This is important because sweat can keep acne-causing bacteria in place longer than normal. Sweat, friction, and heat can cause clogged pores and inflammation. A gentle cleanser, an anti-bacterial spray (see hypochlorous acid (1)), or a salicylic toner on cotton can help combat these effects of sweat.
Studies (2) show a pillowcase contains seventeen thousand times more bacteria than the average toilet seat after just one week. Ideally, you should switch your pillowcase 3 or 4 times a week (you can flip your case each night for more usage).
Conditions such as autoimmune disorders and PCOS, menstruation & menopause, certain medications, stress, pregnancy, puberty, etc... there are so many things that can cause an imbalance of hormones. There are tests to distinguish if and why there is a hormonal imbalance present, but some can be expensive or inaccessible. Intentionally observing lifestyle choices/situations can help explain the underlying issue here.
Skin can be the first thing to have a stress response since it causes a chemical response in the body — whether that looks like sweating, a rash, an acne breakout, eczema & psoriasis flare-ups, or excessive redness. Taking time to determine what stress management practices (3) and coping mechanisms work best for you can be very beneficial for you as a whole, as cliché as it may seem.
We all subconsciously touch, scratch, or rest our hands on our faces. Being extra aware of how often you do this can help avoid breakouts. The bacteria, dirt, and oils on our hands transfer easily to our faces and can lead to clogged pores and acne.
Dairy is essential to many of our diets for protein, fiber, probiotics, vitamins, and more. Unfortunately, it is thought to be a highly inflammatory food group due to the saturated fats commonly found within it. Not all dairy products are linked to the formation of acne, though. Skim milk is shown to cause double the skin problems as whole milk because of additives in skim milk like whey protein and sugar. Regular cow's milk is also shown to cause issues because of artificial hormones within it.
Comedogenic ingredients, or pore-cloggers, are commonly found in over-the-counter skincare products and cause a huge issue in those already prone to acne.
Click here (5) for a list of pore-clogging ingredients.
Moisturizing may seem redundant to those of us with oilier skin, but not moisturizing can contribute to the formation of acne and oily skin! Moisturizing helps maintain our skin's moisture barrier (the acid mantle). The main function of the acid mantle is to prevent anything from entering or exiting through the skin. It prevents water beneath the skin from evaporating and ensures no bacteria can enter through the surface.
A compromised skin barrier can lead to an overproduction of oil to compensate for the lack of natural moisturizing factors. This can lead to clogged pores and acne! Do not skip out on a good moisturizer.
While some medications can help with acne, some can do the opposite (6). Ask your doctor/physician about the side effects of any medications you're on.
It's the same deal with supplements — while some like Omega 3 oil or Zinc ascorbate/gluconate can help manage acne, others such as vitamins B6&12 and iodine can trigger flare-ups.
Though sometimes overwhelming, knowing which foods can cause flare-ups can be reassuring. It can help to know that your pain/struggles are not coming from another, more complex health issue. Still, eliminating your favorite food because it is something you are sensitive to is unrealistic. Awareness of your sensitivity can help you be more mindful of your consumption.
How do you know if you are sensitive to a particular food? The easiest way is to take a lab test (7) to determine everything your body is sensitive to. This lab tests a variety of issues, such as hormonal imbalance, microbiome function, blood sugar function, and inflammatory activity. As with any medical cost, this can be inaccessible and unaffordable.
Another way to determine how your body responds to different foods is to keep a food journal (8) for a few weeks. Carry a physical notebook of how your body feels in different ways shortly after eating. This can include how your stomach responds, a sudden headache, skin irritation, how your bowel/bladder reacts, or other unwanted symptoms. Include what and when you ate and your (approximate) portion size. A food journal can help you be more aware of which foods cause a clear reaction in your body so you can limit them.
Hot water can damage the skin's barrier leading to bacteria attacking the surface.
The minerals in tap water can affect our skin and hair health. It may be worth a try to switch your shower head out with one that softens the water. You can also buy water softeners for sink taps.
Here is a link to the shower attachment (9) I use. This is for the sink tap (10).
We touch our phones maybe more than anything else throughout the day, and we cannot wash our hands enough to ensure what we touch stays clean. When we touch our phones to our faces during a call, all those germs and oils are transferred to our faces and will contribute to a breakout.
If you wear glasses, make sure you clean those daily too!
Icing your face during a breakout can help reduce redness & pain.
Ensure hair conditioner and other pore-clogging products are kept away from your face.
Use a new washcloth or clean towel to wash/dry your face every time.
Drink a bunch of water! Hydration helps with all the causes of acne.
Brush your teeth before washing your face.
ALWAYS wash your hands before touching your face.
Avoid sleeping with your face on someone else's skin (like their chest or arm).
Red, blue, and green LED light therapy can reduce acne and diminish scars caused by it.
Exfoliate with a gentle (preferably chemical) exfoliant no more than 2-3 times weekly.
Wearing SPF 30+ every day is the absolute best thing you can do to protect yourself from sun damage. You should also reapply sunscreen at least every 3 hours or sooner if in direct sunlight, in water, or sweating.
Please do not fall for the rumors that say sunscreen will give you cancer. Not wearing sunscreen will give you skin cancer much, much faster than sunscreen will. If you are seriously concerned about the chemicals in sunscreen, there are so many amazing mineral SPFs on the market today!
Using umbrellas, hats, sunglasses, and cover-up clothing is another great way to ensure your skin is not getting sunburned. Not all SPFs are made equally, so another layer of protection is never a bad idea.
Crow's feet, elevens, smile lines, and forehead wrinkles are naturally formed with age but can worsen with sun damage. Using retinol (best used at night when the skin is resting) can be beneficial to diminish the appearance of fine lines and wrinkles. You can also apply a thin layer to dark spots to help speed up cell turnover and push out damaged melanin cells.
Vitamin C, also known as L-ascorbic acid, can improve the appearance of dark spots caused by sun damage. It also helps with redness, acne scars*, fine lines, and wrinkles, and protects the skin from long-term harm from the sun's UV rays (SPF should still be used daily).
*Not to be used on active acne lesions.
The specific wavelengths from red LED light can penetrate the first few layers of skin and help produce collagen and elastin fibers. It also reduces inflammation, redness, and dark spots.
Acne scars, sun spots, brown patches, and any dark-colored discoloration are considered hyperpigmentation. Products like AHA's, Salicylic acid, Vitamin C, niacinamide, and retinol are great for improving hyperpigmentation. Many clinical treatments can target discoloration with deeper epidermal penetration and sped-up cell turnover*.
*Skin cell turnover: the process of older skin cells shedding so that newer ones come to the surface. Stimulates the production of collagen and elastin, beneficial for nearly all skin concerns. Exfoliation of any kind helps with cell turnover, some methods being more efficient than others.
Acne scars look like red spots deeper within the skin and can take a while to fully fade. This area of discoloration is considered hyperpigmentation because acne scars typically appear darker than one's skin tone.
Sun damage causes dark spots when the skin creates extra melanin to protect the deeper layers from the damaging effects of the sun. Melanin protects us by absorbing the UV rays deep within the skin and reflecting them up to the upper, less volatile layers.
Large, dark patches of skin can have multiple causes including birthmarks, rashes, pigmentation disorders, infections, medical conditions, and in the worst case, skin cancers. Always talk to a medical professional if you are concerned about anything on your skin.
Melanin is abundant in darker skin types and it is readily available to respond to traumas like excessive sun exposure, skin injuries, acne, and inflammation. When skin is damaged and keratinocytes (the most abundant skin cells) are rapidly produced, melanin transfers to the fresh skin cells to ensure they are protected from UV rays. Sometimes the keratinocytes either struggle to uptake the melanin or uptake too much of it, resulting in discoloration of the skin.
Dehydration, sun exposure, stress, and smoking can impact the appearance of hyperpigmentation as with any other skin concern. Observing your lifestyle habits and how they could influence your skin is important regardless.
Rosacea is a chronic but treatable skin condition that causes extreme flushing of the face. Blood vessels in the face enlarge and make the cheeks and nose extra red. There are different subtypes of rosacea, each with their causes and triggers. Causes for the development of rosacea include:
Immune system obstacles
The National Rosacea Society has researched a type of specific anti-microbial molecule called cathelicidins that have been found to cause inflammatory bumps and pimples, and vascular conditions like telangiectasia. In studies, these molecules were found in abundance in patients with rosacea. Mast cells also have a direct role in the activation of certain cathelicidins and are now being researched to find if mast cell stabilizing agents will reduce the production of cathelicidins.
A response to microorganisms
Demodex folliculorum mites - found in hair follicles - are a natural part of the human microbiome. These mites are found in larger numbers in patients with rosacea and it has previously been debated if this is a cause of rosacea. It has now been found that the increased number of Demodex mites can trigger an immune reaction in patients with rosacea, or that the bacteria from the mites can cause an inflammatory response.
Staphylococcus epidermidis is another type of bacteria found in pustules and eyelid margins of rosacea patients. This bacteria was found significantly more in those with rosacea as compared to those without it.
Inappropriate blood vessel function
Researchers have documented that the vascular system and nervous system are closely interlinked suggesting both rosacea symptoms, inflammation and flushing of the face, may be on the same spectrum. Triggers like spicy food, intense emotions, alcohol, skin irritants, and temperature changes already indicate that the sensory nervous system is involved.
Genetics
Twin studies on people with rosacea have been conducted to find that about half of rosacea cases can be attributed to genetics, with the other half being from environmental factors.
Genetic rosacea studies have also made testing for genetic predispositions to rosacea more advanced and closer to being a preventative measure.
The 4 subtypes of Rosacea:
a. Erythematotelangiectatic Rosacea (ETR): main symptoms are redness/flushing and dilated blood vessels
b. Papulopustular Rosacea: aka acne rosacea, has the same symptoms as ETR accompanied by deep papules or pustules (pimples). Patients may also experience extremely oily or dry skin patches that may develop into plaques.
c. Phymatous Rosacea: Individuals with this type of rosacea experience thickened skin that may start as smaller plaques. This is usually the result of poorly managed/untreated rosacea. This can lead to rhinophyma — the thickened skin from rosacea becomes built up around the nose to make it appear more bulbous than normal.
d. Ocular Rosacea: This type of rosacea affects the eye, causing visible blood vessels in and around the eye, itching, swelling, redness, and cysts on the eyes.
Understanding which type of rosacea you have is necessary to be able to treat it.
The different types of rosacea and their causes require different things for treatment. ETR with a microbiome issue requires barrier repair and desensitizing, while Phymatous rosacea can require more intensive treatments like laser or light-based therapies. Working with an esthetician or other skin care professional can be very beneficial in finding what treatment is best for you.
Products/ingredients fit for rosacea skin.
Applying SPF daily is the best way to protect your skin and its barrier. A sulfate-free, gentle cleanser in the morning and night & restoring the pH after is usually great for rosacea. A balanced skin barrier requires an appropriate cleanser, a fitting moisturizer, and an SPF. Inflamed lesions and redness are typically treated with the antibiotic metronidazole or topical azelaic acid. A milder form of Vitamin C called THD ascorbate is also amazing for calming the skin, protecting it from sun damage and free radicals, and will not irritate even sensitive skin.
What to avoid if you struggle with rosacea:
Triggers for rosacea cause flare-ups, meaning the symptoms worsen with certain things.
Rosacea triggers include extra spicy foods, high-stress environments, extreme temperatures, sun exposure, hot showers/baths, alcohol consumption, and more. Learning what triggers your rosacea can help you avoid flare-ups and maintain your skin's health in the long run.