Which Season Is Worst for Acne?
Slightly More Evidence Shows Us That Acne Might Worsen During Winter and Improve in the Summer
The Essential Information
Researchers have performed a dozen studies that look at which season is worst for acne. The results of these studies are conflicting and the answer is not yet definitive. However, the research slightly leans toward winter as the worst season for acne.
Why might acne get worse in the winter? This might be because our skin gets dry in the winter and loses important fats called ceramides. Skin that is out of balance tends to be more susceptible to developing acne.
Why might acne get better in the summer? This may be because the sun's UV rays help reduce inflammation in the skin and also kill acne bacteria.
Study results on what season tends to coincide with more acne are a mixed bag:
- Four studies conclude that acne worsens during winter and improves in the summer
- Three studies conclude the opposite--that acne worsens during summer and improves in the winter
- Five studies conclude that there is no association between seasons and acne
So, as we can see, it's too early to confidently confirm any answer to which season is worst for acne. However, slightly more evidence points toward acne getting worse in the winter and better in the summer, and physicians tend to agree that in the real world this is what they see.
Expand to read details of studies that show that acne may worsen in the winter
In a 1975 British Medical Journal editorial a doctor proposed that acne would improve during the summer months because UV radiation may improve acne symptoms. However, this proposal was based solely on observations and had not been scientifically examined at the time.1
A 2002 study published in the International Journal of Dermatology examined skin diseases of 220 Saudi Arabian patients who visited a dermatologist over the course of a year. The researchers found that acne worsened during winter months but improved during the summer months, with one fifth of all patients visiting the dermatologists reporting acne. However, confounding factors like age prevented the researchers from identifying if the winter season was the sole cause of acne worsening.2
A 2008 study published in the Journal of Dermatology examined the skin diseases of 6300 Turkish pediatric patients, aged 0 - 16, who were admitted to the hospital between 2004 and 2006. The researchers found that acne was the most common skin disease in these patients. Additionally, the researchers reported that more patients with acne were admitted to the hospital during the winter season.3
A 2015 study published in the Journal of the American Academy of Dermatology examined the acne severity of 9301 patients in the Northeastern United States for three years to determine if seasonal changes made acne more severe. The researchers found that acne worsened during winter and improved in the summer.4
Expand to read details of studies that show that acne may worsen in the summer
A 1980 study published in Cutaneous Medicine for the Practitioner that examined seasonal differences in acne severity showed that three percent of acne patients' symptoms worsened during the summer months. The researchers hypothesized that this was likely due to increased sun exposure, although they did not provide a scientific mechanism that would explain this hypothesis.5
A 2009 study published in the Indian Journal of Dermatology examined the relationship between acne and seasonal changes in 309 Indian acne patients. The researchers found that 80 patients experienced seasonal worsening of acne, with a large majority of 71 of those patients' acne worsening during the summer months.6
A 2016 study published in Dermatology Research and Practice examined the prevalence of skin diseases in 23,922 Nepali patients visiting a single hospital. The researchers found that patients reported acne more during the summer season.7
Expand to read details of studies that show no association between seasons and acne
A 1996 study published in the International Journal of Dermatology interviewed 139 patients to determine which season the participants believed worsened their acne. One third of patients reported their acne worsening during winter; one third reported their acne worsening in the summer, and one third reported no worsening during any season.8
A 2008 study published in the journal Clinics of Dermatology examined 3931 acne patients to determine if the season in which a patient received acne treatment affected the potency of the treatment. The researchers found retinoid treatments and antibiotics were more effective in clearing acne during the winter months when compared to summer. Although these findings are intriguing, the scientists did not observe any correlation between acne severity and season.9
A 2009 study published in the Journal of Investigative Dermatology examined the prevalence of acne in 1002 Iranian high school students. The researchers concluded that there was no correlation between season and acne severity.10
A 2015 study published in the Journal of Drugs in Dermatology examined the skin health of 17 New Jersey adolescents for one year to identify if skin properties like sebum (skin oil) production, moisture content, and acne changed with the seasons. The researchers found that the participants' skin produced less sebum and decreased in moisture content during winter when compared to other seasons. However, the researchers did not observe any changes in acne severity over the course of the year.11
A 2016 study published in the International Journal of Dermatology analyzed the data from 700 patient records from a rural Yemeni health clinic to identify the number and types of skin disorders during the winter months. The researchers found that only eight percent of all skin diseases in these patients involved acne but were not able to determine if the season affected acne severity.12
Study Limitations Make It Hard to Draw a Conclusion
The various studies listed above used participants with different genders, ages, and geographical locations. This variety makes it impossible to effectively compare the research in order to draw conclusions about which season is worst for acne. Therefore, scientists will need to perform more carefully controlled research with what is called a "standard research population" in order to determine if acne worsens during a particular season.
While evidence is conflicting, there is slightly more evidence pointing toward worsening of acne during winter and improvement in the summer. This evidence is not overwhelming, but is often supported by dermatologists' own experience when treating their patients.
If acne does in fact get worse in the winter, why might this be so? Let's look at hypotheses that explain why acne may worsen during winter and improve during the summer.
Why Acne Might Worsen During Winter
If acne does in fact worsen in the winter, here's a somewhat plausible explanation that scientists have put forward. But as you will see, the explanation still has some puzzling inconsistencies.
First, it's important to understand that acne is associated with elevated skin oil (sebum) levels in the skin. In other words, more sebum means more acne. That might make you think that scientists found that sebum levels rise in the winter, but the opposite is true. Research has shown that acne patients experience a decrease in sebum during the winter season. Therefore, if acne does indeed worsen during the winter season, it is because of something other than sebum production. To identify what might be the culprit, scientists performed four studies between 2014 and 2015 and concluded that it may stem from changes in skin hydration. More specifically, patients in all four studies experienced a decrease in skin hydration during the winter season. Skin hydration is crucial for maintaining the healthy skin barrier, which is important in managing acne.11,13-16
Additional research on the skin barrier function during winter has found one particular component of the skin barrier called ceramides, which can affect acne severity. Ceramides are found within skin cells and support the skin barrier function. Research has identified that acne patients typically possess lower levels of ceramides than patients with healthy skin, and that the levels of ceramides decrease during the winter season. In addition, research has shown that inside clogged pores is an imbalance of ceramides and other fats. This has led scientists to believe that a decrease in ceramides may partly explain the observation that acne worsens during the winter season.18-22
Why Acne Might Improve During Summer
Scientists have concluded in four separate studies that the UV radiation from the sun may explain acne clearing during the summer months. Research has shown that UV radiation may act as an anti-inflammatory agent. As inflammation is a major contributing factor to acne development, the researchers believe that UV light may decrease inflammation and help clear acne. Additional research has shown that UV light may also help to reduce levels of the bacteria associated with acne called C. acnes. The combination of anti-inflammatory light and a reduction in C. acnes could explain the observations that acne clears during the summer season. However, scientists will need to perform more research to confirm these preliminary findings.1,5,22-24
There is not yet enough evidence to support the idea that acne worsens during a particular season. However, there is slightly stronger evidence that shows acne worsening during the winter season and improving in the summer. Scientists must perform more rigorous and controlled research before we can conclude anything definitively.
- Editorial: Summer acne. Br Med J 4, 125 (1975). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1674867/
- Al-Ameer, A. M. & Al-Akloby, O. M. Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital-based study. Int J Dermatol 41, 870 - 1 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12492972
- Tamer, E., Ilhan, M. N., Polat, M., Lenk, N. & Alli, N. Prevalence of skin diseases among pediatric patients in Turkey. Journal Dermatology 35, 413 - 8 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18705828
- Pascoe, V. L. & Kimball, A. B. Seasonal variation of acne and psoriasis: A 3-year study using the Physician Global Assessment severity scale. Journal of the American Academy of Dermatology 73, 523 - 5 (2015). https://www.jaad.org/article/S0190-9622(15)01740-5/fulltext
- Allen, H. B. & LoPresti, P. J. Acne vulgaris aggravated by sunlight. Cutis 26, 254 - 6 (1980). https://www.ncbi.nlm.nih.gov/pubmed/6448731
- Adityan, B. & Thappa, D. M. Profile of acne vulgaris--a hospital-based study from South India. Indian J Dermatol Venereol Leprol 75, 272 - 8 (2009). https://www.ncbi.nlm.nih.gov/pubmed/19439880
- Poudyal, Y., Ranjit, A., Pathak, S. & Chaudhary, N. Pattern of Pediatric Dermatoses in a Tertiary Care Hospital of Western Nepal. Dermatol Res Pract 2016 (2016). https://www.ncbi.nlm.nih.gov/pubmed/27247564
- Gfesser, M. & Worret, W. I. Seasonal variations in the severity of acne vulgaris. Int J Dermatol 35, 116 - 7 (1996). https://www.ncbi.nlm.nih.gov/pubmed/8850040
- Weiss, S. C., Rowell, R. & Krochmal, L. Impact of seasonality on conducting clinical studies in dermatology. Clin Dermatol 26, 565 - 9 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18755376
- Ghodsi, S. Z., Orawa, H. & Zouboulis, C. C. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Investig Dermatol 129, 2136 - 41 (2009). https://www.ncbi.nlm.nih.gov/pubmed/19282841
- Meyer, K. et al. Evaluation of Seasonal Changes in Facial Skin With and Without Acne. J Drugs Dermatol 14, 593 - 601 (2015). https://www.ncbi.nlm.nih.gov/pubmed/26091385
- Al-Kamel, M. A. Spectrum of winter dermatoses in rural Yemen. Int J Dermatol 55, 512 - 7 (2016). https://www.ncbi.nlm.nih.gov/pubmed/26341716
- Nam, G. W., Baek, J. H., Koh, J. S. & Hwang, J. K. The seasonal variation in skin hydration, sebum, scaliness, brightness and elasticity in Korean females. Skin Res Technol 21, 1 - 8 (2015). https://www.ncbi.nlm.nih.gov/pubmed/24528115
- Youn, S. W., Na, J. I., Choi, S. Y., Huh, C. H. & Park, K. C. Regional and seasonal variations in facial sebum secretions: a proposal for the definition of combination skin type. Skin Res Technol 11, 189 - 95 (2005). https://www.ncbi.nlm.nih.gov/pubmed/15998330
- Song, E. J. et al. A study on seasonal variation of skin parameters in Korean males. Int J Cosmet Sci 37, 92 - 7 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25351787
- Wan, M. J. et al. Seasonal variability in the biophysical properties of forehead skin in women in Guangzhou City, China. Int J Dermatol 54, 1319 - 24 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25557023
- Sahle, F. F., Gebre-Mariam, T., Dobner, B., Wohlrab, J. & Neubert, R. H. Skin diseases associated with the depletion of stratum corneum lipids and stratum corneum lipid substitution therapy. Skin Pharmacol Physiol 28, 42 - 55 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25196193
- Yamamoto, A., Takenouchi, K. & Ito, M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res 287, 214 - 8 (1995). https://www.ncbi.nlm.nih.gov/pubmed/7763094
- Thiboutot, D. & Del Rosso, J. Q. Acne Vulgaris and the Epidermal Barrier: Is Acne Vulgaris Associated with Inherent Epidermal Abnormalities that Cause Impairment of Barrier Functions? Do Any Topical Acne Therapies Alter the Structural and/or Functional Integrity of the Epidermal Barrier? J Clin Aesthet Dermatol 6, 18 - 24 (2013). https://www.ncbi.nlm.nih.gov/pubmed/23441236
- Rogers, J., Harding, C., Mayo, A., Banks, J. & Rawlings, A. Stratum corneum lipids: the effect of ageing and the seasons. Arch Dermatol Res 288, 765 - 70 (1996). https://www.ncbi.nlm.nih.gov/pubmed/8950457
- Conti, A., Rogers, J., Verdejo, P., Harding, C. R. & Rawlings, A. V. Seasonal influences on stratum corneum ceramide 1 fatty acids and the influence of topical essential fatty acids. Int J Cosmet Sci 18, 1 - 12 (1996). https://www.ncbi.nlm.nih.gov/pubmed/19245474
- Magin, P., Pond, D., Smith, W. & Watson, A. A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight. Fam Pract 22, 62 - 70 (2005). https://www.ncbi.nlm.nih.gov/pubmed/15644386
- Lehmuskallio, E., Hassi, J. & Kettunen, P. The skin in the cold. Int J Circumpolar Health 61, 277 - 86 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12369118
- Webster, G. F. Light and laser therapy for acne: sham or science? facts and controversies. Clin Dermatol 28, 31 - 3 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20082947
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