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Acne (young people)

Acne triggers: what flares-up acne?

A trigger for one person’s acne may not be a trigger for another person’s. In general, anything that can make the skin produce more oils can be a trigger for an acne flare-up. Ollie and Tom heard that stress was an acne trigger but didn’t think it had been the case for them personally. Shu En finds that doing sports makes her acne worse, but Becky thinks it helps her skin to ‘empty out’ blocked pores.

Working out your own triggers for acne can be ‘trial-and-error’. Ish says it took eight years for him to work out his acne triggers, like stress, and the importance of developing a skin care routine. Deborah will “work backwards to see what could have caused” a particular break-out. Trying lots of different beauty and cosmetic products, including face washes, could be time-consuming and expensive. Sarah cut out gluten and milk from her diet but didn’t find any difference to her acne. Some people said there were triggers they knew of, but break-outs could still happen unexpectedly. Hester and Becky talked about times when their acne got worse for no obvious reason.
 

Tom finds it unclear and confusing with working out acne triggers.

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Age at interview: 15
Sex: Male
Age at diagnosis: 15
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I think stress probably doesn’t help, is what I’ve heard. I don’t know exactly because I don’t really make that connection myself. But I know people who say that their spots get worse with stress, or like I know people who say that their spots get better in summer and stuff like that. And I don’t know if it’s just something to do with the summer or it’s something to do with them, or if it’s just something they feel but might not actually be true. I don’t know. But for me personally I just kinda go by it day by day. So I don’t really make those sort of connections. I, I would just sort of, I don’t know. I do think they get worse with stress though. And I personally think they get worse if I eat rubbish food the night, the day before. If I’ve had a whole pizza the night before and then forgot to wash my face, when I wake up I’d probably be more spotty than if I ate. But that could, apparently that’s not actually a thing according to my doctor. But I don’t know, different people.
The main examples of triggers (i.e. things which can irritate and make acne worse) were:

•    stress – from school, college and university studies (especially exams, deadlines) and social life. 

Molly and Deborah noticed a cycle between acne and stress: stress triggered acne, which created stress and led to more acne. Becky worries others will think she studies ‘too hard’ because of her acne. Shu En thinks that living independently can be a source of stress on a daily basis.
 

Marga thinks the interaction of stress, eczema and diet might impact her acne.

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Age at interview: 24
Sex: Female
Age at diagnosis: 18
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So, I get eczema when I'm stressed, and often sometimes when you have dry skin or eczema, like on your skin, on your face, I think it can pro-, you can get more spots because of that cos I think it like, the dry skin cells and like clog up your pores I think. I don’t know whether that’s true but-. I sometimes I feel like when I get stressed I get ac-, more spots and dry skin, so I don’t know whether that’s got a relationship to it.

But definitely I get spots when I'm stressed.

Like if I'm, I don’t know, if I've got an exam or if I've got like something due in. Another thing actually is interesting – so when I've, this year when I've been quite depressed I've eaten a lot. I've comfort, comfort eaten, so a lot of high sugar, a lot of sort of refined carbs which sort of like really high in sugar. I've like-, I've eaten a lot of that for when I've like not been feeling great, and that gives me spots which is interesting cos I have like a massive sug-,like I have loads and loads of sugar in my system.

And that gets, definitely gets expressed in my skin which is interesting. Like, if I eat like loads and loads of chocolate or like I guess when I've been feeling down I crave unhealthy food, and that definitely, definitely expresses itself in my skin.

Which might be one of the reasons why I've had this bout of acne. I-, sort of after around, like the end of this-, last year, the start of this year, it might have actually a massive link actually thinking about it.
•    foods and drinks – some foods were seen as ‘bad’ for acne, especially those which are “sugary”, “fatty”, “oily”, “greasy” or fried. 

Spicy food was also a trigger for Yi. Harriet, Molly and Marga had all tried cutting dairy out. Chocolate (or particular brands) was a trigger for Becky, Ish, Eli and Deborah. Alcohol can be a trigger, as for Harriet with wine and cider. Some people thought being dehydrated (not drinking enough water) added to their acne. Others, like Shu En, were unsure if diet [link to TS 18] made any real difference to their acne. A few people said they would rather enjoy foods, like pizza, than miss out on them even if it meant having more spots.
 

Becky shares her experiences with food triggers and drinking water.

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Age at interview: 19
Sex: Female
Age at diagnosis: 16
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After I’ve grown acnes on my face I’ve become very cautious. So I pay a lot of 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, 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. Because doctors said, doctors in [home country] said that it’s better for you to drink hot, like warm water, not cold water, cos yeah. 

Okay.

Yeah. And another thing is if you drink a lot of water you have to go to the toilet. And when you are doing your homework or you prepare for tutorials, you don’t have much time for that. And, yeah, I feel very, very powerless. I, I really want to target this problem, but when I’m facing it I really don’t have a chance to fight it.
 

Molly finds it challenging adjusting her diet to work out food triggers for her acne.

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Age at interview: 20
Sex: Female
Age at diagnosis: 11
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But like at the moment, I’m trying to also experiment with my diet. So like I’ve heard about dairy, I’m currently cut dairy out of my diet. Only like the last two weeks, like this isn’t like a, haven’t done this for very long. Because I heard there’s a big link between dairy and acne, but like again that might be a long-term thing, lifestyle change, but at the moment I’m still kind of keeping it up and see if that does anything, I don’t know.

How are you finding that change with cutting out dairy from your diet?

[Sigh] I really miss cheese which is sad but like I’m having like soya milk and like almond milk which isn’t, doesn’t taste too different in a c-, it tastes different like if you drink it but if you put it in a cup of tea which is where I use most of my milk it doesn’t taste much different. So I haven’t, it’s been more expensive as well but I haven’t, there’s been a lot of, also a lot of things which I haven’t necessarily sillily, like in a silly way, I haven’t realised they were dairy. So like chocolate I was like, I didn’t realise that was dairy until somebody pointed it out and I was like ‘yeah I should cut that out as well’. So yeah it’s kind of a, that’s been more of like an experimental one, so I’ve probably had a few like blips where I haven’t realised that I’m eating dairy. And like when you’re, I think that those kind of dietary changes like you do have like points where you just completely forget that like you’re, you’re cutting something out especially if it’s like something you’re doing on your own terms rather than like being explicitly advised by a doctor. It doesn’t, you don’t always remember. I had eggs, oh I forgot I had scrambled egg today [laughter] that’s got dairy. Oh gosh, so yeah stuff like that.

Where did you find out about the research that's been on like links between food and acne?

I mean my mum was the one who came to me, like my mum is really into like stuff like that. Like she really wants me to go to like an allergy doctor, which I’m considering maybe cos she thinks that like it’s, there’s a link between like food and acne. And the thing isn’t, because I’ve had to for so long I wouldn’t necessarily know what to take out of my diet because it, yeah I’ve had it since I was eleven so, I’ve always drunk milk so maybe. But I would consider going to an allergy doctor specifically and seeing if there were maybe anything in my diet that like wasn’t agreeing with me. Because I, I mean I don’t know much research on the links between diet and acne but I definitely find like when I eat some foods that that can have an implication, so like I cut milk out because, and diary, because I cut milk out for a while just on kind of advice and then when I ha-, and I had milk again, it flared up. So I kind of assumed maybe there was some, I don’t know if that was necessarily a link or a coincidence.
•    weather/environment – some people found cold weather made their acne worse, but others said the opposite. 

Lots of people thought sunshine helped and Alexandra said she also feels better with a slight tan. However, others found that hot and/or humid climates made their skin sweaty and more prone to spots, so they preferred cold and dry weather. Many said finding a sunscreen which didn’t irritate their acne was difficult but important. Other aspects of the environment include: air quality (Becky and Deborah both found ‘polluted’ air worse for their skins), air conditioning (which Deborah noticed was a problem with air flights), water quality (based on mineral content) and water type (sea water helped Naomi’s acne but made Kosta’s worse). Moving to a new city or country triggered flare-ups for Marga and Deborah.
 

Yi talks about the impact of the weather on her acne.

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Age at interview: 23
Sex: Female
Age at diagnosis: 14
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And you said earlier that the weather in England has made your skin worse as well, could you tell me a bit more about that?

Oh, I think it’s not like the English weather has made me bad, it’s just that it’s different between what I’m used to so when the climate change and it may cause some problem for the skin.

Yeah. And the, actually like more red, yeah.

So how is that different to the climate that you’re used to?

Like the current season is like very hot in the summer like nearly 40 degrees and also very cold in the winter so I think England like you always have like, s like was in the 20 or like degrees so, it’s so much different.
 
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Molly thinks her acne is affected by water quality.

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Age at interview: 20
Sex: Female
Age at diagnosis: 11
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Are there any other things that can make your acne flare up more?

I have a thing where like, so like changes in water so like when I go ho-, so I live between home and university. So when I come to university and have like the change in water then that usually is, is quite bad and then like I’ll go a few, maybe a week or so and it will calm down. And then yeah when I go home again it’s, it’s the same thing, it’s the change in water which I don’t, I don’t necessarily understand why it happens when I go home because I’ve always had that water but yeah the change in water does seem to have an effect which I don’t nec-, I don’t really understand why.

I’ve kind of just accepted that at the moment that’s a standard thing that it’s gonna happen when I go home and when I come back to uni. I’m not sure if I've just got very sensitive skin to like changes in water, I don’t know how different the water I, it’s a different water area, like I think [university city] like hard water or I’m the opposite so whichever one, I live in the opposite area.
•    make-up and cosmetic/bathing products – there were mixed views and experiences about these. 

Some people believed make-up did make acne worse, but others rejected this idea. Yi thinks make-up means that her “skin cannot breathe” and Molly worried it might “clog” her pores. Others disagreed that make-up affected their acne and found it upsetting when people implied it was the case. Some people looked for special products which were ‘anti-blemish’, contained ingredients like tea-tree or were labelled as ‘non-comedogenic’. Rebecca’s GP prescribed her an oil-free moisturiser as she had found previous ones triggered her acne.
 

Emma prefers to remove her make-up before going to sleep, which can impact on her social life and hobbies.

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Age at interview: 20
Sex: Female
Age at diagnosis: 10
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Because I like to try and get any products that I have on my skin off in the evening. if I am going out now or staying over with friends now - that can be a bit of a pain, because if I can’t take it off, I feel quite like, ‘oh no, I am going to end up with really bad skin tomorrow’. So I do always try and come back and take it off, but. I ‘spose that’s a bit annoying. And also when I go on things like the Duke of Edinburgh Award and my assessor was like, “Why do you have all these products in your bag?” I was like, “Well, I don’t want my skin to be really bad after four days” [laughs] of hiking. So he thought that was a bit strange but I wanted to take them with me [laughs].

So he didn't quite understand that it was quite important for you?

Yeah, I don’t think he understood quite how important I thought it was to make sure that I had the right products and how much I cared about yeah making sure that my skin was okay. 
 

Ish is careful about cosmetic and body care products he uses.

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Age at interview: 22
Sex: Male
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Yeah, if you put something on, for example fake tan, you have to put moisturising on. You, so you’re not alone trying to look for something that helps your acne. You’re going to go to try to find other products that won’t make it worse. So if you’re tanning or anything like that, you’re going to have to start finding products that will work good with your skin every single time. So, that’s a little bit hassle and a lot of money we’re talking about. I mean just the tanning lotion, if you buy one, it’s about like, thirty, forty pounds. They’re expensive. So it becomes a little bit expensive hobby in the end. Yeah

Like trial and error because you just have to….

Exactly, ’cos something will make you break out a 100 percent, you know, and most of the time, out of ten products, it’s nine products that will make you break out and most of the time, it’s the last product that actually works. 
 
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Eli thinks wearing make-up worsens her acne.

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Age at interview: 13
Sex: Female
Age at diagnosis: 11
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When I came from Greece I didn’t have make-up and stuff cos in Greece we didn’t wear that kind of stuff but when I came in England and at the school I realised everyone was wearing make-up so I decided to get some. I already knew that make-up is not good for the skin cos it’s oily and it doesn’t help but I had to because everyone at my school did wear make-up. So I started wearing make-up and foundation and powder and loads of stuff. But it doesn’t like-, it doesn’t really cover them properly because you can see them, like even when you put foundation. When I was in Greece, every time I go to Greece I have this cousin that has a shop and she buys me this cream for my acne and I use it every night unless I forget it sometimes and it really helps. But by wearing make-up every day that makes my acne worse again. Also I eat chocolate and crisps and stuff which I’ve heard are not like very good for the-, for my spots.
 

Marga disagrees that make-up triggers her acne and instead highlights how it helps her feel more confident.

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Age at interview: 24
Sex: Female
Age at diagnosis: 18
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So, I guess the issue about make-up is often people will say, “You have spots because of the make-up you're wearing,” and that, “If you wear less make-up then the spots will go away.” But from my experience it definitely hasn’t been that. I've had spots regardless of whether I've worn make-up or not. And I think that’s sort of-, it's interesting because make-up has become such, like such a safety net for me, of being able to have more confidence when you have spots. But on the other hand people then assume that, you know, make-up's actually the cause of spots rather than something that’s helped to mask it. 

So, I guess it's that sort of people maybe judging why you have spots or trying to put reasoning as to why you have spots when I’ve spent years and years and years trying to work out why I have spots [laughs]. 
Other things mentioned as triggers were:

•    being tired/not getting enough sleep
•    Scratching acne – when asleep (Eli), anxious or sweaty (Kosta), or bored (Hester)
•    having hair touching your face – Ollie and Abbie changed their hairstyles to stop this
•    shaving facial hair
•    fabrics – polyester bed sheets once caused Deborah’s acne to flare-up

Many people thought their acne was probably triggered by a combination of things so it wasn’t always obvious what prompted a flare-up. Triggers can be unavoidable, as for Sarah who found that “simply going outside seems to make [my acne] quite a bit redder”. Marga, Tom and Becky tried to strike a balance with food triggers – sometimes having a particular ingredient, but not very often or in small quantities. Becky explained, “I don’t think that chocolate is a main reason for causing me acnes. So if I completely quit eating chocolate, which is my favourite, it just reduces a lot of fun in my life”.
 

Becky found that moving to the UK impacted her acne in terms of climate and diet.

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Age at interview: 19
Sex: Female
Age at diagnosis: 16
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So you find that the temperature and the weather as well as food makes a big difference for your skin?

Yes. Like in very cold weather I think that my skin can-, cannot breathe. So it cannot let out some very oily or, something that, that holds my pores. Yeah, and also the weather. Like sometimes I find there is some white bit on my face and, and it happens when I feel very dry, yeah. So, yeah.

So what is the weather like in [home country] compared to the UK when you’ve been, cos you’ve been living here for about a year and a half?

Yes, I think it’s about two years.

About two years, [mm hm].

I think where I lived is very, not humid, is not as dry as here. There, there’s a lot of rain too as here. But it’s more hu-, hu-, wet, yeah.

Yeah. Okay. And what about the food? Have you found that’s been different since you’ve lived in the UK?

Yes, like in [home country] I can, like I eat a lot of vegetables that’s cooked by my mum. But here I don’t really like the salad. I like cucumber but not other, other salad thing. So I eat a lot of fried food and that’s not good for my skin. And also I eat, I ate a lot of chocolate before. And I’m not sure if it actually affects my skin, but the doctor said it’s better for me not to eat them, so I kind of quit them. But I really miss them. So, so I, o-, occasionally I [laughs] eat some chocolate, yeah.
 

Naomi thinks there are several factors which might explain why her acne clears up whilst on holiday.

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Age at interview: 22
Sex: Female
Age at diagnosis: 9
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My mum always used to think that when we went on holiday it got a bit better and I think, I think that wasn’t, I mean maybe it was a combination of factors but I think partly, maybe partly the sun but also I think like ‘cos on like beach holidays and you’re swimming in the sea and like maybe the salt, I don’t know. but like yeah I think when I was younger maybe slightly better on holiday but maybe also that was maybe it was also a stress thing because I was away from school and like my peer group and the pressure of, you know, worrying about other, ‘cos I didn’t, I didn’t worry as much about what my family saw so maybe I was more relaxed on holiday and that kind of helped it but . But there was never anything I could pinpoint that then I could have done. ‘Cos if it, if it was the salt water then I, if I’d known that then I could have, I don’t know, used that and fixed it but, or if it was the sun, you know, I could have gone out in the garden all the time [laughs]. But yeah because I never really knew what it was and it was probably a combination of things yeah I never really knew. 
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