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Acne (young people)

The difference between causes and triggers of acne: overview

Acne causes (‘why do I have acne?’) and triggers (‘what makes my acne worse?’) were key questions for many young people we talked to. Some had ideas about the causes and triggers, but many were unsure or had heard confusing things. Knowledge about causes and triggers came from various sources including doctors, friends and parents, and looking online. Deborah used the internet to research possible triggers, including certain chemicals in beauty/bath products, which had sometimes been helpful.
 

Rachael learnt more about acne causes when she saw her GP.

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Age at interview: 18
Sex: Female
Age at diagnosis: 16
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I remember asking like, "What is causing this?" as well. And they're like… I was like, "Can I wear make-up?" And they were like, "It's not caused by the make-up; like you might think it is but it just, it is the hormones and it is like bacteria and stuff." I don’t really know the exact causes but they were like, "It doesn’t matter if you wear foundation or not; like you’ve either got it or you haven’t got it," and that made me feel a lot better about it I think cos I knew it wasn’t anything I was doing, so yeh.

So, up until that point did you sort of feel like it might have been because you’ve been wearing foundations and?

Yeah, I felt like…I felt like I was wearing the foundation because I had like bad skin but that it was making it worse, but I felt like it was a bit of a cycle that I couldn’t break. But, they like assured me that like that could be a contributing factor but, you do have a skin condition, it's not… it's not your diet; it's not your like what make-up you wear. Cos I was quite active as well, so I did a lot of sport and stuff and… but, no they assured me that it was that, and that made me feel a lot better knowing that it wasn’t my fault yeh. 
 

Dr McPherson talks about acne causes and triggers.

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I think it's always difficult to talk about the difference between causes and triggers. Most people, the cause of their acne is a normal part of puberty and adolescence, and it's to do with a, you know, complex mix of hormones. Particularly androgens, testosterone, which are higher during puberty. So we're not normally looking for kind of an underlying cause, because mostly it's quite well recognised that being in puberty you're kind of acne-prone. And that's partly because of the- mostly because of the hormones. And obviously because of those, the way those hormones will then increase sebum production, which in turn will make it a more favourable state for certain bugs. Particularly p. acnes to live on the skin and cause sort of more problems with acne. There are some other kind of rare causes. So you can have other reasons why you might have increased testosterone. For instance, taking anabolic steroids, or something like that. So very, very unusually there can be other causes. But mostly it's, you know, you’re more likely to have bad acne if you've got genetics or bad- family history, family history of bad acne, and then you're going through puberty. We know that boys tend to have more inflammatory acne in puberty, but girls can have more chronic acne as they get older. So, hormones are the main kind of cause. In terms of triggers, that's a bit more difficult to kind of untangle. Like any inflammatory state, stress can play a role. Which I think, you know, obviously when people find they've got a spot at an important point in their life, and you know, we know that stress can play a role in all of these processes. Other triggers are not so sort of clearly worked out. So people are often interested in diet. And it's a kind of area of increasing research. Probably some places, some places where they have very low dairy diets have very low acne, even in adolescence. So there may be some role for particularly high dairy diets, and that might have some role on the types of hormones and inflammation they have on their skin. Other triggers. So, smoking doesn't seem to make acne- so it doesn't make it better. It's not clear whether it makes it much worse. But mostly people will get acne, you know, even if they have clean skin, if they don't have kind of bad skin habits. It's just unfortunately a part of the way their genetics are and being a teenager.
 

Abbie was confused about acne causes at first.

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Age at interview: 17
Sex: Female
Age at diagnosis: 13
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Can I ask you a bit more about what you knew about acne before you had your first appointment with the GP?

I’d, like I’d looked some things up on the Internet around, cos I used to like think that eating unhealthily made you have acne, or like that, that you were dirty that you had acne. So I used to like look things up on the computer. And there was loads of things like ‘no, it’s not that. It’s just like puberty and it’s like all your hormones and things.’ And all the GPs kept saying that as well. They were like, “You’re young. You’re, you’re going through, like your hormones are all playing up. So it might just sort itself out.” But obviously that wasn’t what I wanted to hear. I wanted it to be gone. But, yeah, so I looked up that it was like something to do with like blocking like your pores or something like that. I can’t really remember. But I just, I wanted to see if there was anything like I was doing wrong, like to see if I’d got the acne. Because I was one of, I was, obviously wasn’t one of the only people that I knew with acne. But I’d got it like the worst out of some of my friends. And I was kind of like ‘oh, why have I got it this bad and they haven’t?’ and stuff like that. And, because there used to be like girls in my year who’d wear like loads of make-up and like wouldn’t getting it. And I’d be ‘oh, why do I get it? I don’t wear any make-up.’ And I used to kind of, that’s why I started searching up things. And it was helpful cos it, it showed me that it was just kind of luck of the draw whether you got it or not.
A few people pointed out that causes and triggers were often confused with each other, but that there is an important difference. Doing things like wearing make-up doesn’t cause acne, but some people found certain products irritated their skin and made them more prone to spots (a trigger). Washing his face before sleep was seen by Will as “laying the groundwork” for better skin but not a ‘cure’ in itself for acne (see also the section on skin care).

Misconceptions about acne causes and triggers

There are myths and misconceptions about acne causes and triggers. Often people had believed these myths themselves early on. Tom was surprised to hear from his GP that there’s no evidence linking diet and acne, even though his friends said there was. Emma thinks it would be good for young people to learn more about acne at school and stop the myths.

Hearing that acne is not caused by the person doing something wrong can make some people feel better – they are relieved to know it’s not their fault. Others felt frustrated that they couldn’t control their skin or change something to help the acne clear up. Naomi felt her skin “just seemed to be bad all the time” and says she “would have done anything to stop that but there was nothing [in terms of triggers] I was aware of.” Abbie wasn’t comforted by knowing that her acne was caused by changing hormones. She thinks that often teenagers “don’t care about hormones or puberty – they just don’t want to have spots any more”.

It can be hurtful when other people unfairly blame the person with acne for having the condition. People worried that their peers would think they were dirty or didn’t wash properly. Devan thinks adults are more understanding than his peers were from primary and secondary school who didn’t “seem to understand that it’s not your fault”.
 

Naomi was upset by others giving incorrect and unwanted advice about acne causes and triggers.

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Age at interview: 22
Sex: Female
Age at diagnosis: 9
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I think I never really had a lot of faith in what just stuff from the shop would do because, you know even pills and creams weren’t doing anything so I mean like what was a face wash going to do. But I think I think like I kind of, because I was so desperate to do something that might help you know, I was so rigorous and I’d be like washing my face like two or three times a day just trying to do something that would make it better and like people used to say, “Oh, you know, you know, you should, you need to drink more water, like that will obviously help.” So I was drinking so much water and like [laughs] I’d be at school with like a bottle of water and just like emptying it and then going and refilling it because I was just so desperate to like kind of, I don't know, I think I thought like maybe it would just wash it out of me or something.

And then one person one time said to my mum, you know, “Oh, it’s the fruit and vegetables, she’s obviously just not having enough fruit and veg.” And so I’d just eat so much fruit because I thought it might help and like nothing made any difference. So, yeah it was crazy. And like you know, one, one person said, “Dairy products are really bad,” so then I just had this massive thing about cheese and like I couldn’t eat cheese because I thought it would make it worse and like it didn’t make any difference, so [laughs]. 

So yeah, I think it really kind of like took over my mind. I mean it was just horrible.
 

Marga finds it annoying when other people imply acne can be easily ‘fixed’.

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Age at interview: 24
Sex: Female
Age at diagnosis: 18
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Or things like, for example, they’ll be like, “Oh if you do this that'll be fine,” or, you know, “It'll be fine in the summer when you get in the sun.” And obviously the sun has-, does make spots better but it doesn’t make them go away. So, I guess it's also that sort of blaséness being like, “Oh if you do this it'll be fine,” and like no, it won't be, [laughs] like if I do that it – they’ll still be there. So I guess for other people who don’t actually-, aren't actually experiencing or aren't in that situation at the time, having the spots I guess it's not-, it's easier for them to make the blasé comments about it. And – as if, I guess it makes you think as if it's like you're doing something wrong and that’s the reason you have spots. I guess it's that sort of blaming in a way.

And it's not, it's not that easy, it's not, it's not as simple as that, you know, if I stop touching my face then my spots will go away [laughs].

Doesn’t really work like that I don’t think, so yeah.
 

Hester talks about other people’s misconceptions about acne.Hester talks about other people’s misconceptions about acne.

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Age at interview: 21
Sex: Female
Age at diagnosis: 15
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A lot of people, I think they think that it's caused by a lot of things which it's only exacerbated by. And I didn't really realise that until I started doing my research. And I think a lot of things that are really unhelpful are often adverts for like cleansing products and stuff like that, which are just not that scientific. And a lot of them are like ‘oh, you just cleanse the dirt out your face’. And I think I found that the most frustrating one, that people would assume that you just didn't wash enough or your skin wasn't clean. Or that it was just because you're really oily. Whereas I've found that I actually have very, very dry skin, which was made worse by a lot of the topical creams. Because obviously they dry your skin out a lot. So I was having to use like really heavy moisturisers, and my skin would still be quite dry. It was only really when I was a teenager for a brief bit that I had oily skin. But other than that, my skin is very, very dry. I would have actually to be using like Bio Oil and things like that. And that doesn't, yeah it wouldn't make my skin oily, so. I think a lot of people think that you just need to wash regularly and it would be okay. A lot of people think it's because you eat a lot of bad food. But I know that can exacerbate it, but none of those things cause acne, it is a medical condition. And I think a lot of people-, everyone wants to give you a suggestion and advice but a lot of it's really unscientific. And I know I've. Yeah [laughs]. This one woman in South Africa sort of suggested that I should try honey and cinnamon. And I think that was the only time I turned round to her and said, “Oh, I'll have to, I'll have to go and tell my dermatologist cos he'll be so pleased that you've found a cure for acne.” But, yeah. I think there's a lot of bad science out there. And people think that spots and having acne are kind of just the same thing, and they are actually quite different. 
‘General health’

Having a ‘healthy lifestyle’ was mentioned as important by some people. This included things like getting enough rest/sleep, drinking lots of water, fresh air, and having a balanced diet (e.g. with vegetable and fruit). However, as Chris added, a healthy lifestyle might be good for the skin but it alone is unlikely to clear up acne. Some felt that GP’s should tell young people with acne more about how to have a healthy lifestyle as well as offering medical treatments. Although Sarah’s and Harriet’s doctors both reassured them that diet and acne were not linked, they felt that diet might be relevant in their cases.
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