Chocolate Causes Breakouts and 19 Other Acne Myths Debunked

Don’t base your skincare regimen on false information. Drs. Katie Rodan and Kathy Fields take on 20 common myths about the causes and cures for acne and set the record straight. Here’s the truth about food, sun, age, Accutane, and more from their book, Unblemished: Stop Breakouts! Fight Acne! Transform Your Life! Reclaim Your Self-Esteem with the Proven 3-Step Program Using Over-the-Counter Medications.

  • Acne Is Your Fault
    False. Acne is not and never will be your fault. Acne is caused by a combination of factors. These include genetics, hormones, bacteria, overabundance of oil, the plugging of skin pores, your unique immune response to the p. acnes bacteria, stress, environmental factors, medications, excessive rubbing or irritation, cosmetics, and even traveling. It is not caused by how you wash your face (or with what) or by any of the foods you eat. Some people never break out; some never stop.
  • Acne Can Be Cured
    False. There is not yet a cure for acne. It’s a complicated condition. Even the prescription drug Accutane, the strongest oral medication for acne, does not provide a permanent cure. But you can help prevent and control mild to moderate acne blemishes once you start following our program.
  • If You Leave Your Acne Alone, You’ll Outgrow It
    False. Don’t wait. It’s so important to start treating breakouts early. Untreated, acne can get worse. For example, comedones (blackheads and whiteheads) can evolve into pustules and pimples. If it does get worse, it can leave scars — physically on your face and emotionally in your heart for a lifetime.
  • Acne Is Just a Little Problem. Don’t Overreact. Stop Worrying About It
    False. Almost everyone who has acne is embarrassed by it — if not mortified and depressed. Acne not only lowers self-esteem, it often affects social behavior. It’s hard to have a social life if you don’t want to leave the house. Acne can even affect job performance, especially if you feel inhibited about being seen and judged by your peers.
  • Spot Treatments Will Cure Acne
    False. Spot treatments may help dry up a newly visible pimple, but that pimple started forming weeks before you were aware of its existence. Instead of spot treatments, it’s wise to preventively treat all acne-prone skin on a daily basis so breakouts can’t get started in the first place. Think of treating acne as you think of brushing your teeth: Do it every day and prevent a problem.
  • Acne Is Caused by Eating Greasy Foods, Chocolate, or Caffeine
    False. Medical studies have found that diet — including chocolate, pizza, potato chips, and french fries — rarely affects acne.However, if certain foods consistently make you break out with acne, it’s common sense to try to avoid them. For example, for some who are supersensitive, eating foods with a high iodine content, such as shellfish, dried fish, and seaweed, may cause flare-ups, which may explain why the Japanese, who usually have a terrific, balanced, low-fat diet, still get acne. Some other studies theorize that the hormones in chicken, beef, and dairy products may precipitate early adolescent acne, but the jury’s still out on that subject. If you’re concerned, substitute other sources of protein and calcium for these products or try hormone-free, organic versions of them.
  • Sugar Causes Acne
    False. An article entitled “Acne Vulgaris: A Disease of Western Civilization” was published in the Archives of Dermatology in December 2002. The writers concluded that there’s an astonishing difference between Western and non-Western societies in terms of how much acne people get — a difference that can’t be due just to what’s in the gene pool. They blamed acne on excess consumption of sugar in Western countries. However, critics of this study noted that the authors looked only at a small, genetically distinct tribe of natives in Papua, New Guinea, to represent non-Western societies. This tribe has a much later onset of puberty than other societies around the world, which means their hormones associated with acne kick in later in life. It is therefore not a representative group.Finding out what causes acne onset will be a tremendous help in acne treatment all over the globe. But to blame acne on sugar alone disregards scientific research and clinical observation. It’s been our experience that eliminating all sugar or fat in a diet doesn’t eliminate acne. We do advocate a healthy diet filled with complex carbohydrates, such as vegetables, fruit, whole grains, and low-fat protein. We believe refined sugars and excessive fat should be kept to a minimum to maintain a healthy body weight. Unfortunately, however, making changes in your diet alone will not stop acne. So don’t beat yourself up because you just had a chocolate brownie; it is not going to create pimples weeks down the road.
  • Drinking Tons of Water Will Flush the Acne Away
    False. Drinking six to eight glasses of water each day is healthy for your body. But not even the priciest designer-bottle spring water can flush away acne. There’s simply no proof that water can clean the skin from the inside out. Furthermore, while dehydration may temporarily make your skin look lifeless, it won’t lead to breakouts.
  • Sun Exposure Will Heal Your Acne
    False. Small amounts of sun exposure may appear to be helping your acne at first; the blue band of visible light helps to sterilize the p. acnes bacteria. Breakouts temporarily dry up and your new tan helps camouflage angry, red blemishes. But prolonged sun exposure eventually increases the plugging of your pores, producing blackheads, whiteheads, and small pimples. Plus the very real danger of skin cancer, to say nothing of premature wrinkling, cannot be overstated. Exposing your skin to the sun without sunscreen will never be a good idea. Its risks outweigh its very minimal benefits.
  • Acne Is Seasonal
    False. Some people claim their acne is seasonal, worse, perhaps, in summer. While temperature and humidity may increase the oil production of your skin, for most there aren’t seasons for acne. It’s a year-round problem.
  • Sunscreen Causes Acne
    False. A good noncomedogenic sunscreen will not cause acne. However, a heavy, occlusive sunscreen will attract and hold on to heat in your follicles, flaring inflammation and causing numerous small red bumps to form. This reaction is not true acne but a condition called miliaria.Find an oil-free, noncomodegenic sunscreen formulated for acne-prone skin. The risk of skin cancer is simply too great to do without it. This is true for people of all ages and all races. Reapply it frequently if you are sweating in the heat or after you go swimming.

    Also remember that acne medicines, such as benzoyl peroxide, Retin-A, and salicylic acid, may increase your skin’s sensitivity to sun exposure. This is even more reason never to leave the house without first applying sunscreen.

  • Acne Comes from Not Washing Your Face Enough
    False. Acne is not caused by dirt or uncleanliness. In fact, if you overwash your face or strip it with rubbing alcohol in an effort to feel clean, you can produce irritation. While face washing does remove surface oil, there is evidence that too frequent washing may stimulate oil production. Washing twice a day is more than enough to remove bacteria and aid in exfoliation.
  • Acne Is Caused by Oily Skin
    False. It is possible — and often common — to have both dry skin and acne. You can also have both oily skin and no acne. Pores will become plugged and acne will form whether your skin is dry or oily.
  • Using the Right Cosmetics Will Cure My Acne
    False. Some eager salespeople at the cosmetics counters may say anything to entice you into trying their line of new potions and creams. Buyer, beware!
  • If I Have Acne, I Can’t Use a Moisturizer
    False. Many people think that if they have acne, they can’t use moisturizers. Actually, noncomedogenic moisturizers, the kind that don’t cause clogged pores, are a must to hydrate parched, dry skin.
  • Acne Is Contagious
    False. Acne is a non-communicable disease. Even if you run your hands over the face of someone with the worst case of acne you’ve ever seen, you won’t get any pimples as a result. You can no more catch acne than you can catch cancer.
  • Accutane Is the Miracle Cure for Acne
    False. Accutane is the most successful drug used to treat acne, but it should be used only for severe cases, not mild ones. It works by shrinking oil glands for one to two (sometimes three) years, and it normalizes the cells lining the pore so plugging does not occur. A significant percentage of people who use Accutane need a second or third course of the drug, and most require topical skin treatments long term to keep their acne at bay. Accutane also has significant side effects, which require careful monitoring by your dermatologist.
  • Hair in Your Face or Hats on Your Head Cause Acne
    False. Hair and hats by themselves can’t cause acne. But using the wrong kinds of products on your hair or too much of them can exacerbate acne. We call this condition mousse abuse. Comedogenic, acne-triggering hair products, whether mousse, gel, pomade, or oil, can occlude (plug) pores near the hairline, creating fine blackheads and whiteheads. People who wear hats to hide their acne may inadvertently cause excess perspiration and irritation, triggering acne breakouts.
  • Blue Light Therapy Can Cure Acne
    False. Blue light therapy is an interesting approach to the treatment of acne, but it’s not a cure. Blue light is part of the rainbow of visible light (410 nanometers wavelength) emitted from a light source from a machine in a doctor’s office. It works by sterilizing the skin for a short period of time, removing acne bacteria and temporarily improving acne when used in conjunction with traditional topical acne medications. As more dermatologists use blue light therapy, we’ll get a better idea of how well it works or whether its expense and frequent visits will disappoint patients in the long run. Studies are ongoing, but it’s simply too soon to tell.

Katie Rodan, M.D., is an associate clinical professor of dermatology at Stanford University School of Medicine. Kathy Fields, M.D., is an assistant clinical professor of dermatology at the University of California-San Francisco. Both have been profiled in Best Doctors in America, and their work has been featured in numerous national magazines and television shows. They are the authors of Unblemished: Stop Breakouts! Fight Acne! Transform Your Life! Reclaim Your Self-Esteem with the Proven 3-Step Program Using Over-the-Counter Medications (Copyright © 2004 by Rodan & Fields Inc.).


Antiaging Products Demystified: 4 Rules to Remember Before You Start Shopping

There are thousands of antiaging products filling our heads with promises, from pricey prestige brands to drugstore options that are more reasonably priced. How can you choose between them, and which ingredients actually might work? Dr. Ellen Marmur, author of Simple Skin Beauty, demystifies the cosmeceutical mystery with these four rules.

Some products state that they prevent and reverse the signs of aging. Others claim to firm, smooth, and lift the skin, and there are plenty that guarantee they stimulate collagen and diminish wrinkles. Anti-aging products do fill our heads with promises. (I completely expect to wake up looking like Gwyneth Paltrow after using one.) There are thousands to pick from, from pricey prestige brands to drugstore options that are more reasonably priced. How can you choose between them, and which ingredients actually might work?

Most of us feel baffled and frustrated, with way too many choices. (Remember my overwhelming shopping trip?) According to the American Academy of Dermatology in Schaumburg, Illinois, 94 percent of women are confused by their anti-aging options. So let’s demystify the cosmeceutical mystery. There are four rules to remember:

1. Prevent aging skin with what you already own: sunscreen.

Sun protection is the best anti-aging product you have and the best investment you can make. Ninety percent of cosmetic skin problems that occur with age (wrinkles, sagging, hyperpigmentation) are caused by sun exposure, according to the Journal of the American Academy of Dermatology. Therefore sunscreen is the best honest-to-goodness miracle cream on the market. There is no point in buying a bunch of anti-aging products to repair damage if you don’t prevent it in the first place by wearing sunscreen every day. Most cosmeceutical ingredients try to mimic substances found in the body, such as antioxidants, peptides, growth factors, coenzymes, copper, and vitamins. So protecting what we already have naturally and maintaining optimal skin health with daily sun protection and moisturizer is worth a thousand anti-aging beauty solutions. In fact, I have a collection of sunscreens and I use them all differently — an oil-free, broad-spectrum SPF 15 for daily use; an SPF 30 when I know I’ll be outside more of the day; a body lotion with added sunscreen; and an even stronger broad-spectrum sunscreen spray for the beach. Because your skin type changes and the amount of sun exposure you receive does too, your sun protection needs to be compatible. Owning several formulations of sunscreen also reduces the excuses not to wear it, and sunscreens are a better investment than a bunch of cosmeceuticals. Think about it this way: every time you put on sunscreen, you’re preventing the signs of aging and therefore saving money on expensive products or cosmetic procedures to fix fine lines or sun spots.

2. Read product labels closely.

The label must list ingredients from the highest concentration to the lowest, so if the anti-aging element you’re looking for, be it niacinamide or vitamin C, is near the bottom, there’s not enough in the product to do anything. (Keep in mind; a high concentration of the chemical is one way to get it into the skin). Most often, a cosmeceutical acts primarily as a good moisturizer, which is wonderful, but it won’t have much more than superficial and temporary results. Most of the ingredients on the label — the water, moisturizers, binders, and preservatives that make up the vehicle — are inactive. Often an anti-aging product includes silicone to provide a smooth texture to the product and make the complexion look smoother too. It may also contain a little glycolic acid or lactic acid to exfoliate the skin and provide instant gratification. These elements don’t actually change anything below the surface of your skin. At least make sure that the antioxidant or peptide you’re buying is very near the top of the ingredients list. De- coding the label has limitations, however. Most of the time a product does not state the concentration or percentage of the ingredients (and it doesn’t have to). And too high a concentration of some ingredients, such as vitamin C, can be toxic to the skin. You also can’t tell from the label whether an ingredient, like an antioxidant, is stable or not.

3. Choose your anti-aging ingredients wisely.
Okay, let’s shift gears. Let’s pretend that all these cosmeceuticals work.

With so many new ingredients promising to fix so many problems, how should you decide among them? Do you need an antioxidant or a peptide? And what is a growth factor, anyway? Is a prescription retinoid safe, or should you try an over-the-counter version first? Step back, look at your skin, and consider what products you already own. A moisturizer? A sunscreen? A chemical exfoliant or a scrub? (Check to see if your moisturizer already contains an antioxidant or one of the ingredients I’ll discuss soon. You may have been using an anti-aging product for some time without even knowing it.) Ask yourself what you are trying to achieve with a cosmeceutical. Are you in your twenties and looking for a preventive product? An antioxidant is a good bet. Do you want to fight wrinkles? Then something with retinoic acid will work. If brown spots and uneven skin tone are your problem, you can use retinoic acid or try a product with niacinamide. Narrow down what it is about your complexion you want to improve, and that will help narrow down your options.

Tending to your complexion is like caring for a garden, which needs a certain amount of water, nutrients, soil, and sunshine to grow and be healthy. If you overfeed or overwater it, the garden is destroyed. In the same way, putting too much of a good thing on your skin is not necessarily better or more effective. I’ve had patients come in with red, irritated skin and show me twenty different products that they use on it. How do all these ingredients react with one another? Are they overlapping the same kinds of chemicals, such as acids, over and over again? Try to pick one or two active ingredients — an antioxidant and a retinoid, for instance — and stick with them for at least three months (a fair amount of time to see if you get results). Switching from one ingredient to another within a span of a couple of weeks — a niacinamide product, then a kojic acid, then an azeleic acid to get rid of brown spots, for example — cancreate a cocktail of chemicals on your face that can be extremely irritating.

4. Research products, and learn the difference between miracles and marketing.
Do your homework on ingredients, and think logically about their claims. Frequently what is proclaimed to be a new chemical innovation turns out to be a derivative of something that already exists. For instance, an exciting ingredient (whose name was created and patented by a cosmetic company) claims to stimulate the production of glycosaminoglycans (GAGs) and increase the storage of moisture in the dermis. This chemical has a cool, sci-fi name and sounds like an amazing discovery, yet it’s simply a plant-derived form of xylose (a sugar molecule like the GAGs). Again, the manufacturer’s tests are proprietary, and most products containing the ingredient also include hyaluronic acid, a superior humectant. So it’s hard to say which one is responsible for any water retention results in the skin. A little sleuthing online can tell you what a hot new ingredient actually is and if the clinical studies behind it are for real.

Most of these ingredients aren’t really under the jurisdiction of a dermatologist. Traditional medical training has nothing to do with a popular antioxidant like CoffeeBerry, or an ingredient like rare, Japanese seaweed. As a doctor, I must form a medically educated opinion about whether these things provide substantial results or not. I read the claims and the literature available, put them through my dermatologic understanding of the body, and judge if it’s a reasonable hypothesis or not. So far three things have been proven to work as anti-agers: sunscreen, moisturizer (to maintain the health of the skin’s barrier), and retinoic acid.


Ellen Marmur, MD, author of Simple Skin Beauty (Copyright © 2009 by Dr. Ellen Marmur), is the Chief of Dermatologic and Cosmetic Surgery at The Mount Sinai Medical center in New York City and specializes in skin cancer surgery, cosmetic surgery, and women’s health dermatology. She lives in Manhattan with her family.



4 Essential Steps to Beautiful Skin

Following this four-step approach will make a world of difference to your skin’s condition now and in the future. From Trish McEvoy: The Power of Makeup by Trish McEvoy

No matter how tired or short on time you are, regular cleansing is an important part of healthy skin maintenance. Do not neglect this step! Its purpose is to remove makeup, debris, and dead skin cells.

CHOICES: Cleansing balms, cleansing creams, cleansing washes, and cleansing bars. As a general rule, drier
skins do better with creamier textures, and oilier skins do better with washes or bars.

The difference between dull skin and glowing skin is right on the surface. The most common cause of dull complexions is a decreased rate of cell turnover. Exfoliation helps the skin look its freshest by refining the surface and restoring its natural radiance. Everyone can benefit from this vital step of removing dead skin cells, which results in a smoother complexion. Exfoliation also allows better penetration of treatment products and moisturizers. Always remember to use your sunscreen in conjunction with any kind of exfoliation, because the new skin you expose is especially vulnerable. How often you exfoliate depends on how your skin looks. If your skin looks dull or if makeup catches on your skin as you apply it, you need to exfoliate. Some people make it a part of their daily skin care regimen, and others do it no more than twice a week — the minimum I would recommend.

CHOICES: You have options here. There are different types, some that contain alpha hydroxy acids (AEAs) and beta hydroxy acids (BHAs) and some that don’t. Check the label to determine what, if any, acid is included.

Considered the first generation of exfoliation and still popular choices, especially when AHA or BHA is not an option because of skin sensitivity. When purchasing a scrub, look for one that contains smooth, synthetic spherical beads, which are more gentle on the skin.

Many exfoliants contain acids, which have the ability to exfoliate and smooth the skin’s surface, as well as speed up the generation of new cells.

ALPHAHYDROXY ACIDS. The most common is glycolic acid, considered the most effective at improving the overall appearance of the skin since it has the smallest molecule, which allows for the deepest penetration. Glycolic acids can be irritating to extremely sensitive skin types.

BETAHYDROXY ACIDS. More commonly known as salicylic acids, BHAs are slightly milder than AH As. They are used to target acne and clear pores as well as improve skin tone and reduce inflammation.

Moisturizers deliver water to the skin, temporarily plump up fine lines, and smooth and soften the appearance of the skin. They also lock in the water that is already there. It’s just a matter of choosing which formula is right for your skin type. Use an oil-free moisturizer if you have normal or oily skin; if you have dry skin; you can use a more enriched formula.

This is a must! Nothing will help you avoid sun damage and wrinkles more than using a daily sunblock or sunscreen. An SPF of 15 with UVA and UVB protection should be the minimum you wear. Apply sunscreen thirty minutes before going outside.

DAILY SUN CARE. On the days when you have limited sun exposure, a moisturizer with a sunscreen is a good choice. It should have an SPF of at least 15. The great part is that it’s as easy as applying a moisturizer — a true no-brainer.

OUTDOOR SUN CARE. If you know you’ll be spending considerable time outside (for instance playing golf or tennis or going to the beach), step up your sun care regimen. Increase your protection factor to an SPF of 30 and remember to reapply every two hours, especially after swimming and vigorous exercise.

SENSITIVE-SKIN SUN CARE. Nonchemical sun products work by creating a physical barrier over the skin. Look for ingredients like titanium dioxide or zinc oxide. Zinc oxide, which traditionally is white and opaque, is now also available in a transparent form to give even the most sensitive skin a broad spectrum of protection.

Trish McEvoy, author of Trish McEvoy: The Power of Makeup (Copyright © 2003 by Trish McEvoy), is the founder of Trish McEvoy Beauty and the cofounder of Trish McEvoy/Dr. Ronald Sherman Skincare Center in New York City. She has received numerous honors and awards for her work and has been featured in many magazines and newspapers and appears frequently on television. She also believes in helping women grow strong and is a supporter of the Girl Scouts U.S.A.



5 Biggest Beauty Bargains on the Planet

When it comes to basic skin care, there are five bargains that Dr. Amy Wechsler, author of The Mind-Beauty Connection, says immediately go on the list of best beauty buys.

Q. When it comes to basic skin, care, what are the biggest beauty bargains on the planet?

A. Five things instantly go on the list.

  • Vaseline — It’s the best lip moisturizer. And talk about cheap! By the way, don’t use any lip balms that contain phenol (Blistex does, for one). They strip the top layer off your lips. That’s why you get addicted to them; they remove your natural protection.
  • For body lotions, Cetaphil Moisturizing Cream and Neutrogena Norwegian Formula Body Lotion.  I go to the local warehouse club and buy big tubs of Cetaphil Cream or the giant pump dispenser of Norwegian Formula — they’re both terrific.
  • Also at the local warehouse club, I buy Dove or Purpose soap by the case. (If your skin is as touchy as mine, buy Dove in the fragrance-free or sensitive-skin formulas.) Neither of these is expensive anyway, but they’re a little more than some supermarket brands, so why not buy in bulk and save the difference? They don’t strip your skin of good oils.
  • For sunscreens, Neutrogena Sensitive Skin SPF 30 sunblock lotion is a world-class bargain. It contains 9.1 percent titanium dioxide, a crushed mineral that protects you instantly. (No. I’m not on Neutrogena’s payroll! I just like many of their products.)
  • Safflower oil. Yes, the kitchen oil you buy at the grocery store. It’s a super moisturizer, especially for gator-dry legs, and gentle enough for babies (some hospitals use it on newborns). This heart-friendly polyunsaturated oil owes its famous skin-enriching actions to its very high linoleic acid content, a fatty acid that skin normally makes to keep its moisture level up and barrier function intact. Since our body’s linoleic acid production gets sluggish as we get older (it’s why older people can have brutally dry skin), safflower oil helps replace it — from the outside in! Smooth it on immediately after a bath or shower while you’re still damp to seal in the moisture. (Don’t overdo: it takes a bit to soak in.)

Amy Wechsler, M.D., is a dermatologist and a psychiatrist, one of only two doctors in the country who are board-certified in both specialties. She is also the author of The Mind-Beauty Connection (Copyright © 2008 by RealAge Corporation). Evidence of the mind-beauty connection walks into her office every day: “Premature aging and adult acne are the two most common skin problems I see, and stress and exhaustion are often at the bottom of both,” she says. Dr. Wechsler practices in New York City, where she lives with her husband and two kids. She is a member of the RealAge Scientific Advisory Board.