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Acne (young people)

Acne, diet and sleep

There is no research to suggest that diet or sleep alone causes acne. However, many people we spoke to felt dehydration and lack of sleep impacted their skin. Some thought food could affect their acne but were unsure about whether changing their diet made their skin better. Others felt worrying too much about diet and sleep could cause stress which wasn’t good for their skin. Most people tried to find a balance between a ‘healthy’ diet, late nights, and living life without too many restrictions. As Marga said, “I don’t want to let it [acne] affect my life completely”.
 

Dr McPherson says the link between diet and acne is unclear.

Dr McPherson says the link between diet and acne is unclear.

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Yeah, I think there are lots of misconceptions. And it's not to do with having dirty skin or not washing your face. It's to do with the hormone levels and your sebum production and your genetics. And that's, that's normally nothing to do with, you know, your diet or how clean or dirty you are, what your food-, whether you eat junk food or not. You know, we do know that probably having a healthy diet, eating fruit and vegetables, is good for your skin generally. But the other way round it's not quite so clear. So I don't think there's a clear link between junk food and acne. And I know lots of-, I see lots of young people who have incredibly healthy diets and have acne in any case. So I think it's , it's not directly linked to the food you eat. Sunshine can help some people with acne, it can be- you know, it probably reduces inflammation and can help some, some people with acne. But you know, face washing is an important part of management, but certainly you can have very clean skin and still have acne. So I think unfortunately you can do everything right, look after your skin, eat lots of fruit and vegetables, and still get spots. And that's, you know, people mustn't feel that they're responsible for that.
 

Becky’s doctor in her home country suggested she drink water, eat more fruit, and get plenty of sleep. Although this helps her skin she also gets anxious about getting her diet right and getting enough sleep.

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Becky’s doctor in her home country suggested she drink water, eat more fruit, and get plenty of sleep. Although this helps her skin she also gets anxious about getting her diet right and getting enough sleep.

Age at interview: 19
Sex: Female
Age at diagnosis: 16
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So you said that you do try and drink more water and sort of vegetables and so on?

Yeah.

Is that something you’ve started doing since the doctor in [home country] said that it could be a cause for your acne?

Yes. Because one thing he mentioned is about food. So I try to eat more vegetables and drink more water and eat more fruit. But it’s better now, but it doesn’t, like it doesn’t completely disappear. So I’m not sure if it’s the main cause of my acne. I think it might be a factor that make my acne worse, but it’s not the main cause of my acne. So I’m still find, trying to find the real cause of my acne, yeah.

After I’ve grown acnes on my face I’ve become very cautious. So I pay a lot of c-, attention to what I eat every day and what I drink. So I used to drink some soft drinks but now I completely like forbid that. And I mean so I have to go to bed very early yet. It’s kind of I used to live free, freely. But now because of my skin condition I have to put a lot of restrictions to my habit and, sorry, yes, and to my diet and to everything that might be, affect, like that might affect my skin. And that’s quite stressful because sometimes you can’t control everything. And when, when I feel that I can’t control, control it, I feel really, really anxious and stressful. Like I think I need to drink a lot of water to speed up the metabolism and it will help to, maybe to, yeah, to better my skin. And then in my typical day I don’t really have a lot of time to drink water because there, there wasn’t enough like water if, in library, like if you want to drink hot water. 

So you think that might be to do with stress from your studies?

It might be. Cos I feel very anxious all the time and I don’t feel that I have enough time for my, for my, for my coursework. And when I sit down, I feel that I’m not very productive. I feel like, “Oh, it’s time for me to drink some more water to make my skin more, yeah, and to have some fruit and vegetables” and something, yeah. So, and sometimes, although I have a lot of work to do, and then I see that it’s about 11 o’clock and I think, “Oh, I’m supposed to go to bed and have a good rest otherwise my skin condition will be worse.” So it kind of makes me very anxious, because of my skin condition. And, and it’s, my skin condition in turn, sorry, the anxious state in turn makes me, like my skin condition worse. 

Okay.

So it’s…

Yeah. So the two interact with each other?

Yeah.
Diet

People often received confusing information on how diet affects acne, if at all. Some people got dietary advice from friends, family, and online forums, and were told to avoid dairy, refined sugar and oily/fatty food. On the other hand, fruit, vegetables, and keeping hydrated were thought to improve skin. Becky and Will got dietary advice from their doctors. However, Tom, Rachael and Sarah were told that there was no clear link between food and acne.
 

While Chris feels that eating healthily and keeping hydrated aren’t enough on their own to clear up acne, once the acne has gone these practices can help keep skin clear.

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While Chris feels that eating healthily and keeping hydrated aren’t enough on their own to clear up acne, once the acne has gone these practices can help keep skin clear.

Age at interview: 20
Sex: Male
Age at diagnosis: 17
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I think diet is quite a key one. That was another sort of factor that, you eventually realise do, does or can affect it. But, yeah, diet, I suppose the main one. Maybe stress to a certain extent. You might have certain bad weeks, but because you fluctuate quite a lot it’s difficult to sort of pin point what’s the cause, like if there’s a cause effect relationship of like stress or diet you can only kind of guess. So, yes, I suppose I didn’t really understand like all the main causes. But, you kind of just, you kind of just do your best to get on with it and try and eat well and try and hydration. I knew can affect it as well. But, like I say, because you fluctuate so much you kind of, you are sceptical whether like, you know, keeping hydrated and keeping a good diet, it does actually work or not. So, I think it’s kind of like an individual sort of level. 

Was it raised ever by any of the GPs or dermatologists about sort of things like diet and stress? 

No, not really. Not at all. They didn’t really go into like how your lifestyle can affect it, or at least I don’t remember them going into that sort of thing. That was more like me looking up on the internet like how to sort of prevent sort of acne and things like that. 

But obviously to a certain extent that doesn’t, that will work, to a certain extent for like certain individuals, but when you’ve got acne, like, just keeping hydrated and a general, general good diet is not going to do a great deal. I mean, it might help, but it’s not going to like clear it.

I think my skin will be fine from now on. Touch wood. I think with Roaccutane (isotretinoin) when, when you’ve been on it, you’ve got a lot less chance of getting acne again. So I’m quite confident I won’t get it again and as long as I like, I am like sort of doing the stuff like keeping hydrated and having a good diet and like doing a little bit exercise that’s going to help.
 

Yi remembers being told not to eat sugary or spicy foods. She found it hard as she likes these foods, but has recently started eating them again.

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Yi remembers being told not to eat sugary or spicy foods. She found it hard as she likes these foods, but has recently started eating them again.

Age at interview: 23
Sex: Female
Age at diagnosis: 14
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And do not eat anything that like ice cream, chocolate and sweets like that or spicy ones. So but I love eating them [laughs].

Oh.

So it’s very hard for me like to not eat anything like special sweets or. Oh like ‘OK I will not touch them’ like so hard [laughs].

So what do you do about that, do you still eat some spicy and sweet foods?

I’m not sure it’s that, I cut them for like two years completely and I just recently like got them back again because I stopped seeing the doctor and I think my skin is getting better for these days. But I still can’t like eat that much and like controlled to a limited… Yeah.
Most people tried to maintain a “balanced” diet or eat less foods considered ‘bad’ for the skin, such as pizza and chocolate. Many tried to eliminate dairy, which had a big impact for Harriet and Deborah.
 

Harriet finds that eating dairy products tends to give her more spots.

Harriet finds that eating dairy products tends to give her more spots.

Age at interview: 21
Sex: Female
Age at diagnosis: 12
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I was just comple-, like constantly on Google, like googling what foods are bad, what you shouldn’t drink or do. And like I mostly had my hair like tied up in a bun so it was all out of my face. I changed my pillowcase every single night. Like I’m an absolute skin expert now [laughs]. Well, a self-confessed skin expert. 

[Laughs]

But, yeah, so I did, I did sort of read that you should, like dairy is, I read one, in one place that nothing you eat will affect it, but then I found that sometimes it does. So I wouldn’t eat, like if I eat eggs or cream or things like that, then it tends to, or it tended to get quite bad. So I’d avoid things like that, yeah.

Is that something you still avoid now like in sort of remission and recovery or...?

Yeah, well, I find it still has an impact. If I eat sort of a lot of dairy or anything like that, then I will tend to get more spots.
 

Marga takes the combined pill to help with her acne. Although there is no clear link between diet and acne, she thinks dairy is a dietary trigger of hers and wonders about hormonal links to this.

Marga takes the combined pill to help with her acne. Although there is no clear link between diet and acne, she thinks dairy is a dietary trigger of hers and wonders about hormonal links to this.

Age at interview: 24
Sex: Female
Age at diagnosis: 18
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Did they talk about things like causes and triggers and the sort of medical side of it?

Yes, they went through the fact that it was probably hormonal which is why I was on the Yasmin, and yeah, they basically went sort of outlined the fact that my hormones are probably up and down, and things like that and they said eventually it will level out – which I guess gave me confidence because I knew that this isn't forever, and like it's just because my hormones are quite fluctuating at the moment. Interestingly though, I've-, basically I've given up dairy. This is, they, the doctors didn’t mention anything like this, but I heard from a friend that dairy can actually be a trigger of acne. I've given it up probably about two-, two and a half years now. I still eat it from time to time, so I'll still eat cheese on pizza for example but I switched to soya milk; I don’t drink milk. And that’s been amazing as well for my skin, which is obviously something that the doctor hasn’t really mentioned to me at all. But my skin has got so-, also I've noticed a significant improvement for example when I went off the Lymecycline and had that about six month period, nine month period where I wasn’t on anything apart from the benzoyl peroxide. Even before that, actually before I went on Lymecycline I also had given up dairy and it really, really helped. Because I notice when I now then have cheese I'll, you know, maybe like two or three days in a row, I'll-, I can guarantee that I'll get a few spots which is, you know, I haven’t really mentioned that to my doctor; I don’t know whether I feel a bit stupid saying it because they’ve never mentioned to me that food can be a trigger. So that’s, yeah, that’s another thing that dietary that I've changed as well which I feel like as well helps with that control element cos I feel like, you know, I know that that’s bad for my skin; I wonder whether it's the cow hormones or something in the, in the milk. 
Changing diet didn’t work for everyone. Sarah tried excluding gluten and milk but it didn’t make her skin any clearer. Marga ate fresh yeast, but it “tasted disgusting,” and she doesn’t think it made a difference. Hester thinks that acne should be seen as a medical condition rather than something caused by eating “a lot of bad food”.

Some people said that, because acne can fluctuate on a day to day basis and flare-ups can have multiple causes, changing diet alone won’t necessarily mean clear skin. This is why some people felt that instead of trying to control their acne through their diet, they would rather enjoy their food, accepting that it may have an impact their skin. Becky thinks that not eating chocolate “reduces a lot of fun” in her life. Similarly, Ollie feels that the best way to deal with acne is “to get treatment, as opposed to just sort of eating less pizza”.
 

Tom tries to eat things that are better for his skin, but isn’t too strict about his diet.

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Tom tries to eat things that are better for his skin, but isn’t too strict about his diet.

Age at interview: 15
Sex: Male
Age at diagnosis: 15
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I don’t drink or smoke. Just, not anything to do with spots, I just wouldn’t smoke myself, cos I think it’s silly. And then drinking, I’m kinda young, so I don’t really, I haven’t really got into that yet. 

Diet. I might avoid the occasional thing. So I might be like in the Co-op with my friends like, “Oh, I’m going to get a Crunchie. I’m going to get a Mars bar.” And I’ll be like, “I’m going to get a Fruit Shoot today.” Which is still really sugary, but it’s not as bad as like whatever I was thinking about getting. So it’s not like a big change. I’m not like, I know friends who have just gone, “I’m not gonna to eat this because I know it’ll be bad for my skin.” 

So about, about the diet. Before that, had you been sort of cutting certain foods out?

Not really ‘cos I just kind of figured that, I’m not really that age where I want to have a diet and I’m quite happy how I am. And I was like if I’m going to have spots, I’m going to have spots but I also want to enjoy pizza and stuff. So I just kind of got on with it.
Sleep

For most people we talked to, their acne did not disturb their sleep. A few said it could affect them in different ways though. Devan said that large spots on his back could be painful and wake him up. Rachael and Hester sometimes had to sleep on their backs to avoid putting pressure on spots on their faces. Eli sometimes scratches her acne in her sleep which can wake her up and damage her skin. Abbie and Kosta mentioned that some creams they put on before bed irritate or sting which makes it harder to sleep, but Abbie felt this “wasn’t a massive deal”. The stress of having acne and not knowing what to do about it could also affect sleep. Some people had time-consuming skin care and treatment routines at night. Becky, Alexandra and Shu En thought a lack of sleep could make their acne worse.
 

When her acne was bad, Hester describes what would happen if her spots on her face burst during the night and bled onto her pillow. Sometimes she had to take painkillers to sleep.

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When her acne was bad, Hester describes what would happen if her spots on her face burst during the night and bled onto her pillow. Sometimes she had to take painkillers to sleep.

Age at interview: 21
Sex: Female
Age at diagnosis: 15
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With the big lump it just used to kind of ooze [laugh]. It’s not very pretty. But yeah, and like underneath I think kind of sort of like bloody fluid just used to leak out, and that would, that would be kind of what would come down. And then I think because it was leaking like that, it would kind of like crust over. So I'd get like a hard kind of, yeah, a hard crust, like. And that's what would get stuck to like my pillow, for example. And then obviously when I woke up like I'd sort of pull it off with it. So yeah, and just like random sporadic bleeding as well. Especially in the night I think cos I’d sort of rub my face against it. But yeah, it was very, very sore.

So when it was really bad I used to take painkillers to sleep. And I couldn't really lie on my face. So I’d just kind of like, just lie on my back [laugh]. Yeah, lie on my back and try not to move. And I think once I got to sleep it was okay, but then it was just like I started to feel quite embarrassed because I'd end up making a bit of a mess. And then like even if I washed the sheets, like some of them obviously sometimes the blood doesn't quite come out. And like. Yeah. It was just quite [laugh], it felt a bit like disgusting I guess. And yeah, it was just a bit awkward. Most people were like, “Oh, you’re bleeding” [laugh]. And yeah, just being painful, like I just- my sleep quality was quite affected by that, because I couldn't really get to sleep. And yeah, the pain- I mean painkillers helped but not significantly. Like they couldn't help the fact that it would obviously bleed in the night and things like that. And then if you wake up and then you kind of have to get a bit more painkillers in. It depends on, I mean, different nights would be like particularly bad, and. Yeah. I think it's just-. And feeling like self-conscious that, and like I knew that when I went to sleep like I'd wake up and, and then just having to deal with like the kind of mess. 
 

For Naomi the stress of not knowing how best to deal with her acne kept her awake at night.

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For Naomi the stress of not knowing how best to deal with her acne kept her awake at night.

Age at interview: 22
Sex: Female
Age at diagnosis: 9
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Has it ever affected anything like sleeping patterns, getting to sleep or staying asleep?

Well yeah, I think so actually because obviously when I was like going to sleep that would be when I would be like thinking about it. And like I’d often get quite upset. So yeah I think so. I think like stopping me getting to sleep – yeah not, not staying asleep that was, that would be fine but yeah often like I’d just be lying awake thinking about it, feeling miserable. And particularly [clears throat] particularly when I had the implant and then that made it worse and like that let me up a lot because I felt like it was my fault. Because I felt like I'd been kind of talked into having it and I'd kind of been, I felt a bit misled because obviously they’d said, “Oh, like don’t worry, like if it’s a problem we’ll just take it out and it will go back to normal.” But I felt like I should have said, “No,” that it wasn’t worth the risk and so I, yeah that was particularly kind of yeah, frustrating for me because I felt responsible. And like the whole time before I’d never really felt like I had any control over like what made it better or worse and then suddenly it was like, it had become a lot worse and it was sort of my fault. And yeah so that was quite frustrating.

And that definitely kept me up [laughs]. And then also all the times that I kind of lay awake wondering what to do about it and like yeah. So yeah, yeah I think it did affect my sleep [laughs].
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