their friends will expose them to toxins that cause acne. I would argue that letting them go further down that path is also not very nice or ethical.

  4. Good post – even though your ‘types’ might be somewhat speculative (where is the research that acne causes/ effective treatments cluster in ‘types’) – this post makes sense – so what I am saying is I believe you have a point- but that it is very much a hypothesis (or a whole bunch of them) at this point (or do you have aforementioned evidence?).
    I just have had a interesting experience – painkillers (a combination of aspirin and acetaminophen) seem to put my acne in remission – or at least a lot less severe. According to this article I am most likely a Inflammatory type – gut issues for instance.
    So I am guessing that aspirin and possibly acetaminophen Works through anti inflammatory pathways to minimize my acne – anybody else experienced this?

    • Yes, this post is more hypothetical than my usual posts. There indeed is no solid evidence that effective acne treatments cluster around the types in this article. There’s anecdotal evidence and weak scientific to suggest this might be the case. For example, quitting milk doesn’t help everyone with acne, which should be the case if hormones played a significant part in everyone’s acne.

      I do think that there’s reasonably good evidence to show each of the types is a factor in acne. I simply took it a step further by hypothesizing that they constitute different problems, or acne types.

      Whether this turns out to be true or not isn’t the main point. My purpose for this article was to try and simplify and make sense of all the confusing recommendations for acne. In essence, saying that you probably don’t have to follow all the recommendations, just focus on the ones the most relevant for your situation. But yes, it’s much more speculative than my other posts.

      As to your experience with aspirin. We should start by considering the difference between antioxidant and anti-inflammatory substances. People sometimes use them to mean the same thing, but that’s not correct. Antioxidants scavenge free radicals and other oxidizing substances that cause injury to the body. Inflammation is the body’s response to the injury, as well as against bacteria and pathogens.

      As far as I know, aspirin doesn’t scavenge free radicals. It inhibits the immune system response that creates inflammation. To put in other words, it inhibits the healing response to an injury – rather than working against the substance that caused the injury.

      This doesn’t automatically mean it works against the inflammatory-type acne. Here’s where this gets a bit more complicated. All acne types are the same at the skin level. Once a pimple has gotten started, regardless of the type, it proceeds the same way: blocked pore > bacterial growth > inflammation. Where the types differ is what kicks off the process.

      I don’t know how aspirin reduces your acne. My guess is that it reduces the immune response to bacteria in blocked skin pores. This in itself is not a bad thing as there’s evidence to suggest the immune response is much stronger in acne-prone skin than in normal skin.

      I hope I’m making some sense to you 🙂

  5. Seppo,

    We are more in agreement than not. My comments are more directed towards the New Age philosophies that say mind is everything and ignore current medical knowledge, or cherry pick to support their arguments.
    The whole mind/body field is going to be a source of debate for a long time to come in medicine. There are even Quantum theories of the mind appearing. Maybe, spots in the Quantum world could be caused by a future thought!

    The fact that I’m posting on this site could be viewed as being overly concerned about acne. That is one for a psychologist to consider.

    I’m digressing here. As you say, the point of your article was to highlight that acne can be considered as different types of diseases

    • Glad to hear we are in agreement. One thing I despise about the new age psychobabble is their demonization of healthy negative emotions. One reason I like REBT is that it sees normal negative emotional responses as healthy. It’s perfectly healthy to feel some concern if you have acne, or some anger when someone screws you over. These emotions can be very constructive and motivate you to take action.

      It’s only when those responses become unhealthy or interfere with your life that they are deemed as problem to be addressed.

  6. Thanks for the answer Seppo 😀 – it really does seem to be working so far though – still 80% clear (compared too normal) – but havn’t stopped taking them yet – obviously that is when it will get interesting

  7. Hey Seppo, great article!

    I have been to my dermatologist and all see wants to do is prescribe a pill and said acne isn’t affected by diet. This woman should have her medical license taken away trying to force a chemical pill on me. Anyways I only get pimples on my forehead and then get pimples on my neck. Either ingrown hairs or cysts. What do you think is causing this. I take all the supplements you say, have a great diet, and workout. It seems the more healthier I am the acne keeps coming. I don’t think it is hormonal or that I have food allergies. I usually get hot flashes and start sweating like crazy and that seems weird for a guy. Also when it comes to the weekend my skin usually clears up and I don’t worry about it as much, except when I drink alcohol but I have cut that down. Any suggestions? Also do you think I should see a naturopathic doctor? Cheers maate, looking forward to the feedback. LETS BEAT THIS!!!

    • Yes, it’s sad that so many doctors still push the myth that diet doesn’t affect acne.

      There’s not really enough information here to comment on what causes your acne. I searched Google for hot flashes on men and it seems to be caused by testosterone deficiency. That should make it very difficult to get acne.

      Have you been able to identify any acne triggers? Things that fairly reliably trigger a breakout? What about the opposite? Is there anything you’ve done that has helped your skin?

      You said that you don’t worry about your skin that much during weekends. Do you worry about it a lot during weekdays?

      Naturopaths. There are pros and cons with the various natural medicine practitioners. They are usually better than doctors at looking for and identifying diet and lifestyle-related causes for health problems. On the other hand, most of them have more or less graduated from the ‘Hogwarts school of magical healing’. I have big problems trusting any of the alternative medicine practitioners since so much of what they do and say doesn’t adhere to scientifically-understood reality. Many are prone to using bogus diagnostic techniques to diagnose imaginary health problems.

      If you can find one that grounds her work and recommendations to science and evidence then I wouldn’t hesitate visiting him.

  8. why do my questions never get answered and I get booted off the site? Doesn’t seem like a wise way to treat customers or get more of them.

    • Nobody is getting booted off the site. Your comments went into the moderation queue and won’t appear until I manually approved them. For some reason the comment spam algo has been quite vigilant as there’s nothing abnormal about your comments.

      As to questions not getting answered. That’s largely because for the past 2 weeks I’ve also ‘worked a day job’, I’ve done some consulting for a local company and haven’t had much time during the week to answer comments here.

  9. Hi Seppo, im having acne problems for the last 5 years and i also tried everything but nothing helped. I read your posts and they actually make a lot of sense, and its nice to know that other people can understand what im coming thru. I would like to get your book it seems very helpfull, and cause nobody couldnt help me i decided to try it myself so your book occured as a good solution. But i dont know how to get it cause they dont have it in bookstores in Belgrade so if you could tell me another way to get it that would be so great.

  10. Gosh I’m so confused. When I was diagnosed with a gut dysbiosis, I started taking some milder forms of antibiotics to begin with and a probiotic called s. boulardii, it worked fine but, I got a pimple which depressed me a bit for some reason, and then I kept getting a pimple every 2 days in the course of a week. I just had the biggest fight with my mom where she literally just disowned me and my skin has been an outrage, I have two major pimples and a few hiding beneath my beard, + two small on my left side of the eye.

    Counting the total to about 7 pimples in less than two weeks. I’ve reached to the point where I can see something’s not right here! But I dunno if it’s the antibiotics/probiotic or my emotional trauma with my mom that is causing this. Or if it’s both. 🙁

      • Is there anything you would recommend for people treating a dysbiosis when you’re in the situation as above?

        That being said. I’ve used different probiotic stains before with no problems, and I’ve never tried S. Boulardii. I think that, I may react negatively to the S. Boulardii (or some of the antibiotics, I didn’t get your standard kind of antibiotics, I got oil of oregano and two others which were against yeast) but not regular probiotics.. Either way. I’ll have to test it out to correct the mess that I’ve been making

        • Out of all the acne types I have the least amount of reliable information on how to deal with gut/inflammatory acne. For me personally avoiding dietary triggers works the best. Nothing else I’ve tried really helped, and in some cases made things worse. Here are somethings one could try:

          – Glutamine supplements
          – Eating a healthy amount of non-irritating fruits and vegetables. These provide fiber to keep things moving and food for beneficial bacteria
          – Stress reduction and sufficient sleep
          – Exercise
          – Probiotics and fermented foods might help some people
          – Antibiotics to kill off bacteria that have migrated up to the small intestine

  11. Hi Seppo,

    I finally purchased your book and now I can read the members only posts! Woohoo! 🙂

    After reading this post I know for sure that I have emotional acne, but I think I may have other forms. I’m going to work on healing my gut and limiting dairy again (I love cheese and yogurt, but I’m not a huge milk drinker). I added gluten back into my diet after about 5 weeks of elimination and I have to say that while it didn’t help my skin, it certainly made a difference in my gut health. I can’t believe how gassy I am now! Lol! It didn’t miraculously solve all of my life problems like some health sites claim, but I do think eliminating it had some positive effects on my digestion. This makes me wonder if perhaps I need to focus on FODMAPS, which I haven’t addressed before. I just really want to exhaust all of my options so that at the end of the day I can at least say that I tried it all, accept things for what they are and move on and forward.

    I do have a question. If all other types of acne have been addressed and it comes down to genetics, how does Accutane play into this? In your opinion is it better to wait until one is in their 40s or 50s and hope it resolves by then or go forward with Accutane?

    As always, thank you again for another awesome post! Just a small request, would you consider doing a post about vegetable oils? It would be nice to have some scientific evidence backing or refuting some of the claims made by various health gurus. I’m very interested in the impact various oils may or may not have on acne.

    Thanks again,
    Amanda

    • Thank you for buying the book. I hope you find the information useful. I’m actually working to update and convert it into an online course at the moment. Books are such a pain in the a** to update that I keep putting it off. Having it as an online course makes it much easier to add new information and update things.

      I added gluten back into my diet after about 5 weeks of elimination and I have to say that while it didn’t help my skin, it certainly made a difference in my gut health. I can’t believe how gassy I am now! Lol!

      Lol, now you know what I mean when I said earlier. That it was only after I had my working working properly for a while that I realized how bad it was before.

      It might be worth trying low FODMAP diet for some time to see if it helps. The good thing is that you don’t have to try it for very long. In my case it takes only a few days for my gut to settle down.

      I do have a question. If all other types of acne have been addressed and it comes down to genetics, how does Accutane play into this? In your opinion is it better to wait until one is in their 40s or 50s and hope it resolves by then or go forward with Accutane?

      Accutane suppresses or damages the oil producing glands in the skin. It probably doesn’t remove the genetic tendency for acne, but it does reduce the effect those genes have on the skin.

      How long to wait? It depends on how much acne bothers you. For me, acne is a big issue. Even though I’ve had much more acne recently (over the last 5 to 6 weeks) I don’t let it bother or dictate my life. So for me it doesn’t really make sense to take Accutane. But this is not the case for everyone and for someone who is more bothered about their acne it makes sense to take Accutane earlier.

      It might take a very long time for acne to go away on its own. It’s not uncommon for 50-year old people to still have some acne.

      Regarding vegetable oils, I discussed them with another commentator here. The post is just a placeholder for the discussion. It’s not very organized, but it should give you the general idea of what I think:

      https://www.acneeinstein.com/pufa-omega-6-acne/

  12. Thanks Seppo! I was kind of wondering and confused about the Omega 6 content in whole foods and your articles helped to clear some of that up.

    Prior to eliminating gluten I wouldn’t have even considered gut issues as a potential cause. Now I’m starting to think otherwise. I get what you were saying now 🙂

    I have read a lot of forums where women stop taking oral contraceptives and their skin becomes a mess after years of clear skin. Obviously their acne is hormonal, but many go on to say that diet cleared their skin back up. I understand how diet balances hormones, but if birth control clears the skin then is diet really the culprit? I ask this because the only times I’ve had clear skin, I mean a nearly flawless complexion have been on a few different brands of oral contraceptives. While I was on them my diet didn’t make a difference. I still have yet to figure out if diet really affects my acne. I guess my point is that I’m struggling to figure out what type of acne I indeed have and how to appropriately treat it. It’s just so complex! I thought I was at the end of the road, but I’m not so sure now. I’m realizing that there are still more things to try, but I don’t want to waste time addressing an issue that may not affect my skin.

    What has been difficult is not demonizing any one thing as the cause. I think this goes along with the idea of confirmation bias you spoke of. I’ve been guilty of doing that many times, which only complicates matters further. Acne is such a tricky disease. I wish scientists would figure out how to turn off the master regulator of acne (I forget the name. mTor maybe?). That would be awesome! Then again, I’m not a scientist and I have no idea what type of trickle down effect that would have within the body lol.

    • Regarding acne types. It would probably be better to talk about DOMINANT acne type rather than acne type. The thing is that all acne is hormonal to some degree. People without functional androgen receptors in the skin don’t get acne. Similarly, people with chronically low IGF-1 levels don’t get acne. Those hormones are absolutely required to get acne. So with acne type I guess it would be better to talk about the acne type that triggers your acne. That also explains why BC pills can clear many types of acne. They, to some degree, negate the effect androgens have on the skin. I hope this makes sense?

      What has been difficult is not demonizing any one thing as the cause.

      If it makes you feel any better, you are certainly not the only one with this problem. I get many emails asking me to tell them what foods they should avoid to have clear skin. I guess it’s human nature to always seek out that one villain that causes all the problems.

      There actually is already a drug that inhibits the mTor pathway. It’s called rapamycin. The problem is that it also suppresses the immune system, and, as if things weren’t complicated enough, one of the more common side effects is acne! https://www.ncbi.nlm.nih.gov/pubmed/24654608

  13. Seppo, I just read your Zen booklet. Would you say that those who started having acne during puberty have hormonal-type acne?

    • Not necessary. My acne started during teen years and, aside from a brief respite after Accutane, hasn’t let up. I think it would be better to call this as dominant acne type. Hormones affect all types of acne and I’m sure inflammation plays a role in for everyone with acne. But for some people hormones play a much larger role and for others it comes down to inflammation. So speaking of dominant acne type probably gives a more accurate idea.

  14. Do you have information on Make-up brands you like anywhere? I know mineral makeup is supposedly better for acne prone skin. Any brands you like? Some of them still have weird ingredients in them.

    Thanks!

  15. Nice post! I have always wondered why do I get cleaner face when I am traveling to other places. I think weather and pollution in my city stress my face and then I get more acne.

    I have had acne for over 15 years (I am 29 now), this is not severe acne since 10 years, from time to time I get almost totally clean but I have my “episodes” so I have decided to mix different approaches explained here to attack it from different points, so what am I doing and not only for acne but for healthy life in general is:
    * Reducing dairy products, sugar and gluten
    * Taking probiotics
    * Started meditation some days ago
    * Drinking green tea
    * Washing my face with tea tree

    I am waiting for the Exposed Skin Care to start topical treatment because I think I have been missing topical treatments and considering weather and pollution this might be the one thing I’ve been missing in recent years.

    I hope I can clean my face so I can start a laser treatment for scars. I am full of hope now because when you have had acne for all this time you finished getting used to it and forgetting you can fix it better.

    • Climate has a big impact on the skin. When I’m in Thailand (hot and humid) my skin is ridiculously oily. But in the cooler climate of Europe my skin it does much better. Pollution is also known to cause skin damage. Nobody has shown it causes acne, but it can cause the kind of oxidative damage that starts the acne formation process.

  16. There are no special types of acne – it’s just plain old acne. Most of those things you mentioned like hormone’s, diet and inflammation are aggravating factors and some of those things have no basis in factual reality. Also the majority of those with acne do not have a hormone imbalance but rather a follicle sensitivity to androgen’s (this is far to the only component to acne).

    Acne has a basis in genetics. But that is very complex, too complex for most people to even understand. More occlusive pores also seem to be more common among acne sufferers than clear skinned folks. Acne is mostly a disorder of the shedding of the skin as opposed to just the oil glands. People with acne have skin that just dose not exfoliate normally.

    • The points you raised are correct but incomplete. It’s true that most people with acne don’t have overt hormonal imbalance and that the issue is skin conversion. But it’s equally true that insulin increases the rate of skin conversion and that treatments that reduce insulin (drugs, supplements, diet) have been shown to reduce acne. Whether you want to call that hormonal or not is a matter of terminology, but the fact is that treatments that ‘balance’ hormones do help with acne.

      Problems in shedding the skin are a part of acne, as are problems with the oil glands. There’s plenty of research to show that sebum peroxidation causes hyperkeratinization and shedding problems. One contributing factor to sebum peroxidation is shortage of antioxidants that protect sebum. Why there are not enough antioxidants in the skin remains to be seen. One hypothesis is that acne patients (at least some) are under higher than normal oxidative stress and the antioxidants simply run out. Contrary to what you claim, there is evidence to support all of these ‘types’. I’m the first one to agree the evidence is not conclusive, but it’s more than enough to raise the possibility.

  17. Hello Seppo!
    I sent you an email some days ago but I guess it’s better to post it here. I have insulin resistance, I inherited a joint condition from my mother and every time I consume a lot of carbohydrates, my joints hurt. Usually I know I’ve eaten too much when one of my fingers hurt. I suffer from acne too and I’m lactose intolerant. At first I thought my acne was caused by consuming lactose, which it is, but not quite. I started consuming a low carb, almost ketogenic diet three months ago. Most part of the month I stick to it, and I notice improvement on my joints doing that. Before trying a low carb diet I took metformin when I consumed a lot of carbs, my doctor advised me to do that, and it helped but a low carb diet was better for me. I also notice an improvement on my face. I have carbs cravings, especially when I’m going to menstruate, so I found L-Lysine could help me getting my GI under control, and I also notice an incredible improvement on my skin. I took it for a month and a half. From having 12 small pimples on my skin at that time of the month, I had 3. I had two cystic blemishes that wouldn’t go away for months, and they disappeared on a week. The acne that took weeks to heal, now takes three days tops to clear. I usually applied BP and clindamycin with no fantastic improvements and it really improved (I got cleared!) with my diet, l-lysine and adding Sulphur soap 2x a week. I usually drink green tea on an empty stomach 5x a week. My question is… Recently I stopped taking the L-lysine because I notice I would have a heavier period and bleed more days, plus, my period would start somedays later and sometimes I would spot during my cycle (I got an IUD placed four months ago). I found in some blogs that some girls miss their period and they link it to the Lysine. I don’t know what to do. I want to know if you know something about L-lysine, if it really helps, if it really affects cycles or if I’m just having weird cycles, I’m scared the L-Lysine would get me pregnant, as metformin and a lot of hormone regulating supplements can cause that. Do you know anything else I can take to help my GI and my skin under control? Thank you so much for your time. I love your blog, it’s being life changing.

    • I couldn’t find any reliable information about l-lysine and whether it could affect acne or related problems (hormones, insulin).

      Period abnormalities are often linked to insulin resistance or excess androgens. Given that l-lysine is an amino acid that’s readily available in foods, I doubt that taking it would have huge effects on hormones. I could very well be wrong, but my money is that the women who attribute it to period abnormalities are confusing correlation with causation. But, again, I don’t really know.

      Try taking inositol and maybe 2 cups of spearmint tea a day. Both help with blood sugar and androgen abnormalities.

  18. Hello.. do you know if there is any relation between antidepressants and acne? Ive read that acne is actually a very rare side effect of the 2 types of medications that I have taken.. and both times I think they aggraveted my acne.. but the doctor says isn’t possible.. weird cause I was feeling more relaxed but acne still there.. so stress had nothing to do with it? hope you can help thanks

  19. Hey Seppo, there is one thing that interests me: it seems to me that most cures for acne (be it dietary, supplements or topical) only work against formation of new acne. But i really dont know what to do with acne i already have. I have mild underskin acne on my jaw, they are usually not inflamed at all and it seems to me they will never really go away, they have been like this for about two years, always in the same places. When i breal out, its always same spots cycling between inflamatory and non inflammatory phase. I really dont know how the solve this.

    • The skin constantly renews itself, and it seems implausible that the exact same pimples would stay on the skin. Perhaps pimples constantly form on the same spot in your skin. I would show those to a doctor and see if they can taken out. Perhaps there’s something in that spot in your skin that’s gone wrong and causes pimples to form there.

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