Acne - A Four Letter Word


Is it not enough that we are blessed with the whole aging cycle, PMS, wrinkles, lines, graying hair and arthritis as we grow more mature and wise? Everyone always told you that acne was just a complexion problem and that you would outgrow it if you stopped eating so many french fries, hamburgers, sodas, chocolate and candies! 

How can acne go away when so many of us inherited the gene that causes acne from our parents and ingest medication, vitamins, homeopathic remedies, hormones and birth control pills which exacerbate the very problem we are trying to get rid of? 

I'll bet your parents never told you that one out of three adult women and one out of five adult men have Adult Cosmetic Acne from their skin care products, shaving creams, sun blocks, makeup, acne products and self tanning products. Since consumers are taught from the cradle to purchase by The Three P's:  Perfume, Packaging and Price, the cosmetic companies just change the color, fragrance and packaging for men so it will appeal to their psyche.

If you have inherited (genetic) acne and have cosmetic acne from products, it simply does not go away as we age. Instead, we reap the benefits of aging skin and the effect it has had on our acne, giving us discolored, uneven, bumpy, leathery, red or irritated looking skin.

For most sufferers, Acne is truly a FOUR LETTER WORD and worst nightmare come true. What could possibly be more exciting than going into a board meeting, national sales meeting, class reunion or group therapy session with an uneven, scarred or bumpy face full of ZITS? I can't think of anything except total memory loss or a huge unpaid bill from the IRS right in the middle of a PMS cycle!

Acne Statistics and Facts

85% of all U.S. teenagers are affected.

25% of these will have permanent scars.

20% of all adults have active acne.

60 million Americans have active acne.

20 million Americans have acne badly enough to cause scars.

Acne is an autosomal (dominant characteristic gene) inherited disease.

Only 11% of acne sufferers seek help.

Acne is socially taboo.

The medical establishment or society does not take acne seriously.

Past acne treatment has staggering failure rates

False Myths About Acne

"Chocolate and greasy foods cause acne."

"Dirty skin and hair on your forehead cause acne."

"Sexual frustration and thoughts cause acne."

"Acne is a teenage disease."

"Acne scars will disappear with time."

"I do not have acne...just complexion problems."

"No treatment works."

"The right cosmetics will improve my acne."

"Acne is a manifestation of psychological problems."


In the first part of this series, we covered the myths, aggravating factors, and genetic predispositions that cause acne to form. Now we will cover the Acne cycle how lesions form, and how to eradicate them.

There are two basic kinds of lesions or zits: non-inflammatory and inflammatory

Whichever kind or combination you get, the lesions or zits you have take 90 days to form. So there are zits forming right now that you will not see or feel for about three months, unless they are exacerbated by stress or medication.

Non-inflammatory Lesions 

Each lesion starts out as a micro comedo or hard white "millet seed" under the skin. Normally, a comedo turns into a closed comedone or hard white bump and then turns into open comedones or blackheads and fall out. This process, unless exacerbated by stress, takes about three months.

Non-inflammatory acne lesions don't give the pizza-face look that inflammatory lesions do, and from a distance, the skin looks relatively clear. Scarring from extraction may occur if the entire lesion is not removed leaving discoloration, holes or craters, and/or keloids or raised scars. Have your lesions removed by a professional.

Inflammatory Lesions

In this case, the hard millet seed turns into a papule (a sore bump commonly called a pimple), which has no opening. As more inflammation takes place, pus develops near the surface and turns into a pustule.  If the lesion is very deep under the skin, it turns into a nodule filled with pus and becomes about the size of the end of your little finger or larger.

In terms of treatment and removal, inflammatory acne is easier to clear as it responds to medication quicker than non-inflammatory acne.  Well, you might say, all of this is very interesting. How does it concern me and how do I get rid of it quickly, efficiently, and economically so that I look normal?

For a long time, it has been almost impossible for consumers to obtain accurate, helpful information about acne.  Because of the misinformation pervading the skin care market, the average individual has spent thousands of dollars and been to at least ten different treatment centers before they get real help.

The Most Important Points to Remember for Treating Acne:

Length of time the professional has been treating and clearing acne.

Overall success rate.

Is there a product guarantee?

Are the products non-comedogenic (do not cause additional acne)?

Is the professional recommended by a physician to treat acne?

Does the professional complete a thorough inventory of your medications, both prescription and over-the-counter and explain possible side effects to you?

Will they clear your Acne in 90 days or less?

Will they explain how to lighten or stop discoloration, reduce the effects of scarring and be able to suggest medical help to reduce deep scarring if necessary?

If you would like our suggestions and recommendations for Clearing your Acne please order the Try Me Pack of your choice, fill out our Skin Analysis and send it to us. Filling out a profile will ensure that you have ordered the correct products for your particular skin conditions, as well as enable us to start you on the path to flawless skin much more quickly!  Acne will always be a four-letter word unless you make an educated and informed decision to clear it up.


The Four Grades of Acne

Grade I

Consists predominantly of whiteheads (closed comedones) and blackheads (open comedones). There is an occasional inflammatory lesion, however, there are at least 25 lesions on one side of the face at any given time.

Grade II

Maturation Arrest Acne is the most difficult to treat and evaluate. The face becomes STUDDED with many whiteheads (closed comedones) and from a distance looks clear. Up close the skin feels and looks rough. The lesion count reveals 50-100 whiteheads on only one side of the face with an occasional inflammatory lesion.

Grade III

In addition to the mixture of whiteheads (closed comedones) and blackheads (open comedones), there are a constant number of inflammatory lesions (7-10,) pustules and papules at any one time on one side of the face. Grade Three Acne is painful because of the swelling, size, and duration of the lesions.

Grade IV

Cystic acne contains all of the above lesions plus nodules and cysts. It is very painful both physically and emotionally with severe inflammation that is very red or purplish in color and is commonly called "Pizza Face" Acne. Grade Four responds very quickly to treatment because all of the lesions are on the surface.

The Two Basic Causes of Acne

1. Acne is Inherited

The gene which gives one acne is autosomal, or a dominant characteristic gene. If a brown and blue-eyed couple had a child, the baby would have brown eyes because brown is the dominant characteristic or autosomal gene. If you want to blame someone for your acne, blame your parents because they gave it to you. You did not get it from eating too many fast food hamburgers with French fries, drinking too many sodas, eating chocolate, thinking about sex, having sex, or not washing your face.

2. Cosmetics

Cosmetics are the second largest contributing factor for adult women and men who suffer from acne. 99% of the over the counter items you buy to cleanse your hair, wash your face, apply powder or foundation with, use to reduce lines and wrinkles, shave or use sunblock and self-tanners are comedogenic or acne causing. Comedogenic (ko-mea-de-oh-gen-ic) ingredients have the ability to form the small open and closed lesions generically called blackheads and whiteheads, which look like small bumps under or on top of our skin. These lesions are non-inflammatory, not the "Big Mothers" one sees in inflammatory acne where it looks like your nose has been moved to the side of your cheek just in time for your new portrait! 

If your blush is comedogenic, you will have these lesions in the blush area. Your lipstick or lip liner would cause lesions to occur around the lips. Foundation, powder, sunblock, moisturizers, acne products, and skin care products would affect your whole face. If Comedogenic Ingredients are in all of your products, then lesions and zits will appear everywhere. My favorites are Isopropyl Myristate and Sodium Lauryl Sulfate, which are the main ingredients in the toilet and drain uncloggers!! They are the main or first ingredients in almost all skin care products because of their ability to make clogs disappear and make your products feel smooth and silky.

They also give you cosmetic acne. Many companies label their products as "non-comedogenic" and still include bad ingredients in their products. Since most acne sufferers have oily areas on their skin, many companies label their products as water-based or oil-free and use Acetylated or Ethoxylated Lanolin. Because these oils are synthetic and do not come from animals or plants it is legal to use the term "oil-free" on the label. However, synthetic oils still make you oily and they cause acne. 

For more information on this topic, please read the articles, Become An Acne Detective which contains a list of Comedogenic Ingredients and I Bought Everything They Told Me To and I Still Have Zits, which teaches you how to test your products for oil.

In the first part of this article, we uncovered the myths about acne and discussed two major causes: heredity and cosmetic or comedogenic ingredients. Now we will look at additional factors, which can aggravate or exacerbate Acne: Stress, Heat and Humidity and Medications.


1. Stress

Did you ever feel like you were trying to push a very large boulder up a very steep hill? We all have stress in our lives, whether large or small, which affect how we feel, look, and respond to life including, but not limited to Acne. Unfortunately, stress exacerbates any disease or illness and Acne is no exception. When stress occurs, the adrenal gland (which produces adrenaline) stimulates the pituitary (hormone gland) to make extra Progesterone to help cope with the stress, and ten days later additional Breakouts occur keeping the "ZIT CYCLE" in full swing. The bad news is that stress may cause a small non-inflammatory lesion such as a whitehead or blackhead to turn into a mature nodule ("Big Mother") in less than 24 hours. When dealing with stress and acne, it is important to remember that it is the manner with which we handle the stress that effects our acne.

The Stress Effect

Men: Although they are not immune to stress, and do have "flare-ups", men are more fortunate. When men go through puberty they start creating large amounts of Testosterone and continue to create it throughout their lives at high levels keeping their sebaceous (oil) glands at maximum stimulation. Men produce most of their male hormones in the testes and only a small amount in the adrenal gland. Men do not have monthly hormone fluctuations causing their hormone levels to go up and down, therefore, extra surges of hormone production in men have less effect on their Acne.

Women: The stress effect is very important during a female s 28-day menstrual cycle. On the 15th day of a normal cycle, the body produces Estrogen to promote ovulation. On the 18th day, her body produces Progesterone or Androgen to stop ovulation. It takes about 10 days for Progesterone to travel through the bloodstream into the skin. This, unfortunately, brings her to the start of her menstruation, which is when most women flare up! This "flare up" of Acne produces our friend MORE STRESS and the whole cycle begins again.

What You Can Do About It

When the body s resistance is lowered through stress the immediate stress-acne effect is seen. The interruption of healing caused by the stress hurts the acne sufferers weakest link, the hair follicle or pore. New lesions start to form, healing lesions start to break down again, blackheads and whiteheads turn into Big Mothers overnight, and the skin becomes more oily or unhealthy looking.

Handling stress may include medication, walking, exercise, shopping, resting or quiet time, yoga, reading, or any activity which promotes relaxation and calm. Whatever allows you to Control Your Stress instead of letting your stress control you is the important factor. 

2. Heat and Humidity

False: Hot water opens pores and Cold water closes pores. 
(How many times did your mother tell you that one?)

True: Pores have no muscles and do not open and close.

Behind every old wife's tale is a grain of truth.

Heat and humidity (St. Louis has the second highest rating in the U.S.) cause acne flare-ups because the skin "swells" from the cardiovascular system kicking in. When you get hot or exercise, two things happen at once. Your skin swells from the freshly oxygenated blood sent to the surface to feed the muscles that are "working" and then you start to perspire producing acids and salts to "cool" the body off. This combination of swelling skin with acids and salts irritates and dries the skin and can cause ZITS to get worse and become larger. (In Vietnam, many soldiers had acne flare-ups on their entire bodies because of the heat and humidity.)

Individuals who have a phone pressed up against their face all day long (Telephone Acne), get acne on the chin and sides of the face. If you wear sports glasses, helmets, hats, or headbands while doing physical activities you will get zits around the eyes, hairline, or forehead. Physicians, nurses, and dental technicians who wear face masks get more lesions around their mouths, chins, and lower cheeks. Heat, humidity, exercise, and perspiration can cause dryness and irritation in the very areas that have acne. It is very important to use a Cool It Bag when doing any sport or when exposed to heat and humidity.

Truth: Cold or ice causes the skin to compact or get "thinner."

When you ICE lesions or areas, which are covered with Zits, these areas shrink slightly in size. This allows products like Miracle Zit, Fix Zit, Smoothing, Firming & Brightening Creme, 20% Smoothing Gel, Lightening, Brightening & Redefining Illuminator, Retina, Renova and Avita to work more quickly to minimize or eradicate these lesions. Ice your face with an ice cube for one minute before applying your products.

A physician would have you do this for a sprain, burn, or bruise to reduce swelling and irritation. Keep these Acne Fighting Products in the refrigerator because they also work more quickly when cold.

3. Medication

Medications also causes many acne flare-ups and can give acne to individuals that do not already have it. Many medications such as Progesterone (Androgen) dominant birth control pills and hormones, given to women for menopause as well as birth control, cause acne to worsen and appear in individuals who did not have it before starting the medication. This can happen within a matter of weeks. 


Progesterone (Androgen dominant) birth control pills are preferred by physicians because there are fewer side effects in terms of your health associated with them, cardiovascular problems such as blood clotting and migraine headache. For Acne-prone women these pills result in Acne flare-ups by stimulating greater production of sebum (oil,) consequently the skin becomes oilier and in a few weeks, Acne Lesions start to appear. 

Estrogen dominant birth control pills give extra Estrogen to your system and Acne Lesions start to clear. The synthetic Estrogen in the medication leads the pituitary message center to shut down all the hormones normally produced in the ovaries. Since about one-half of a woman s Testosterone is produced in her ovaries, the Estrogen pill lowers her Testosterone, which means less sebum (oil) is produced and Acne abates. 

For many women, menopause means a reduction in Estrogen. Estrogen is the hormone that keeps our skin youthful looking, soft, and supple. Progesterone now becomes the dominant hormone. Many women are prescribed Estrogen and Progesterone together for menopause and the additional Progesterone can cause an Acne problem. Too much Progesterone promotes excessive hair growth (hirsutism), acne, oily skin, and weight gain.


Pregnancy, while not a drug or medication, can have a very strong effect on your Acne. Many women experience "flare-ups" during the first trimester (first through the third month of pregnancy) because her body contains extra Progesterone during this time. The good news is that during the second and third trimester (fourth through the ninth month of pregnancy) and the first three months after the baby is born, your body is flooded with Estrogen. Your skin should be beautiful because the Estrogen keeps sebum production at a minimum and your Acne is held at bay!

Need to Know Information

Have your blood tested and ask to be checked for hormone levels to determine if you have too much Progesterone or Androgen in your body if you are female. This test will let you know if the Acne "decorating" your face is because of a hormone imbalance caused by your own body, the birth control pills or hormones you are taking, or Genetic (Inherited) Acne. Very Oily Skin, Hyper Pigmentation, Rash, Excessive Hair Growth, Acne Lesions, etc. may be hallmarks of too much Progesterone.

Research any medication you are taking in a Nursing Drug Handbook, PDR (Physicians Desk Reference) or on the Internet to find out if the side effects (listed under Contra-Indications - Skin,) are Acne, Oily Skin, Hyper Pigmentation, Rash, or Excessive Hair Growth.

Keep a record of the dates you started taking medications, whether for Acne or another condition and see what the progress of your Acne has been since starting the medication. Is your Acne better, worse, or the same? Was this medication supposed to help clear your Acne? If you have been on it longer than one or two months and there is NO IMPROVEMENT or your Acne HAS BECOME WORSE, then consider discontinuing the medication. 

Research your Birth Control Pills and Hormone Replacement Pills to find out if they are Progesterone or Androgen dominant and why your physician prescribed this particular pill for you. There are new birth control pills on the market, which are made for Acne Sufferers and will not induce or make your Acne worse. The new Tri-Phasis like Tri-Cyclen are effective. Many physicians prefer Progesterone dominant pills because the side effects on the body are lower than Estrogen dominant birth control pills. However, for Acne Sufferers they make your Acne worse and will not help you to clear it up at all.

Additional Medications Which Cause Acne

Steroids: used for arthritis, chronic allergies, kidney ailments and psoriasis

Danazol or Danocrine: used to treat endometriosis and fibro-cystic disease

Dilantin: used for Epilepsy

Lithium: used as a Bi-Polar medication

In addition, many of the over-the-counter topical acne medications contain Comedogenic (acne-causing) ingredients, which will worsen existing Acne or give Cosmetic Acne to those who do not already have it. Learn to Become An Acne Detective. Check with your physician, look in a Nursing Drug Handbook or PDR, (Physicians Desk Reference) for any medications you may be taking to make sure that they are not causing problems for your Acne.

Barbara Strickland 1998-2016. This information is published and may not be reprinted.

Sage Skin Care, Inc.