Acne begins when glands at the base of hair follicles secrete too much sebum, an oily substance that lubricates the skin. The problem is not the oil itself (which simply gives you oily skin), but rather that excess amounts, along with dead skin cells, can clog the follicles causing whiteheads or blackheads. If bacteria on the skin invade the clogged follicles, the follicle wall can rupture, resulting in redness and inflammation—that is, a pimple.
Teens develop acne when a flood of androgen hormones causes the oil glands to go wild. Hormones play a role in acne development in adults, too, which explains why many women have acne flare-ups prior to their menstrual periods and during pregnancy. Some women experience acne for the first time, or a worsening of it, in the years leading up to menopause. Genetics, climate (both very dry and humid conditions), cosmetics and skin care products, certain medications, emotional stress, and lack of sleep may also contribute to acne.
The literature is rife with inconsistencies about the role of diet in acne. Some research implicates carbohydrate-rich foods with a high glycemic index, such as white rice, white bread, and pretzels. These are quickly broken down into sugar in the blood and thus raise insulin levels, which may increase production of hormones implicated in acne. According to a review in the Journal of the Academy of Nutrition and Dietetics, frequent dairy consumption (milk in particular) may also be a culprit, while there is limited evidence that omega-3 fats may be protective.
After all these years, its role in acne is still debatable. In a study in the Journal of Clinical and Aesthetic Dermatology in 2014, young men with mild acne took capsules of pure cocoa, gelatin, or a combination of varying amounts of each. Acne worsened over the next week, roughly corresponding to the amount of cocoa consumed. But before you toss your chocolate, keep in mind that the study was small (13 men completed it), did not include women, used only one brand of cocoa, and had other design problems. More research is needed.
Achieving clear skin can take some time and may require a combination of strategies. If self-help steps don’t help enough, see a dermatologist. Treatment options include topical retinoids, topical benzoyl peroxide, topical and oral antibiotics, and photodynamic (light) therapy. Topical dapsone (Aczone), which has both anti-inflammatory and antimicrobial properties, is a newer medication that’s being promoted for adult women. Hormonal therapy (oral contraceptives and anti-androgens) are other possible options in hard-to-treat cases. Oral isotretinoin (Accutane) is also effective but is used less often because of adverse reactions.