I’ve been reading acne related articles and studies from around the world, with topics ranging from genetics to Accutane flare risk factors. After reading them all I took a moment to see if there is a common thread linking them together. One thread I seem to keep finding is stress. Keep in mind that I am simply starting a discussion and not trying to draw any sort of scientific conclusion. Please present your own evidence as well.


1. A Canadian study I read found that living in urban areas was related to Accutane relapse. I know from personal experience that living in an urban area comes with added stressors. While I personally prefer the urban lifestyle, driving is more difficult, sirens wail, and crowds are common. You must stay more on guard to stay safe, even if that means staying more aware while crossing busy streets.

2. A Norwegian study showed a possible link between poor diet and acne in adolescents. While the conclusion was “too early to give evidence-based diet advice” it nonetheless once again shed light on the diet/acne connection. Researchers do not have a consensus about which type of diet is best or worst for acne sufferers, but if poor diet is related to acne, stress would be a factor here as well. A poor diet physically stresses the body. High glycemic (sugary) diets also cause mood swings and can affect mental stress levels.

3. An International Journal of Dermatology article focused on the impact of DHEA-S, an androgen (male sex hormone), on female adult-onset acne. Leutenizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, sex hormone binding globulin (SHBG), and DHEA-S were all evaluated. DHEA-S was the only androgen that was significantly higher in women with acne. DHEA-S is produced in the adrenal gland, the same gland that is activated during times of stress.

So what if stress was more intricately related to acne than we previously theorized? Anything that helps mitigate stress would then help with acne symptoms. Eating a low glycemic diet, getting plenty of rest, exercising, and breathing or meditating, would be potentially beneficial options.

So the clocks turned back and we all got another hour of sleep. Guess what? That’s good for acne.

Lack of sleep is a huge physical stressor. It’s not just mental stress that can aggravate acne. Physical stress like overworking, overexercising, and undersleeping can also increase the symptoms of acne. Getting your eight hours, or however much sleep your body requires, is a great way to help keep your skin in check.

Working the night shift: Dr. Fulton, one of my big heroes in acne research has said in his classes, “I can get pretty much anyone cleared up, unless they work the night shift.” His comment has always stuck with me. While I have not had lots of experience with people who work the night shift, if his experience is correct, it is not just the amount of sleep that is important, but also when we sleep. Science has named our internal biological clock the “human circadian rhythm”. Melatonin levels rise sharply at night and fall during the day. Our hypothalmus and much of the rest of our bodies are hardwired to produce a natural rhythm of sleep and wakefulness.

So if you or someone you know works the night shift and can’t seem to clear up, this may be something to think about.


Hey you guys. I wanted to show you the supps that I take each day. I’ve read enough evidence to come to the conclusion that supplementing with fish oil and zinc is prudent. I also supplement with some other stuff, which I thought I’d share. Here’s a list of what I take each day:

Fish oil: Three 1000mg pills. Fish oil is a potent anti-inflammatory. Acne is an inflammatory disease. Plus, fish oil is great for heart health and a bevy of other diseases. No-brainer. I take Country Life brand because they don’t give me any fish burps.

Zinc: There is probably more evidence backing up zinc for controlling acne than any other supplement. Study after study show about 40% reduction in acne lesions. Keep in mind that placebo is 30%, so zinc outpaces placebo, albeit not to an astonishing degree. I take one 30-50mg pill per day, depending on what’s on sale. Zinc becomes toxic at levels above 100mg/day.

Multi-vitamin: Just to cover my bases I take a name brand multi-vitamin. I prefer a large name brand because I figure they’ve got more to lose if they are found negligent in some way, such as not putting the required amount of vitamins in there. From what I’ve read, we don’t know if a multi-vitamin is definitely beneficial, and multi-vitamins do not contain polyphenols, the life-giving chemicals in plants. But taking a multi makes me feel better just in case.

Borage oil/evening primrose oil: Borage oil, or evening primrose oil both contain GLA (gamma linoleic acid). Their anti-inflammatory activity and efficacy are controversial and still up for debate. So why do I take it? Because I saw a naturopath a few years ago and she told me to, so I take them on occasion. Yeah, not a good reason. I’ll probably stop taking them soon :) But for full disclosure, I thought I’d let you know I take them. If you have recent evidence of their efficacy or non-efficacy please let me know.

Vitamin D3: I take one 1000mg vitamin D3 pill per day. I don’t eat vitamin D fortified dairy much at all, and my sun exposure is limited, so I make sure to take a D3 pill each day.

That’s it. It’s a handful as you can see, but I’ve become adept at gulping them all down in one swig. Have I noticed effects from them? Honestly, not really. But it feels good to take them just for bodily insurance. Hopefully evidence will mount regarding all of the above mentioned supplements so we have a better idea of which are truly beneficial.

Cool news you guys. I’ve been working with Daniel, our intern, as well as a statistician, and a well known doctor to put together a “prospective dietary trial” on milk and acne. What is a “prospective dietary trial”? Well, it means basically that we’re going to ask people on Acne.org to stop eating and drinking dairy and to fill out surveys and take pictures to document changes in their acne symptoms. If we get enough people to volunteer and follow through, it could be seminal research on the topic. Pretty darn cool.

Daniel, our intern, has been amazing with all of this–big shout out to him. He’s basically running the show. But all of us can be involved too! I’ve decided to be a candidate for the study, which will be hard because it will mean no pizza, but I’ll do it in the name of science! I’ll let you all know when this starts and when you can sign up.

One of my other summer research projects has been to look into B5 for y’all. I got excited reading the initial hypothesis from Dr. Leung, but the more I read on, the more I realized there is no evidence to back anything up. I can’t be more skeptical at this point.

I’ve been pouring over scar research for days now. It is pretty endless, but I’m making progress. I’ve read through the latest summaries of research as well as a bunch of your comments on the scar treatment ratings pages. I have a couple of initial strong feelings:

1. Prevention is key! Scar treatment is hardcore–bleeding, oozing, bruizing, pain, long recovery time, permanent change in pigmentation at times, and major expense. It is far easier to prevent acne than it is to attend to scars. I happen to not be prone to scarring, but if I were, I would be diligent on the regimen and I would also be serious about creating anti-inflammatory action in my body. I’d be all about fish oil, zinc, eating well, exercising, and if I was healing from a pretty hardcore zit, I’d take an advil or two during recovery to prevent over-inflammation in my body and the scar response (this is only theorized and not proven to work, but I’d try it). I’d also refuse to pick at my skin, knowing that picking can cause as much scarring as the acne itself.

2. Scar revision is more of an art than a science. I’ve researched 19 different procedures so far. These 19 different procedures often need to be combined for best results. If I were looking for a doctor to take care of my scarring, I would look specifically for a plastic surgeon who specializes in acne scarring. Furthermore, I would not just take their word for it. Lots of people seem to “specialize” in whatever you’re paying $4000 for. Rather, I’d feel more comfortable if they themselves had scar revision treatment performed and if this is what got them into plastic surgery to begin with. I’d also make sure they had lots of before and after pictures for me to look at of their own previous clients. To give you an idea of what I mean regarding combination of treatments, if you have some ice pick scars, some narrow and some wide boxcar scars, and several rolling scars here and there, your treatment might consist of one or two punch excisions, one or two punch elevations, a bunch of subcisions, and perhaps some 75% TCA applied directly to a few scars. Then, 6 weeks would pass and you might get CO2 laser revision, followed by Er:YAG, or alternately, 5 medium depth TCA peels, with a little needling should it be required. I think you catch my drift.

I’m angered and motivated from some of the reviews you guys have written about doctors with a laser just sitting you down in the chair with no prep work and just lasering away, taking your $3500 and being done with it, leaving you with less than desirable results. Let’s help educate one another so those of us who need scar revision can be better advocates for themselves and others. I’ll post what I’ve got on the updated scars pages soon.

Research was again spotty regarding drugs and acne. I found no published studies or trials specific to drugs and acne, so I took the next logical step and looked at how drugs affect hormone levels. I found information on marijuana, cocaine, and ecstacy (MDMA) but not methamphetamines or other drugs. A synopsis of what I found is on the new drugs and acne page.

If I had to sum it up in two sentences: Drugs may affect hormone levels, which may or may not in turn affect acne, but as of this point in time, more research is needed. Additionally, drugs can have negative effects on stress levels, picking, and regimen adherence which may prove detrimental to acne symptoms.

Today I’m doing some research into drugs and acne. Unfortunately, I found no clinical studies on the topic, so I am having to cast my net more widely. I’m going to look into the effects of drugs and alcohol on the endocrine (hormone) system. For instance, it seems that marijuana effects the hormone levels of rats and monkeys, but evidence in humans is less consistent.

This is going to require a trip to the medical library, but once I’ve got the evidence in my hands, I’ll distill it down for us and we’ll try to draw a hypothesis or two from the studies that have been performed.