Propagated by word of mouth, popular magazines, newspapers, and teenage Internet chat rooms, the blame for unsightly pimples has been placed on everything from lack of sleep to eating too much chocolate to a dirty face to not drinking enough water and — this one is really popular in locker rooms — exercise.
"There are substantial differences between popular belief and scientific support, yet this does not change the way patients attempt to care for their acne," says Alexa Boer Kimball, MD, PhD, an assistant professor of dermatology at Harvard Medical School in Boston.
Kimball joined other dermatologists at an American Academy of Dermatology press briefing on acne presented as part of the dermatology group's annual meeting in New Orleans.
Tina Alster, MD, a clinical professor of dermatology at Georgetown University Medical Center in Washington, agrees with Kimball. Alster, who also spoke at the press briefing, says some of her most educated patients still hang on to the myths handed down through the generations.
"Parents at times use the acne myths to correct their children's diet, warning them to stay away from chips and chocolate," Alster says. "Otherwise smart people are still clinging to these notions."
And now a solid fact about acne: At some time in their lives nearly 80 percent of Americans will suffer from some degree of acne.
Although it is more common in the teenage years and early adulthood, acne can occur in adults as well.
Only about 8 to 30 percent of adolescents ever seek professional medical attention for their acne, says Alster. Rather than seeking treatment — and information — from expert sources, acne "knowledge" is passed around among friends, family, and casual acquaintances, Alster says. Most of this "knowledge" is "based on anecdotal observation and conjecture with little supporting evidence."
This point was confirmed in a Stanford University survey of 103 female college freshmen, which found that the young women's knowledge of acne was based more on fiction than fact.
For instance, 91 percent of the young women believed acne could be worsened by poor hygiene, 88 percent thought increased stress triggered acne outbreaks, and 85 percent said that "popping pimples" makes acne worse. Wrong, wrong, and wrong, say the experts.
Additionally, about two of every three women said poor diet, lack of sleep, and not drinking enough water affected acne. Again, Kimball says there is no evidence that any of these were factors in the outbreak of acne.
"The general public believes that cleaner skin will resort to fewer blemishes, but dermatologists know that overwashing can irritate and exacerbate the condition," she explains.
Another study of 24 Stanford men showed that there wasn't a significant difference in whether the face was washed once a day, twice a day, or four times a day. "Men who only washed their faces once a day were slightly worse, those who washed twice a day improved some, and the men who washed four times a day remained the same," says Kimball.
Dermatologists recommend washing twice a day with a mild cleanser, says Kimball.
Moreover, while many acne products are sold over the counter, Kimball and Alster say that it is worthwhile to consult a dermatologist before experimenting with these products.
"It is important for anyone who is affected by acne to seek the help of a dermatologist who can diagnose and provide treatment options that are specific to the patient's skin type," Kimball says.
Sources: American Academy of Dermatology, 63rd Annual Meeting, New Orleans, Feb. 18-22, 2005. AAD press conference, Feb. 21, 2005, "Putting Your Best Face Forward." Alexa Boer Kimball, MD, PhD, assistant professor of dermatology, Harvard Medical School, Boston. Tina Alster, MD, clinical professor of dermatology, Georgetown University Medical Center, Washington, D.C.
By Peggy Peck
Reviewed by Brunilda Nazario, MD
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