It is unclear exactly why some people are more prone to pimples than others. Hormone fluctuation and genetic factors may play a role, as acne often runs in families, but some other factors are possible.
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Good and bad bacteria
Just as in the gut, we have “good” bacteria that protect against disease and “bad” bacteria that cause disease, scientists have suggested that the same may be true for the skin.
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Researchers at the Washington University School of Medicine identified two unique strains of P. acnes in the skin of 20 percent of people with pimples, while those with healthy skin tended not to harbor these strains. source
Another strain of P. acnes had the opposite effect. People with pimples tended not to have this strain, but those with healthy skin did have it.
This may indicate that particular types of bacteria determine the severity and frequency of pimples. The researchers suggest that these bacteria may also interact with different factors, such as hormone and sebum levels. They call for more research.
Yeast infections
Acne-type breakouts have also been linked to yeast infections.
Pityrosporum, also known as malassezia or folliculutis, happens when a pityrosporum yeast enters the hair follicles and multiplies, triggering an itchy eruption of tiny, itchy, rounded pimples, that resembles acne. It mainly occurs on the upper chest, shoulders, and upper back, but it can also affect the face.
Most people have this yeast on their skin, but if too much develops, it can cause a problem. It can happen to both men and women in young to middle-age.
Humid, sweaty environments, clothes made of synthetic fibers, and the use of oily skin products can all make this worse.
The condition is common in adolescents, probably because of increased sebaceous gland activity. It is not the same as acne, but it is often confused with it.
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Antibiotics that are usually used for acne can make also make the condition worse, as they suppress the bacteria that would otherwise control the yeast. Antifungal treatment is needed in the case of malassezia.
Testosterone sensitivity
Researchers have found a link between acne pimples and higher levels of testosterone and other androgens, the “male” hormones that also exist in lower levels in females.
Higher testosterone levels appear to to trigger greater activity in the sebaceous glands, resulting in more clogged pores and higher chance of acne.
Dietary factors
The role of diet in acne is unclear, but, since a healthy, balanced, diet is known to promote good health, some dietary factors may affect the likelihood of getting acne or pimples.
Vitamins A, D, and E are all known to play a role in maintaining healthy skin, so it is possible that an adequate supply of these vitamins may help prevent acne.
Milk consumption has been associated with acne. If milk does play a role, this could be due to the hormones in milk. However, findings have been inconclusive.
It has often been said that sugar and chocolate trigger acne, but research findings have not supported this.
Studies have linked a low glycemic-index (GI) diet with lower levels of insulin in the blood, lower levels of androgen, and a reduced likelihood of acne.
However, the results are not conclusive. Moreover, advocating a low GI diet could discourage people from consuming enough whole grains and other healthful foods that could provide useful nutrients.
Although acne is related to sebum production, avoiding all fat in the diet is not advisable. Healthy polyunsaturated and monounsaturated fats are necessary for key bodily functions. A fat-free or very low-fat diet can cause the skin to dry out and prompt the body to increase sebum production.
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A good intake of fats from nuts, seeds, and olive oil may help by keeping inflammation in check, supporting the body in maintaining healthy blood sugar levels, and maintaining good skin moisture levels so as to provide an effective barrier and immune response to prevent bacterial infection.
According to the American Academy of Dermatology (AAD), “There is not enough data to recommend dietary changes for acne patients.”
If dietary changes are to play a role in acne treatment, the AAD suggest that this should be as a “complement to proven acne treatments,” rather than as a sole treatment. They suggest that individuals monitor themselves to see what might trigger a breakout.
Tips include:
- keeping a food diary, and sharing it with a dermatologist
- waiting for 12 weeks after cutting out a particular food, as it may take time to see the impact
- continuing with regular acne treatment while making any dietary changes
Some medical conditions also increase the chance of pimples, for example, polycystic ovarian syndrome (PCOS).
Since acne appears to stem from a complex interaction of nutrients, hormones, and other factors, it is difficult to pinpoint exactly what causes pimples to worsen.
If acne and pimples start to affect a person’s quality of life and self esteem, a doctor or dermatologist can often help.
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