What

Certain factors are known to cause or aggravate acne. Avoiding these factors contributes to better treatment results, as well as preventing relapses after successful treatment.

Picking and squeezing
It is common to pick at acne lesions and squeeze out the retained sebaceous materials, under the mistaken impression that this will unblock the pore and speed up healing. In fact, this often causes unnecessary skin injury, introduces bacteria, and worsens inflammation. The result is often darker, deeper and more permanent scars.

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Premenstrual flares
Women may complain of acne flares just before their menses. These premenstrual flares affect up to 40% of women with acne, and are related to normal fluctuations in hormone levels over the menstrual cycle. The flares usually resolve quickly after the menses end. The regular use of topical anti-acne creams may help reduce premenstrual flares.

Stress
Acne often worsens during periods of stress, worry, anxiety and tension. A recent study by researchers from Stanford University published in the July 2003 Archives of Dermatology reported that acne in a group of students deteriorated with increasing stress levels in the examination period, suggesting that changing hormones and neuroactive substances produced during stress may have a significant influence on acne. Flares during stressful periods are probably also exacerbated by failure to use the anti-acne creams regularly. To prevent and minimize such flares, patients should learn stress reduction and relaxation techniques, and diligently apply anti-acne creams daily over acne-prone areas, even if they have no breakouts.

Creams and medicaments
Certain creams and medicaments may make acne worse, including some medicated creams and thick, oily creams. Topical steroids, often prescribed to treat eczema, may lead to an outbreak if used excessively and inappropriately. This type of acne is often characterized by multiple red, inflamed monomorphic papules and pustules.

Drugs
Some drugs are well documented as aggravators or even causes of acne. These include corticosteroids given either orally or by injections, lithium for treating manic-depressive illness, and testosterone pills/injections which may be used by professional athletes and bodybuilders to increase musc’e mass~ Danazol, sometimes given to women for
endometriosiS (growth of tissue from the uterus in parts of the body other than the uterus), is similar in effect to testosterone and can aggravate acne.

Cosmetics
Most people can use cosmetics without any side effects, but a small group of users develop cosmetic acne, which usually presents as small, raised whiteheads or small, inflamed papules and pustules over the face where the product has been applied. Since the acne usually appears gradually after several months of repeated use of a comedogenic product, many people do not connect their outbreaks with the product in question. A woman with cosmetic acne is caught in a vicious cycle: the more she breaks out, the more make-up she uses to cover it up, which only leads to worsening of the acne.

Ingredients in cosmetics that may aggravate acne include lanolin, analogs of isopropyl myristate, algae extract, cocoa butter, laureth-4, lauric acid, octyl palmitate, coconut oil,
and D&C red pigments. Practically speaking, it is difficult to remember all the ingredients in cosmetics that may aggravate acne. As a general rule, it is best to use cosmetics from well-established, reputable companies that have tested their products extensively and have labeled them non-comedogenic.

Climate
Acne tends to worsen in hot, humid climates and work environments, such as kitchens and steam rooms. Why heat and humidity have such an aggravating effect on acne is not exactly known. We do know, however, that the outer layer of the skin (stratum corneum) swells tremendously under humid conditions. The pressure from the swelling could block the opening of the pilo-sebaceous unit and cause acne to develop.

An artificial source of steam may also aggravate acne. Many people who use facial steaming devices believe they are “opening their pores” — they may actually be swelling them shut.

Occupation
Jobs that involve contact with certain chemicals may also worsen acne. These chemicals include insoluble cutting oils (in the engineering and manufacturing industries), crude petroleum (in the oil refining industry), diesel oil (in motor mechanics), and halogenated aromatic hydrocarbons (in industries manufacturing conductors and insulators, and insecticides, fungicides, and herbicides).

What Make Acne Worse?