tag:theconversation.com,2011:/africa/topics/acne-11779/articlesAcne – The Conversation2023-08-23T12:25:48Ztag:theconversation.com,2011:article/2118612023-08-23T12:25:48Z2023-08-23T12:25:48ZAcne bacteria trigger cells to produce fats, oils and other lipids essential to skin health – new research<figure><img src="https://images.theconversation.com/files/543536/original/file-20230818-27-a54vaz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2094%2C1416&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's more to the bacterium _Cutibacterium acnes_ than meets the eye.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-shot-of-the-face-of-a-young-woman-with-royalty-free-image/1581451668">Youngoldman/iStock via Getty Images Plus</a></span></figcaption></figure><p>The skin is the <a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">largest organ of the body</a>, and it plays a crucial role as the first line of defense against pathogens and insults from the external environment. It provides important functions like temperature regulation and moisture retention. And despite the misconception that lipids harm your skin by causing oiliness and acne, they actually <a href="https://doi.org/10.1126/sciadv.adg6262">play a vital role</a> in maintaining the skin barrier.</p>
<p>Lipids – organic compounds that include <a href="https://www.khanacademy.org/science/biology/macromolecules/lipids/a/lipids">fats, oils, waxes and other types of molecules</a> – are essential components of the outermost layer of skin. Changes to the skin’s lipid composition can disrupt its ability to function as a protective barrier, leading to a <a href="https://doi.org/10.1046/j.0022-202x.2001.01455.x">range of skin diseases</a>, including eczema and psoriasis.</p>
<p>Human skin is colonized by <a href="https://doi.org/10.1038/nrmicro.2017.157">thousands of species of bacteria</a>. One of the most common microbes on the skin, <a href="https://doi.org/10.3390/microorganisms9030628"><em>Cutibacterium acnes</em>, or <em>C. acnes</em></a>, is well known for its potential involvement in causing acne, but its broader effects on skin health are less understood.</p>
<p>I am a <a href="https://profiles.ucsd.edu/samia.l.almoughrabie">researcher in dermatology</a> working in the <a href="https://dermatology.ucsd.edu/research/basic-science/gallo-lab/index.html">Gallo Lab</a> at the University of California, San Diego. My colleagues and I study how the skin defends the body against infections and the environment, with a particular focus on the skin microbiome, or the microbes living on the skin. In our recently published research conducted in collaboration with SILAB, a company developing active ingredients for skincare products, we found that <em>C. acnes</em> triggers certain skin cells to <a href="https://doi.org/10.1126/sciadv.adg6262">significantly increase production of lipids</a> that are important to maintaining the skin barrier.</p>
<h2>Skin bacteria and lipid synthesis</h2>
<p>To determine the role that bacteria play in lipid production, we exposed keratinocytes, the cells that <a href="https://www.britannica.com/science/human-skin/The-epidermis#">make up the epidermis</a>, to different bacteria naturally present on the skin and analyzed changes in lipid composition. </p>
<p>Of the common skin bacteria we tested, only <em>C. acnes</em> triggered an <a href="https://doi.org/10.1126/sciadv.adg6262">increase in lipid production</a> within these cells. More specifically, we found a threefold increase in total lipids, including ceramides, cholesterol, free fatty acids and especially triglycerides. Each of these lipid types are essential to maintaining the skin barrier, locking in moisture and protecting against damage. These findings suggest that <em>C. acnes</em> plays a distinctive role in the lipid skin regulation. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MWE3U3FItlc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The skin microbiome contains bacteria and other microbes that help protect your body.</span></figcaption>
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<p>We found that <em>C. acnes</em> induced this increase in lipid production by producing a type of short-chain fatty acid called <a href="https://doi.org/10.1126/sciadv.adg6262">propionic acid</a>. Propionic acid creates an acidic skin environment that provides a number of benefits, including limiting pathogen growth, reducing staph infections and contributing to anti-inflammatory effects in the gut. </p>
<p>We also identified the <a href="https://doi.org/10.1126/sciadv.adg6262">specific gene and receptor</a> that regulate lipid synthesis through <em>C. acnes</em>. Blocking these components also blocked <em>C. acnes</em>-induced lipid synthesis.</p>
<p>In all, our findings highlight the substantial role that a common skin bacterium and its chemical byproducts play in shaping the composition of skin lipids.</p>
<h2>Reinforcing the skin barrier</h2>
<p>Our research suggests that propionic acid from <em>C. acnes</em> has <a href="https://doi.org/10.1126/sciadv.adg6262">multiple advantageous effects</a> on the skin barrier. For example, by increasing the lipid content in skin cells, propionic acid reduced water loss through the skin.</p>
<p>We also found that the lipids skin cells produce after exposure to <em>C. acnes</em> or propionic acid have antimicrobial effects against <em>C. acnes</em>. This suggests that the lipids <em>C. acnes</em> helps produce have a dual role: They not only control the presence of <em>C. acnes</em> on the skin but also contribute to the overall balance of the skin microbiome so one species of microbe doesn’t dominate the rest.</p>
<p>In the complex interplay between the skin and its microbial inhabitants, the ubiquitous <em>C. acnes</em> is emerging as an important player. Further research to better understand the skin microbiome may help lead to new treatments for skin conditions.</p><img src="https://counter.theconversation.com/content/211861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samia Almoughrabie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bacteria and lipids get a bad rap for causing breakouts and oily skin. But both play an essential role in helping your skin barrier stay strong against pathogens and insults from the environment.Samia Almoughrabie, Postdoctoral Researcher in Dermatology, University of California, San DiegoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699412021-11-24T03:31:44Z2021-11-24T03:31:44ZHow to wear a mask in the heat<figure><img src="https://images.theconversation.com/files/433580/original/file-20211123-20-1cxhigv.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-attractive-pineapples-wearing-face-mask-1685952682">Shutterstock</a></span></figcaption></figure><p>Summer is on its way and you might be wondering how you’re going to wear a mask as the weather gets warmer.</p>
<p>Which mask is best? Is there anything you can do to prevent “<a href="https://www.dailycardinal.com/article/2021/02/how-to-handle-macne?ct=content_open&cv=cbox_latest">macne</a>”? How can you stop the ear loops from chafing? How do you prevent your sunglasses fogging up? </p>
<p>Here are some practical tips to keep you comfortable while helping you stay safe.</p>
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<strong>
Read more:
<a href="https://theconversation.com/which-mask-works-best-we-filmed-people-coughing-and-sneezing-to-find-out-143173">Which mask works best? We filmed people coughing and sneezing to find out</a>
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<h2>Which mask is best in the heat?</h2>
<p><a href="https://www.bmj.com/content/372/bmj.n432">Disposable surgical masks</a> are more effective at filtering out viruses than cloth masks but to remain effective they should only be used once. Cloth masks are not quite as effective but can be washed and reused. </p>
<p>According to the World Health Organization, cloth masks <a href="https://www.bmj.com/content/372/bmj.n432">should have three layers</a>. The inner layer should be soft cotton as this is <a href="https://theconversation.com/how-do-i-know-if-my-mask-actually-works-what-about-the-candle-test-144124">more comfortable on the face</a>. This is also more absorbent, and less irritating, than synthetic materials. <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html">Cloth masks</a> with synthetic material in the inner layer will also increase sweating, so avoid these.</p>
<p>All masks become less effective when damp – from the damp air you exhale and from your sweat. The best mask to wear in the heat is the one you are most likely to wear.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cloth masks laid out on a yellow background" src="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you choose a cloth mask, make sure the inner layer is made from soft cotton.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/flat-lay-design-colorful-fashion-face-1683124312">Shutterstock</a></span>
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<h2>Sweating, wearing masks and macne</h2>
<p>Wearing a mask can affect your skin in a number of ways. It <a href="https://pubmed.ncbi.nlm.nih.gov/32605056/">increases skin temperature</a> and sweating, which can worsen acne or other skin conditions. That’s where the term “macne” or “<a href="https://www.wired.com/story/mascne-causes-and-treatments/">mascne</a>” comes from.</p>
<p>Mask wearing also <a href="https://pubmed.ncbi.nlm.nih.gov/33217053/">increases production of sebum</a> (skin oil), which can clog pores. </p>
<p>Masks can cause friction if they don’t fit well. They can also cause sensitivity reactions if the innermost layer is made from synthetic fibres, and depending on how you wash them.</p>
<p>While it might seem odd, your skin also <a href="https://pubmed.ncbi.nlm.nih.gov/33813749/">gets drier</a> under a mask. That’s possibly because the humidity under the mask disrupts the normal skin barrier. </p>
<p><strong>What to do</strong></p>
<p>If you want to wear a cloth mask, a soft cotton-lined one is recommended to reduce the risk of skin irritation. <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">Dermatologists also recommend</a> avoiding makeup, such as some foundation and face powder, when wearing a mask, to avoid clogging the pores.</p>
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<p>Dermatologists <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">also recommend</a> washing your mask regularly, preferably after each use. If you are prone to skin conditions use a laundry detergent for sensitive skin to wash your mask, as normal laundry detergents contain perfumes and chemicals that can cause skin reactions. Avoid using fabric softeners for the same reason. </p>
<p>Dermatologists also <a href="https://www.aad.org/public/everyday-care/skin-care-basics/care/face-washing-101">suggest</a> washing your face morning and night with lukewarm water and a mild cleanser and avoiding irritating solutions such as retinoids or aftershave. A <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">moisturiser</a> before and after mask wearing can help rehydrate the skin; ensuring your mask fits snugly will reduce friction.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/13-insider-tips-on-how-to-wear-a-mask-without-your-glasses-fogging-up-getting-short-of-breath-or-your-ears-hurting-143001">13 insider tips on how to wear a mask without your glasses fogging up, getting short of breath or your ears hurting</a>
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<hr>
<h2>Avoid sore ears</h2>
<p>When you wear a mask for extended periods, the elastic loops can cause painful pressure on the backs of your ears.</p>
<p>To prevent this, use <a href="https://www.usatoday.com/videos/tech/problemsolved/2021/01/05/use-paper-clips-save-your-ears-face-mask-loop-pressure/4130220001/">paper clips</a> to join the loops together at the back of your head, taking the pressure off your ears.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1251910401219940352"}"></div></p>
<p>Another nifty solution is to use a <a href="https://www.businessinsider.com.au/headband-that-holds-up-face-mask-healthcare-workers-2020-4">headband with buttons</a> or paper clips attached. You attach the ear loops to the buttons/paper clips rather than putting the loops over your ears.</p>
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<h2>How do you stop your sunnies fogging up?</h2>
<p>People who wear prescription glasses will be used to avoiding fogging while wearing a mask. The same advice applies to people wearing sunglasses.</p>
<p>Sunnies fog up when you wear a mask because the warm water vapour in your breath comes out the top of your mask <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293317/">and condenses</a> on your lenses.</p>
<p>Prevent the moist air from reaching your sunnies by:</p>
<ul>
<li><p>resting them on the mask rather than above the mask. The pressure of the sunnies reduces the chance of vapour exiting the top of the mask</p></li>
<li><p>pinching the top of the surgical mask to improve the fit around the top of your nose. If using a cloth mask, insert a pipe cleaner in the top to shape the mask over the nose</p></li>
<li><p>using soft tape suitable for skin to tape down the top of the mask. If you do this, test the tape somewhere else on your body first to make sure you don’t have a reaction to it.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1461730641125548033"}"></div></p>
<p>Other anti-fogging strategies include:</p>
<ul>
<li><p>using anti-fogging wipes or spray on the lenses, which you can buy over the counter from your local pharmacy or at an optometrist</p></li>
<li><p>making your own anti-fogging effect by rubbing a thin layer of liquid soap or shaving cream across the inside of each lens.</p></li>
</ul>
<p>Use anti-fogging solutions with care, though, as some may damage any anti-glare or anti-UV films on the lens. Check with your optometrist if unsure.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-get-your-kid-to-wear-a-mask-here-are-5-things-you-can-try-166648">Can't get your kid to wear a mask? Here are 5 things you can try</a>
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<h2>In a nutshell</h2>
<p>Whether you choose to wear a cloth or surgical mask this summer, these simple tips will help this become more comfortable as the temperatures rise, you sweat more and your skin may become more irritated.</p>
<p>But make sure you wear your mask correctly. Wearing it <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html">under your nose</a> makes it completely ineffective. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-easy-to-judge-but-some-people-really-cant-wear-a-mask-143258">It's easy to judge. But some people really can't wear a mask</a>
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</p>
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<img src="https://counter.theconversation.com/content/169941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Griffith University postgraduate Infection Prevention and Control program. </span></em></p>Here are some practical tips to keep you comfortable while helping you stay safe.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1390962020-06-11T22:02:36Z2020-06-11T22:02:36ZStrange physical symptoms? Blame the chronic stress of life during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/340478/original/file-20200609-165397-btma4q.jpg?ixlib=rb-1.1.0&rect=502%2C10%2C5985%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic stress can lead to inflammation, which can result in physical symptoms as well as mental health symptoms.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>During the current COVID-19 pandemic have you been wondering why you’re getting headaches more often? Or stomach aches? Or feeling itchy or getting pimples? Or why your periods are irregular or more painful than usual? Exciting recent science suggests that the answers may lie in our body’s <a href="https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780190681777.001.0001/oxfordhb-9780190681777">biological reactions to stress</a>. </p>
<p>Our biological stress response system — the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181830/pdf/DialoguesClinNeurosci-8-383.pdf">hypothalamic-pituitary-adrenal</a> (HPA) axis — evolved hundreds of millions of years ago to help our vertebrate ancestors quickly mobilize energy to confront imminent, life-or-death threats, such as predator attacks. In the short term, this system is exquisite in its efficiency and crucial to survival. </p>
<p>The problem with our current situation is that it has been going on for months, and the end is not clearly in sight. <a href="https://doi.org/10.1177%2F2470547017692328">Chronic stress</a> sends the HPA axis into overdrive, with effects felt throughout the body. These symptoms can even serve as further sources of stress. Understanding why our bodies are reacting in these ways can help us develop strategies to prevent stress from getting under our skin.</p>
<h2>The biological stress response</h2>
<p>When animals perceive a threat in their environment, the HPA axis stimulates the adrenal glands to release the hormone cortisol. Cortisol, along with adrenaline, work to pump oxygen to the major muscles to enable the animal to fight or escape. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Human stress response was designed to cope with short-term threats like predator attacks, not the chronic stress of things like COVID-19.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This “fight/flight” response produces physical symptoms such as heart palpitations and chest tightness (the heart pumping oxygen to the major muscles), and stomach butterflies, nausea and tingling (blood leaving the stomach and extremities to get to the major muscles). </p>
<p>The HPA axis also interacts with the <a href="http://www.doi.org/10.1093/oxfordhb/9780190681777.013.24">immune system</a> to help with the aftermath. Cortisol is a potent anti-inflammatory and binds to large numbers of <a href="https://doi.org/10.1155/2012/403908">receptors in the skin</a> to help repair wounds and fight infection.</p>
<p>The HPA axis doesn’t know the difference between the life-or-death threat of a predator attack and modern stressors. So, in the early stages of this crisis, if your stomach did flip-flops, or you felt your heart racing, when reading about surges in COVID-19 cases, your body was doing what it was designed to do even though at that moment you were not in any imminent physical danger.</p>
<h2>The problem of chronic stress</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic stress can lead to inflammation, which can result in physical symptoms as well as mental health symptoms.</span>
<span class="attribution"><span class="source">(Piqsels)</span></span>
</figcaption>
</figure>
<p>A predator attack is time-limited. In contrast, the COVID-19 pandemic has been going on for weeks, and may be compounded by social isolation, job or financial insecurity and care-taking responsibilities. Unfortunately, all the HPA axis knows is that it needs to release stress hormones when we perceive a threat in our environment. So, if we perceive our environment as threatening all the time, then the HPA axis will release these chemicals all the time. </p>
<p>One of the most pronounced effects of long-term cortisol release is <a href="http://doi.org/10.1111/j.1749-6632.2012.06633.x">glucocorticoid resistance</a>. This is when cells in the immune system become less sensitive to the anti-inflammatory effects of cortisol. As a result, cortisol starts to increase inflammation throughout the body and brain. </p>
<p>So, your itchiness and rashes? All of the cortisol receptors in your skin may no longer be receptive to cortisol’s anti-inflammatory effects and instead, chemicals are released that <a href="https://doi.org/10.1155/2012/403908">inflame the skin</a>. </p>
<p>Your <a href="https://doi.org/10.1038/s41582-019-0216-y">headaches or stomach aches</a>? <a href="http://dx.doi.org/10.1136/oem.2003.012302">Painful periods</a>? All of these symptoms can also be the result of inflammation in these organ systems caused by chronic HPA axis activation. </p>
<p>Even psychological symptoms, such as feelings of <a href="http://www.doi.org/10.1093/oxfordhb/9780190681777.013.24">depression or loneliness</a>, have been linked to the release of pro-inflammatory chemicals caused by chronic stress. </p>
<h2>Taking control of your stress response</h2>
<p>Much of what is perceived as stressful on a day-to-day level is not specific to contracting the COVID-19 virus, but instead is the result of changes that we have had to make in our lives. A switch to working from home, or not working, has disrupted our sleeping, eating and activity schedules that regulate our internal circadian clock. Staying indoors means lower exercise and activity levels. Many people, especially those living alone, are socially isolated from friends and loved ones. </p>
<p><a href="https://doi.org/10.1186/s41606-017-0019-2">Disrupted circadian routines</a>, <a href="https://doi.org/10.1371/journal.pone.0078350">lack of exercise</a> and <a href="https://doi.org/10.1016/j.neubiorev.2020.02.002">social isolation</a> have all been strongly linked to dysregulation of the body’s stress and immune systems, and release of pro-inflammatory chemicals in the body and brain. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical distancing during COVID-19 shouldn’t mean losing contact with loved ones.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Fortunately, even small positive changes in these areas can have strong stress-reducing effects. Keeping a <a href="https://doi.org/10.1038/nri3386">regular routine</a> by going to bed, getting up and eating at consistent times each day has been linked to greater overall health by promoting healthy function of the HPA axis and immune system. Even 20 minutes of <a href="https://doi.org/10.1016/j.bbi.2016.12.017">moderate exercise</a>, which inside could include exercise videos or jogging around at home, regulates the HPA axis, reduces inflammation and has strong mood-lifting effects. </p>
<p>Finally, talking regularly with friends and loved ones, even remotely or at a distance, is one of the best things you can do to protect against the biological and <a href="https://doi.org/10.1111/aphw.12000">psychological</a> effects of stress. Remember, we’re all in this together!</p><img src="https://counter.theconversation.com/content/139096/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Harkness receives funding from the Social Sciences and Humanities Research Council. Kate Harkness receives royalties from sales of the Oxford Handbook of Stress and Mental Health. </span></em></p>Itchy skin? More aches and pains? Unusual rash? Headaches? Pimples? If you’ve been experiencing unusual physical symptoms recently, the stress of the COVID-19 pandemic may be the reason.Kate Harkness, Professor of Psychology and Psychiatry and Director of the Mood Research Laboratory, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1202222019-09-26T20:11:44Z2019-09-26T20:11:44Z‘How do I control my oily skin and prevent pimples?’ A dermatologist explains<figure><img src="https://images.theconversation.com/files/287298/original/file-20190808-144838-pdxqu7.png?ixlib=rb-1.1.0&rect=287%2C137%2C3389%2C1736&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's nothing worse then a sore pimple. But there's a few things you can do to avoid a breakout. </span> <span class="attribution"><span class="source">Wes Mountain</span></span></figcaption></figure><blockquote>
<p>How can I control the excessive oil secretions on my face that leads to acne?
Anonymous</p>
</blockquote>
<p>Pimples are the worst! They hurt, pop up overnight and can be impossible to hide. </p>
<p>You’re right that oily skin is believed to be the most critical factor for causing acne. </p>
<p>But rest assured, there are a few things you can do to keep your oil at bay and control the likelihood of a break out. </p>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<h2>Why am I so oily… all the time!</h2>
<p>Before we start talking about how to <em>avoid</em> acne, let’s chat about why oily skin causes acne. </p>
<p>Oily skin is caused by the overproduction of sebum by an overactive oil gland (also known as the <em>pilosebaceous unit</em>, which is just a fancy term for a hair follicle and its oil gland). </p>
<p>There are a few reasons we get acne, one being the pore of the oil gland can be blocked – this can be made worse by using certain types of makeup. </p>
<p>Some of our hormones during puberty drive sebum overproduction, hence acne-overload. Fun fact: anabolic steroids, typically used by bodybuilders, <a href="https://www.ncbi.nlm.nih.gov/pubmed/17274777">can trigger acne too</a>.</p>
<p>Acne bacteria lives on the skin and its overgrowth around your oil glands can worsen inflammation and pus formation. This is what causes acne to hurt sometimes.</p>
<p>If there’s a strong history of acne in your family, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22243446">there’s a good chance</a> you might get it too. </p>
<p>It is also linked to medical conditions such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/15788499">polycystic ovarian syndrome.</a></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-wrong-with-me-im-never-happy-and-i-hate-school-120889">'What is wrong with me? I'm never happy and I hate school'</a>
</strong>
</em>
</p>
<hr>
<h2>Trust me on this, a proper skin routine is everything</h2>
<p>As a dermatologist, I recommend cleaning your face every morning and evening. If you wear make up, ALWAYS wipe it off before going to bed – no excuses!</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1015&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1015&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1015&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1276&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1276&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288299/original/file-20190816-192219-v4jq22.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1276&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>Using pore-clogging oil-based make up can worsen or cause acne. This can become worse if make up is not thoroughly removed!</p>
<p>If you want to hide your acne with make up, just be sure to use brands that contain good ingredients (I talk a bit more about this below).</p>
<h2>A few tips to help keep your skin clear 🌟</h2>
<ol>
<li><p><strong>Diet:</strong> Eat a healthy balanced diet containing low glycaemic index food groups with complex carbohydrates and omega-3 fatty acids. There might be a role for <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/pde.13904">oral zinc supplements</a>. It is best to avoid sugary, processed and refined food. </p></li>
<li><p><strong>Make up and hair products:</strong> If you choose to wear make up, opt for mineral-based foundations, eg. La Roche Posay, Bare Minerals, Nude by Nature, Jane Iredale, Youngblood and Ultraceuticals. Wash your hair regularly with shampoo, especially if you’re using hair products and if you have oily hair or scalp. Avoid using oil-based products on your face and beware of oil-based pomades and hair wax, especially near your forehead.</p></li>
<li><p><strong>Regular use of a good quality broad spectrum SPF 30 and above ultralight sunscreen lotion:</strong> This reduces early onset wrinkles, pigmentation issues and in the long-term reduces your risk of developing sunspots and dangerous skin cancers. </p></li>
<li><p><strong>Maintain a healthy weight and embrace exercise:</strong> Not only is this good for mental health (stress can lead to acne), it <a href="https://www.ncbi.nlm.nih.gov/pubmed/23975508">also reduces levels of acne-causing hormones.</a></p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-lumps-and-bumps-on-and-under-the-skin-what-are-they-59313">Common lumps and bumps on and under the skin: what are they?</a>
</strong>
</em>
</p>
<hr>
<h2>About to leave the house and still feel oily?</h2>
<p>I recommend using a blotting paper or oil-control film when this happens. They aren’t too expensive – Target sells packs of 100 for A$5 – and can be bought at supermarkets and pharmacies.</p>
<p>You can also apply a thin layer of mattifying gel or a mineral-based loose powder foundation to reduce and absorb excess oil. </p>
<h2>Some final words of advice</h2>
<ol>
<li><p>Use oil-free and non-comedogenic cleansers, moisturisers and make up. When picking a foundation opt for “oil free” liquid silicone (dimethicone or cyclomethicone) matte foundations over oil foundations</p></li>
<li><p>remember to thoroughly remove your make up with a make up remover</p></li>
<li><p>avoid touching, picking or scratching your pimples</p></li>
<li><p>if you feel your acne is particularly bad, make sure you see your GP or get a referral to see a dermatologist. It’s always best to get on top of your acne and reduce risk of acne scarring.</p></li>
</ol><img src="https://counter.theconversation.com/content/120222/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Celestine Wong currently holds a Consultant position at the Monash Medical Centre. She also works privately at Chroma Dermatology, Melbourne City Dermatology and Melbourne Eastside Dermatology.</span></em></p>Oily skin can be a real pain, especially if it leads to pimples. A few simple tricks can keep your skin healthy and decrease the chance of a breakout.Celestine Wong, Consultant Dermatologist, Monash HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1117062019-02-19T16:07:22Z2019-02-19T16:07:22ZSeven myths and truths about healthy skin<figure><img src="https://images.theconversation.com/files/259717/original/file-20190219-43258-1yb5wkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-african-woman-wearing-ear-rings-740139493">Shutterstock</a></span></figcaption></figure><p>Skin is <a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">our largest organ</a> and something we may take for granted when it’s healthy. As an academic dermatologist I frequently hear misleading “facts” that seem to be stubbornly enduring. Here are some of the most commonly shared myths that can be cleared up immediately, and some truths you can rely on.</p>
<h2>Skin constantly renews itself</h2>
<p><strong>TRUE</strong> The skin provides a dynamic barrier between your body’s internal environment and the outside world. Cells called keratinocytes in <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the epidermis</a> (the outer layer of skin) are constantly dividing to produce a supply of cells that move up through this layer and are shed from its surface. Skin is a rich source of <a href="https://www.eurostemcell.org/skin-stem-cells-where-do-they-live-and-what-can-they-do">stem cells</a> with the capacity to divide and renew themselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A good skincare regime starts with removing dirt from skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-handsome-afro-american-man-582848200">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Drink two litres of water a day for healthy skin</h2>
<p><strong>FALSE</strong> The amount of water you drink does not directly affect your skin. Water is supplied to the skin by blood flowing through <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the dermis</a>, the inner layer of skin; water is lost from the epidermis, especially in a dry environment.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU1MDYwODk1OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTI4NjI0ODYwMCIsImsiOiJwaG90by8xMjg2MjQ4NjAwL2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJpQWVwL1hHa0ViY1NvNUx1TWJicmF1WFBCaDQiXQ%2Fshutterstock_1286248600.jpg&pi=33421636&m=1286248600&src=u1CBEbNYSfJuR53ejxoklA-1-2">Shutterstock</a></span>
</figcaption>
</figure>
<p>Water is needed to maintain skin hydration and when you become seriously dehydrated your skin appears dull and is less elastic. In a healthy person the internal organs – kidneys, heart and blood vessels – control the amount of water reaching the skin. There is no fixed volume of water that you need to drink, it simply depends on the amounts you are using and losing.</p>
<h2>Stress can make skin unhealthy</h2>
<p><strong>TRUE</strong> There are many health issues in modern life that we blame on stress, but several skin conditions have been shown in scientific studies (see below), to be worsened by life events, possibly via stress hormones including <a href="http://www.yourhormones.info/hormones/cortisol/">cortisol</a> (a steroid hormone made in the adrenal glands). Notable examples are <a href="https://www.dermnetnz.org/topics/alopecia-areata/">alopecia areata</a>, an auto-immune condition where the body’s immunity begins to attack the hair follicles, causing hair to fall out; <a href="https://www.ncbi.nlm.nih.gov/pubmed/29729012">psoriasis</a>, another auto-immune condition that causes skin thickening, scaling and inflammation; and <a href="https://www.ncbi.nlm.nih.gov/pubmed/29023418">eczema</a>, itchy red skin inflammation often occurring alongside asthma, hay fever and other allergies. Unfortunately a flare up of these skin conditions is exactly what you don’t need when you are feeling stressed or under pressure.</p>
<h2>Eating chocolate causes acne</h2>
<p><strong>FALSE</strong> Acne vulgaris, the common “teenage” <a href="https://www.dermnetnz.org/topics/acne-vulgaris">acne</a> which can actually persist into your 30s and 40s, occurs as a result of the interaction between hormonal effects on grease glands in the skin, plus the skin’s immune response to blocked pores and microbes living on the skin.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p>Eating a high fat diet is unhealthy for many reasons, but it doesn’t cause acne. In fact some tablets prescribed for severe acne such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Food+increases+the+bioavailability+of+isotretinoin">oral isotretinoin</a> are better absorbed when pills are swallowed with a fatty meal – and that could include chocolate.</p>
<h2>Washing powder causes eczema</h2>
<p><strong>FALSE</strong> Eczema is a condition where the skin is dry, itchy and red. It is caused by a combination of genetic factors (how your skin is made) and environmental effects, leading to inflammation. Soap, detergents and washing powders can irritate the skin and contribute to dryness because they remove oil from the skin (just as washing-up liquid removes grease from your dishes). Biological washing powders contain enzymes – proteins that break down fats and other proteins to remove stains – and these can irritate sensitive skin, so they may worsen eczema. It is important that any washing power is thoroughly rinsed out of clothing before it is worn, to avoid skin irritation.</p>
<h2>White marks on nails = calcium deficiency</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=690&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=690&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=690&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=867&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=867&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=867&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong>FALSE</strong> Nails are manufactured in the nail matrix, an area under the skin at the top edge of your nail. If the matrix is traumatised, bumped or bitten, an irregularity in the developing nail occurs and air can become trapped. This appears as a white mark as the nail grows out. Calcium is important for healthy nails (as well as bones and teeth) but these white marks are not a sign of deficiency.</p>
<h2>Sunshine is good for you</h2>
<p><strong>TRUE & FALSE</strong> Many people have experienced the feel-good factor of a sunny day, but there are good and bad effects of sunlight. Light from the sun includes a mixture of <a href="https://www.britannica.com/science/sunlight-solar-radiation">different wavelengths of light</a>: some are visible to the human eye, some are shorter than the colours we can see – these are called <a href="https://uihc.org/health-topics/what-difference-between-uva-and-uvb-rays">ultraviolet</a> (UV) – and some are longer, the infrared. Different wavelengths have different effects on skin.</p>
<p>UVB is used by skin to manufacture <a href="https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/">vitamin D</a> which is essential for bone health. Without sun exposure this vitamin must be obtained from the diet. Dermatologists use specific wavelengths of UVA and UVB in carefully controlled doses to reduce skin inflammation, a valuable treatment for some skin conditions. </p>
<p>But when the skin is exposed to too much UV it can damage the skin cells’ DNA, leading to uncontrolled growth – the basis of cancer. As a simple rule, unless you have a disease or treatment that suppresses your immune system, sunshine is good for you in moderation, but always avoid getting sunburned.</p>
<h2>Keep it simple</h2>
<p>The basic principles of keeping skin healthy are mainly common sense. You should wash your skin regularly to remove dirt, but not so much that you remove the essential moisture and water-proofing substances. Use a moisturiser if your skin feels tight or dry – a greasy ointment works best unless you have acne-prone skin, in which case you should use a non-greasy water-based cream. Avoid stress if possible, eat a healthy diet and drink water when you feel thirsty. And finally, protect your skin from too much sun with a hat and clothing or sunscreen.</p><img src="https://counter.theconversation.com/content/111706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.</span></em></p>When it comes to looking after your skin, some stubborn “facts” endure, so a dermatologist sets the record straight.Sara Brown, Professor of Molecular & Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037352018-09-25T15:13:46Z2018-09-25T15:13:46ZWhy older skin heals with less scarring<figure><img src="https://images.theconversation.com/files/237662/original/file-20180924-117383-olicyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Large scar after surgery on the abdomen young woman.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/scars-removal-concept-large-scar-after-740292784?src=p2QH5MZ6U88TTDQ4BHbDzg-1-30">OneSideProFoto/SHutterstock.com</a></span></figcaption></figure><p>When it comes to your skin, getting older isn’t all bad news. Older people heal skin wounds with thinner scars. </p>
<p>As a practicing dermatologist, my physician colleagues and I make this somewhat counterintuitive observation routinely. But how this occurs is not well understood. Mailyn Nishiguchi, a graduate student, Casey Spencer, a research technician, and I worked together to <a href="https://www.cell.com/cell-reports/fulltext/S2211-1247(18)31340-8">discover how aging normally modulates how our skin heals and the thickness of our scars</a>. </p>
<p><a href="https://www.thomasleunglab.org">My laboratory</a> at the University of Pennsylvania studies how to heal human tissues without a scar. Organisms heal skin wounds using two different processes: scar formation and tissue regeneration. Tissue regeneration results in the return of the original tissue architecture and absence of scars. Scar formation results in fibrous tissue deposition that obliterates the tissue architecture, and generates a thick line of raised red skin. Mammals generally repair injured tissue with scar formation. </p>
<p>In experiments we observed that when young mice were injured, they healed with a scar. However, when elderly mice were injured, their skin wounds regenerated and repaired without a scar. These results reflected what we have observed in our clinic patients. We concluded that aging improves tissue regeneration in both mice and humans, and we set out to understand how this works. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Older mice heal skin injuries without a scar.</span>
<span class="attribution"><span class="source">Thomas Leung</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>First, we wanted to see if this change was due to a circulating factor in the blood. We exchanged blood between young and old mice through a technique called parabiosis. When elderly mice were exposed to young blood, their skin no longer regenerated as well. Thus, young blood contained a circulating chemical that promotes scar formation and prevents tissue regeneration from occurring.</p>
<p>To identify this factor, we compared gene activity between injured young and elderly human skin. We focused only on the genes of proteins circulating in the blood and found 13 different proteins in old versus young skin. One of them, SDF1, had previously been shown to regulate tissue regeneration in the <a href="https://doi.org/10.1101/gad.267724.115">skin</a>, <a href="https://doi.org/10.1371/journal.pone.0079768">lung</a> and <a href="https://doi.org/10.1038/nature12681">liver</a>.</p>
<p>To prove that SDF1 may be the mysterious factor responsible for scarring in the young animals, we engineered a mouse that lacked the SDF1 protein in the skin. When SDF1 was eliminated, young mice regenerated their skin with no scarring, just as in elderly mice. Therefore, we concluded that SDF1 promotes scar formation in young mice.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=312&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=312&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=312&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A factor in young blood promotes scar formation.</span>
<span class="attribution"><span class="source">Thomas Leung</span></span>
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<p>How does getting older shut off SDF1 production? We discovered that a different protein, called EZH2, turns off the SDF1 gene, and as mice aged, the amount of EZH2 rose. To take this one step further, we used a drug to block EZH2 function in elderly mice. In the absence of EZH2, elderly mice reactivated SDF1 and lost their ability to regenerate their skin.</p>
<p>We wanted to see if these findings also held true in human skin. Similar to mice, skin injury in young people triggered SDF1 production, and this induction was diminished in elderly human skin. We also showed that EZH2 is the reason behind this change. In this case, mouse and human skin behaved in the same way.</p>
<p>Why do mice and humans form more scars when they are young? We speculate that this is a trade-off between speed and quality. Tissue regeneration is a slow process – it takes a month for our skin injuries to regenerate. Meanwhile, a scar can form in little as three to five days. As a young animal, one would want an injury to heal as quickly as possible to live to fight another day. You will tolerate imperfect healing for a faster response. Whereas, older animals that have passed their reproductive prime may not need to heal as fast.</p>
<p>Taken together, we identified a rare example where aging improves tissue function, specifically the tissue repair process. We are planning a clinical trial with the drug, plerixafor, an existing FDA-approved SDF1 inhibitor which is currently used to mobilize stem cells for bone marrow transplant patients, to test its efficacy in preventing scar formation in humans. </p>
<p>Currently, there are no effective treatments on the market to prevent scar formation. In addition to scars from acne and incidental trauma, we hope this approach may be beneficial for many types of human tissue injuries, including the genetic disease epidermolysis bullosa, an extremely debilitating blistering skin disease, in burn patients, or patients with keloid scars.</p><img src="https://counter.theconversation.com/content/103735/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Leung receives funding from National Institutes of Health, U.S. Department of Veterans Affairs, and the Moseley Foundation. </span></em></p>When kids get injured their skin heals fast, but usually with nasty-looking scars. Now scientists studying the genes of old mice have figured out how they regenerate skin and block scars.Thomas Leung, Assistant Professor of Dermatology, University of PennsylvaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/931092018-03-28T14:56:23Z2018-03-28T14:56:23ZWhy the beauty industry will never fully embrace spots, scars and pimples<figure><img src="https://images.theconversation.com/files/211962/original/file-20180326-148729-13an34g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trying to achieve that 'flawless finish'. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=nY-I5IeL2KiU5ANGN8N1yw-1-70">Shutterstock</a></span></figcaption></figure><p><a href="https://www.instagram.com/p/BfjAjGWgMC3/?hl=en&taken-by=emeraldxbeauty">L’Oreal recently fired beauty vlogger Kadeeja Khan</a> from a hair advert. An agency working for the company approached Kadeeja through her Instagram account, arranged her travel and sent her details of the shoot. But on the day of the shoot, <a href="http://metro.co.uk/2018/03/03/beauty-vlogger-kadeeja-khan-dropped-loreal-campaign-skin-issues-7357688/">L'Oreal’s agency emailed</a> Kadeeja saying it was sorry but “L'Oreal can’t be involved with people with skin issues”. Kadeeja has acne. </p>
<p>L’Oreal claims <a href="https://www.thesun.co.uk/fabulous/5685213/acne-suffering-instagram-star-humiliated-loreal-drop-offer-work-skin-issues/">this was just a mix up</a>, that their <a href="https://www.cosmopolitan.com/uk/beauty-hair/a19052256/kadeeja-khan-loreal-dropped-campaign-acne-skin-issues/">agency had made a mistake</a> “where the wrong profile had been cast” and that they actually “work with women and men with all skin types and celebrate beauty in all its diversity”. But as Kadeeja pointed out, apparently not women like her. She wasn’t invited back to do the shoot. </p>
<p>The reality, as research shows, is that not all skin types are represented by L’Oreal or in the media generally. In our previous research, my and colleagues and I coded every image of a man featured in <a href="https://glenjankowski.files.wordpress.com/2017/11/jankowskiea2014.pdf">popular men’s magazines</a>, <a href="https://glenjankowski.files.wordpress.com/2016/09/the-appearance-potency-of-mens-websites.pdf">dating websites and porn sites</a>. Unsurprisingly, we found the majority of the images used were of men who were muscular, had full heads of hair and were young. </p>
<p>We also found just 203 – or three per cent of the 6,349 images featured – had a skin blemish or an unsymmetrical facial feature. These features were minor such as faint eye wrinkles or a slightly unsymmetrical nose. There were no images of men with acne. We also found similar results for the images of women.</p>
<h2>No acne, scars or blemishes</h2>
<p>In general, people with visible facial differences, such as acne, are rarely represented and when they are represented in media they are often <a href="http://www.rudermanfoundation.org/wp-content/uploads/2016/07/TV-White-Paper_final.final_.pdf">villified</a>. Just think of Scar from The Lion King, Lord Voldemort from Harry Potter and more recently <a href="https://themighty.com/2015/06/how-hollywood-portrays-people-with-facial-difference-as-villians/">Dr Poison from Wonder Woman</a> – these are all characters with prominent facial scarring who represent the “baddies”. </p>
<p>Acne also faces stigma. The NHS has <a href="https://www.nhs.uk/conditions/acne/causes/">tried to break this stigma</a> by rebutting the persistent myths surrounding acne: that it is caused by a bad diet or how clean your face is. It’s not. </p>
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<p>Blemished skin isn’t the only under represented skin type. Older skin and darker skin is also seen less often in popular culture. Such is the poor representation of darker skin that my colleagues and I found there were twice as many lighter skinned Black women featured than darker skinned Black women, even in <a href="https://glenjankowski.files.wordpress.com/2017/07/jankowski-et-al-2017-light-except-lupita.pdf">Black women’s magazines</a>. </p>
<h2>Extreme airbrushing</h2>
<p>The poor representation of all skin types is especially true for many cosmetic companies. In 2009, Proctor & Gamble’s Olay <a href="https://www.theguardian.com/media/2009/dec/16/twiggys-olay-ad-banned-airbrushing">announced</a> they were using fashion model Twiggy to head up one of their adverts. Twiggy had a skin “type” rarely featured in advertising – one that had some evidence of ageing – she was 59 at the time. So how did Olay celebrate this skin type? They got rid of it. </p>
<p><a href="https://www.theguardian.com/media/2009/dec/16/twiggys-olay-ad-banned-airbrushing">Ofcom banned the advert</a> for its extensive airbrushing of Twiggy’s skin which they argued could give a misleading impression of the effect the product could achieve. </p>
<p>Other companies such as L’Oreal are no better. At least <a href="http://www.dailymail.co.uk/femail/article-2094440/Rachel-Weisz-advert-banned-LOreal-admits-airbrushing.html">three of their adverts have been banned</a> for extensive airbrushing of female celebrities’ faces – including Rachel Weisz and Julia Roberts. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211963/original/file-20180326-148720-ce0mwu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Love the skin you’re in.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=nY-I5IeL2KiU5ANGN8N1yw-1-70">Shutterstock</a></span>
</figcaption>
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<p>L’Oreal’s decision to fire Kadeeja is reminiscent of a <a href="https://jezebel.com/5573505/craigslist-ad-hints-that-dove-wants-real-women-but-only-if-theyre-flawless">casting call</a> for Dove’s Real Beauty campaign in 2010 which aims to create a world where “<a href="https://www.dove.com/uk/stories/campaigns.html">every body is beautiful</a>”. The casting call specified that Dove was looking for “three or four real women for a Dove Print Campaign”. The call stated that the women “must have flawless skin”, “nice bodies” and that “beautiful hair and skin is a must”. </p>
<p>Dove also got into trouble in 2008 when a photo editor claimed he had extensively airbrushed some of the images of real women in Dove’s adverts. This was later backtracked, with the editor claiming his words had been <a href="https://www.campaignlive.co.uk/article/dove-dangin-dispute-real-beauty-ad-retouching-claim/808249">taken out of context</a>. </p>
<p>Companies like Dove – or its parent company Unilever – need to sell their next anti-cellulite, anti-wrinkle and skin bleaching creams. So while Dove’s campaign might claim “every body is beautiful”, its profits depend on women believing that bodies with cellulite or wrinkles are not.</p>
<p>Someone like Kadeeja, is an antidote to this and the plethora of images of women and men in the media that have flawless skin. So while, yes, she posts makeup tips, she is also “acne positive”. She regularly posts pictures of herself without makeup, with acne, showing her 146,000 Instagram followers that “<a href="https://www.instagram.com/p/Besw5QuAiLx/?hl=en&taken-by=emeraldxbeauty">looks are not everything</a>” and that “<a href="https://www.instagram.com/p/BgJWPwsg_HN/?hl=en&taken-by=emeraldxbeauty">beauty is self confidence applied directly to the face</a>”. And in that sense, by today’s standards of beauty, she is pretty radical.</p><img src="https://counter.theconversation.com/content/93109/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Jankowski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with visible facial differences, such as acne, are rarely represented in the media and when they are, they are often vilified.Glen Jankowski, Senior Lecturer in the School of Social Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/914152018-03-22T23:46:30Z2018-03-22T23:46:30ZBeauty is skin-deep: why our complexion is so important to us<figure><img src="https://images.theconversation.com/files/210612/original/file-20180315-104673-c6hkvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Skin is seen as a marker of health, and thus beauty. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/hDlIX2hq5u8">Noah Buscher/Unsplash</a></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>We’re all attracted to a beautiful face. We like to look at them, we feel drawn to them and we aspire to have one. Many researchers and others have investigated what we humans identify as “beautiful”: symmetry, large evenly spaced eyes, white teeth, a well-proportioned nose and of course, a flawless complexion. The skin is of utmost importance when people judge someone as beautiful.</p>
<p>When choosing a mate, men rank female beauty more highly than women rate male appearance. <a href="http://beauty-review.nl/wp-content/uploads/2014/04/The-effects-of-skin-colour-distribution-and-topography-cues-on-the-perception-of-female-facial-age-and-health.pdf">Female beauty</a> is thought to signal youth, fertility and health. </p>
<p>Beauty can also signal
<a href="https://wiwi.uni-paderborn.de/fileadmin/dep1ls6/Research/Beauty_and_the_Labor_Market_Hamermesh_Biddle.pdf">high status</a>. People with “plain looks” earn about 10% less than people who are average-looking, who in turn earn around 5% less than people who are good-looking.</p>
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Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
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<h2>Skin as a marker of health and beauty</h2>
<p>Even the best facial structure can be unbalanced by skin that is flawed.</p>
<p>There are many skin conditions that are perfectly natural, yet because of our beliefs around skin and health, these can cause the sufferers extreme self-consciousness. </p>
<p>Examples include: <a href="https://www.dermnetnz.org/topics/melasma/">chloasma</a>, the facial pigmentation that often occurs during pregnancy; <a href="https://www.dermnetnz.org/topics/telangiectasia/">starburst telangiectasias</a>, the broken capillaries that appear on the lower thighs and calves of many women as they age; and <a href="https://www.dermnetnz.org/topics/dermatosis-papulosa-nigra/">dermatosis papulosa nigra</a>, the brown marks that accumulate on the upper cheeks and temples, especially in people of Asian or African descent. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chloasma (pigmentation) often affects pregnant women.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Teenagers with <a href="https://escholarship.org/uc/item/4hp8n68p">acne</a> are more likely to withdraw socially. It may impair school performance and result in severe <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2006.00979.x">depression and even suicide</a>. </p>
<p>There are hundreds of <a href="http://www.dermnet.com/">skin diseases</a> that can change facial appearance, including rashes such as rosacea and skin cancers. Surgery for skin cancer can <a href="https://www.google.com.au/search?q=skin+cancer+disfigurement&rlz=1C1OKWM_enAU783AU786&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjb7sicn_zZAhVHV7wKHcImAeoQ_AUICigB&biw=2560&bih=1334">leave noticeable marks and scars</a> that make the survivor self-conscious.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
</strong>
</em>
</p>
<hr>
<h2>Industries built on our self-consciousness</h2>
<p>Perhaps alongside the greying of the hair, skin is the most visible sign of ageing. As we age the skin changes. These changes are most pronounced in the areas exposed daily to the sun, such as the face, neck and the backs of our hands. </p>
<p>There the skin thins, loses volume and elasticity and becomes dull. Dark rings develop under the eyes. Wrinkles appear. The skin sags and blemishes and scars accumulate. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Despite having no negative physical health effects, acne can cause major self-esteem problems in youth.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>People spend a lot of money in attempts to regain their youthful appearance. The global cosmetics industry is worth about <a href="https://www.businesswire.com/news/home/20150727005524/en/Research-Markets-Global-Cosmetics-Market-2015-2020-Market">US$500 billion</a>. Sales of skin and sun care products, make-up and colour cosmetics generate over 36% of the worldwide cosmetic market. </p>
<p>We use foundation makeup to conceal freckles and blemishes, moisturisers and fillers to hide dryness, concealers to disguise broken capillaries and pimples. And increasingly people are using botox to remove wrinkles, fillers to replace volume, and laser to remove flaws from the top layer of skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<p>We should all use sunscreen to protect the skin from sun damage and prescription medications to cure the skin of diseases when necessary.</p>
<p>In 2018, we find ourselves living longer, working later and remarrying more. We’re having to trade on our beauty much later in life.</p>
<p>In a better world, beauty would be irrelevant. Unfortunately in our world it’s one of our most valuable assets. The best we can do is to protect our skin from sunburn, seek advice from a dermatologist when we notice any skin problems, and accept we weren’t born with the skin of Beyonce. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-of-the-most-life-threatening-skin-conditions-and-what-you-should-know-about-them-92610">Four of the most life-threatening skin conditions and what you should know about them</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/91415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite skin conditions such as acne having no negative health effects, they can take a huge toll on the confidence and mental health of the person.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752882017-09-27T20:01:04Z2017-09-27T20:01:04ZHealth Check: do we have to clean out our pores?<figure><img src="https://images.theconversation.com/files/185212/original/file-20170908-19911-1a3hd2u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pores are self-cleaning, so you don't need to rip out or scrub off their contents. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Many of us would have seen, if not tried, various products claiming to clean the dirt out of our pores. From scrubs to cleansers to plasters that stick to our faces, there are many tools at our disposal. </p>
<p>But do we actually need to clean out our pores? Or are the little black stems on the other side of the sticky plaster or mask fine where they are? </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tTXHoN3jkM8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">There are many products on the market to clean out pores.</span></figcaption>
</figure>
<p>The pores on our face, just like our ear canals, are designed to clean themselves. So for most people, leaving them to their own devices is fine, and just cleansing the face is enough. But there are a variety of reasons why pores can become blocked, causing blackheads to form under the skin. These blackheads are made up mostly of dead skin, and some dirt.</p>
<p>Hormones, bacteria or sometimes too much cleansing (because this can irritate the skin, causing it to thicken) can cause pores to block. This is a common cause of acne. This is because when the pore blocks there is back pressure in the oil gland which can then rupture, releasing very irritating oils. It’s these that cause the red lesions known as acne.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-is-makeup-bad-for-your-skin-82820">Health Check: is makeup bad for your skin?</a>
</strong>
</em>
</p>
<hr>
<p>It’s important to never squeeze a blackhead too much because you might cause the oil glands to rupture back into the skin, causing an even worse reaction. You can buy a special blackhead removing tool from the chemist and this avoids breaking a blackhead under the skin. There are also medical prescription gels that can clear pores. Vitamin A products stop the skin lining the pores from thickening, so they don’t block the oil glands, leading to acne. </p>
<p>Some people have genetically bigger and more noticeable pores, and pores get bigger as we age. This doesn’t mean they’re more likely to fill up with dirt. The only issue is some people don’t like the way this looks and can feel self-conscious about their bigger pores.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185213/original/file-20170908-9585-jhp9xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people don’t like their visible pores.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What are you trying to achieve?</h2>
<p>There are a few different ways to think about your pores. Some people have normal skin and just want to clean their face. In some people pores are blocked with a condition such as acne. And some have normal skin and just want their pores to appear smaller.</p>
<p>If your skin is normal (no acne and the pores are not prominent) and you just want to clean your face, just wash your face gently to avoid irritating your skin, which can cause your pores to appear bigger. Using hot water can inflame your face and dry it out, so stick with lukewarm or cool water. Use a gentle cleanser, but if your skin is on the dry side, you don’t need to use a cleanser. </p>
<p>If you want to use one, make sure it’s non-abrasive and doesn’t contain chemicals that will dry out your face. Pat your face dry with a soft towel and don’t rub it or scrub it. This can irritate the pores and cause them to swell and block.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/helen-mirren-was-probably-right-about-moisturiser-so-heres-an-owners-guide-to-looking-after-your-skin-82781">Helen Mirren was probably right about moisturiser, so here's an owner's guide to looking after your skin</a>
</strong>
</em>
</p>
<hr>
<p>If you have acne, using a chemical exfoliant such as alpha hydroxy and or beta hydroxy acid will exfoliate your skin without having to scrub it. This means there is no damage to the pore. The longer you leave the cleanser on the more it works.</p>
<p>If you overdo it, the skin will dry and start to flake and scale. Importantly, a break from the cleanser is better than just putting on moisturiser, which could add to the pore blockage.</p>
<p>If your aim is cosmetic and you want to make your pores appear smaller, many opt for micro-dermabrasion. This is a process that many dermal technicians perform with an abrasive device and suction to wear away the very top layer of the skin (the epidermis). The process is usually performed with the aid of a strong cleanser. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185214/original/file-20170908-16025-1bu05gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Micro-dermabrasion wears away the very top layer of skin, but has to be performed by a technician, and not too regularly to avoid irritation.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>This treatment is not something to try yourself. The suction can help unblock the pores, but too much friction can irritate them. So you have to ensure you’re not getting worse after these treatments. This treatment should be used no more than once a month, since it can damage your skin if it’s done too often.</p>
<h2>What can be harmful?</h2>
<p><strong>Steaming</strong>: heating the face can make the blood vessels stand out and cause rosacea (a red rash) in those who are prone to it. The oils are dissolved more readily and stripped from the face, which means, unless you really have very oily skin, it will dry out. <a href="https://link.springer.com/referenceworkentry/10.1007%2F978-3-540-89656-2_42">We now know heat ages the skin</a> so it makes sense to avoid this type of treatment for most people.</p>
<p><strong>Facial brush</strong>: while a facial brush will exfoliate your skin, the risk is that the pore will swell due to the irritation, causing more blockage.</p>
<p><strong>Facial scrub</strong>: gels, creams, cleansers and scrubs containing tiny particles that exfoliate your face can also cause swelling and block the pores.</p>
<p><strong>Pore strips</strong>: clay masks and pore-strips pull out the substances that accumulate in pores. They do remove the pore contents faster than nature intended, but they are relatively gentle on the pore compared to the scrubs. They can, however, leave the skin more sensitive to anything applied shorty after.</p><img src="https://counter.theconversation.com/content/75288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many of us would have seen, if not tried, various products claiming to clean the dirt out of our pores. But do we need to?Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/638102016-11-21T02:23:05Z2016-11-21T02:23:05ZHealth Check: are cosmetics containing Vitamin A safe during pregnancy?<figure><img src="https://images.theconversation.com/files/145118/original/image-20161109-16721-1o1q1ct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant women are told to avoid vitamin A due to the risk of birth defects, but does anti-ageing cream count?</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Cosmetics promise us many things, but could certain types of skin-care products containing vitamin A be harmful to unborn children? </p>
<p><a href="https://en.wikipedia.org/wiki/Vitamin_A">Vitamin A</a> is one of the most recognisable vitamins. It’s essential for tissue development and plays an important role in vision. In many developing countries, <a href="http://www.who.int/nutrition/topics/vad/en/">childhood vision problems</a> are due to vitamin A deficiency. </p>
<p>Too much vitamin A can be harmful too, as <a href="https://www.theguardian.com/science/antarctica-live/2013/dec/04/douglas-mawson-antarctic-trek">Antarctic trekkers discovered</a>. When starving, they ate their dogs (including their livers, which are high in Vitamin A) and suffered illness and eventually death. </p>
<p>Vitamin A is also important for skin integrity and function. Vitamin A is actually a group of related unsaturated fatty compounds that includes <a href="https://en.wikipedia.org/wiki/Retinol">retinol</a>, retinal and retinoic acid. Vitamin A and synthetic analogues of vitamin A are used to treat a variety of skin conditions, as well as some forms of cancer. </p>
<p>As well as dermatological uses of vitamin A, it may be found in some “anti-ageing” cosmetics and sunscreens because of its effect on the skin. </p>
<p>However, because vitamin A plays a role in foetal development, using pharmaceutical levels of vitamin A during pregnancy may interfere with the development of the foetus and cause deformities, especially of the face and palate. Is there a risk of this occurring with cosmetics?</p>
<h2>What vitamin A is used for</h2>
<p>Acne is a complex long-term inflammatory disease of the skin that centres on the hair follicle. There are excessive secretions in the follicle, too much protein is made and bacteria infect the site. Acne can range from mild to moderate to severe disease with the potential for disfiguring scarring.</p>
<p>Acne is resistant to many of the treatments that would usually be used in an inflammatory disease. Therapy for acne can be complex, but vitamin A in the form of “<a href="https://en.wikipedia.org/wiki/Tretinoin">tretinoin</a>” or “isotretinoin” plays a significant role in treating acne. Synthetic vitamin A is also used.</p>
<p>While most of these products are rubbed on the skin, oral isotretinoin is the treatment of choice for severe adult acne. Typical concentrations of trentinoin cream range from 0.01% to 0.1%.</p>
<p>Both Tretinoin and retinol have been incorporated into a variety of cosmetics and sunscreens. Tretinoin stimulates supporting cells in the skin to make more of the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/">supporting structure of the skin</a>, which reduces wrinkling and some of the damaging effects of sunlight on skin. </p>
<p>Tretinoin can also normalise some of the pigment changes in skin with ageing and sun exposure. While the <a href="http://www.ncbi.nlm.nih.gov/pubmed/23839179">initial research</a> was done on tretinoin, retinol has been shown to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/25607905">effective in cosmetic applications</a> as well (although around ten times less potent than tretinoin). Cosmetics available in Australia appear to have retinol in them, rather than any other form of vitamin A.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=636&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=636&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=636&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=799&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=799&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=799&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many anti-ageing creams contain Vitamin A.</span>
<span class="attribution"><a class="source" href="http://www.biovea.net/au/product_detail.aspx?PID=4287&TI=GGLAU&C=N&gclid=CJnnwqzFmtACFYmSvQodDAALZA">Screenshot, Biovea</a></span>
</figcaption>
</figure>
<p>While it’s generally accepted the ranges of tretinoin or retinol in cosmetics are similar to those found in pharmaceutically active products, this information can be very difficult to find. It’s also hard to find which “anti-ageing” products these compounds are actually in. </p>
<p>While some internet-based sales sites prominently feature their retinol content and one group claims to have a high 1% retinol content product (compared to 0.1% for tretinoin), another prominent anti-ageing product lists retinol under “inactive ingredients” with no actual concentration given.</p>
<p>Finding health warnings on cosmetics is variable as well. Aside from the risks of birth defects, tretinoin and retinol are both associated with adverse effects, ranging from <a href="http://www.nps.org.au/medicines/skin/acne-medicines/tretinoin-acne-medicines/retrieve-cream">rash and dry skin to irritation and burning</a>. </p>
<p>Some cosmetics sites and products mention this, some don’t. None of the products I surveyed mention issues with birth defects in any easy-to-find place.</p>
<h2>Vitamin A compounds and birth defects</h2>
<p><a href="http://www.medscape.com/viewarticle/492119">Oral consumption of isotretinoin</a> has been clearly shown to produce birth defects. However, tretonin and retinol applied to the skin are less likely to be associated with birth defects. </p>
<p>Tretonin is poorly absorbed from the skin and rapidly broken down. In animal studies tretinoin applied to the skin at levels higher than used in humans produced no birth defects. For example in rats, concentrations of 0.5 milligrams per kilogram per day were applied to the skin without effect. </p>
<p>Fewer studies have been done with retinol, but it too is <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511092">poorly absorbed</a> through the skin.</p>
<p>Overall, poor absorption and the small surface area the retinoids were applied to would suggest the levels achieved in the blood would be too low to harm the developing child. </p>
<p>There were early <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/">case reports</a> (isolated reports after use of the product) of birth defects following skin application of tretinoin in humans. Since then there have been four relatively large studies in humans where pregnant women who were or were not exposed to tretinoin were followed for birth defects. No differences in birth defects were found between the groups (for recent reviews see <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/">here</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24528911">here</a>).</p>
<p>In the most <a href="http://onlinelibrary.wiley.com/doi/10.1177/0091270011429566/abstract">recent and largest study</a> reported in 2012, 235 pregnant women exposed to a variety of retinoids applied to the skin from the beginning of pregnancy were compared with 444 controls. No differences were seen between groups in rates of spontaneous abortion, minor birth defects or major birth defects. No child showed features of retinoid embryopathy (birth defects caused by Vitamin A).</p>
<h2>The bottom line</h2>
<p>Despite the low risk suggested by these studies, experts still suggest pregnant women avoid applying vitamin A-based formulations to their skin during early pregnancy.</p>
<p>On the other hand, if you have used a cosmetic containing a retinol or a similar vitamin A-like compound during pregnancy, there’s no need to panic. Stop using the product and consult with your health care professional. </p>
<p>If you are planning to becoming pregnant, it would be wise to check any “anti-ageing” cosmetics or sunscreens to determine which ones have retinol or other forms of vitamin A in them (you may have to do some sleuthing) and, as always, have a conversation with your health care professional.</p><img src="https://counter.theconversation.com/content/63810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adulterants and contaminants in herbal medicines. He has previously received funding from both the Australian Research Council and the NHMRC for Alzhiemer's related research. </span></em></p>Anti-ageing cosmetics are common and many contain forms of vitamin A, but are there any risks using vitamin A on your skin during pregnancy?Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/536312016-03-21T01:04:24Z2016-03-21T01:04:24ZHealth Check: is it bad to pop your pimples?<figure><img src="https://images.theconversation.com/files/115215/original/image-20160316-25492-1rlyp3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trying to pop pimples can actually make your skin worse.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/kenstein/5996376188/in/photolist-4T8KSp-pazd4-2PZKN-3L89Hk-a8SZJm-4VNBuz-6bcqDf-6ayrrQ-rZYPy4">Runs With Scissors/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>To squeeze or not to squeeze? I’ll admit that I’m no skin saint. I have stood in front of the mirror on a number of occasions as a teenager with a big pimple staring right back at me. And yes, despite being advised not to, I have squeezed, picked and popped. </p>
<p>But is this really a crime against the skin?</p>
<p>The answer is yes. Squeezing and trying to pop pimples is <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072395/">definitely not the best solution</a> and can actually make your skin worse. </p>
<h2>How pimples form</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1023&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1023&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1023&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1285&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1285&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115371/original/image-20160317-30222-374nl5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1285&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More than 80% of teenagers suffer from pimples.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Acne is one of the most common inflammatory skin conditions in adolescents. More than <a href="http://www.ncbi.nlm.nih.gov/pubmed/23560567">80% of teenagers</a> battle with pimples. It can also occur later in life for a number of reasons, including an <a href="http://www.ncbi.nlm.nih.gov/pubmed/25597414">imbalance of hormones called androgens</a>.</p>
<p>At the moment, we need more research to fully understand the causes of acne. Oil glands (sebaceous glands), located in the skin at the base of the hair follicle, excrete oil (sebum) to lubricate the surface of the skin and hair. All parts of the body contain sebaceous glands, except the palms and soles of the feet.</p>
<p>Acne was previously thought to come from lack of normal shedding of the skin cells that line the sebaceous (oil gland) follicle. This was thought to lead to thickened skin and the formation of small comedones (black and white heads). </p>
<p>But there has been a shift in this thinking in recent years. Acne is now viewed primarily as an <a href="http://www.ncbi.nlm.nih.gov/pubmed/26741394">inflammatory skin disorder</a>.</p>
<h2>Why you shouldn’t squeeze</h2>
<p>A pimple is like a little bag under the skin that contains oil, bacteria and inflammation. Squeezing it can result in these contents being pushed into surrounding skin, making the problem worse. It can also lead to infection and temporary darkening of the skin in that area. </p>
<p>On top of this, the inflammation can become so bad that scarring is left behind when the pimple finally settles down. And scarring (unlike the pimple) <a href="http://www.ncbi.nlm.nih.gov/pubmed/26059729">can be permanent</a>.</p>
<p>If you resist the urge to squeeze, pimples will usually resolve over a week or so without scarring. The “white” contents will also settle down or spontaneously pop when ready.</p>
<p>If large pimples require urgent treatment, a dermatologist can get rid of the contents of a pimple safely. They may also give it an injection that decreases inflammation and the pimple in a day or so.</p>
<p>If pimples are something you battle with even on a monthly basis, it is advisable to see a dermatologist to find out what can be done to control the flares.</p>
<h2>How to prevent pimples</h2>
<p>If you want to avoid pimples, here are some ways you can have healthier and clearer skin:</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=911&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=911&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=911&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1144&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1144&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115740/original/image-20160321-4415-q145le.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1144&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For clearer skin, eat at a healthy, well-balanced diet.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<ol>
<li><p>Eat a healthy, well-balanced diet low in sugar. This includes nuts, legumes, fish, red meat, fruits and vegetables. A number of well-conducted trials support the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25454036">benefits of a diet with a low glycemic load</a> for patients who have acne. Some studies suggest a higher risk of acne with frequent milk consumption, but more research is needed before dietary recommendations can be made. It’s advisable to keep a diary to see if any of these foods directly aggravate acne and avoid them if this is the case.</p></li>
<li><p>Avoid excessive scrubbing, cleansing and exfoliating. Acne doesn’t happen due to accumulation of dirt and grime on the skin and can’t simply be washed away. Using many products can increase skin irritation and dryness and compound the problem.</p></li>
<li><p>Choose oil-free cleansers, moisturisers and sunscreen (these are usually labelled “non-comedogenic” on packaging).</p></li>
<li><p>Choose silicone-based hair products rather than greasy ones. Greasy hair products can make more oil and grease accumulate on the skin, which will make acne worse.</p></li>
</ol>
<p>And if you do get pimples, try to resist the urge to squeeze!</p><img src="https://counter.theconversation.com/content/53631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Rodrigues does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Squeezing and trying to pop pimples is definitely not the best solution and can actually make your skin worse.Michelle Rodrigues, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/561882016-03-18T10:05:59Z2016-03-18T10:05:59ZAcne treatment: antibiotics don’t need to kill bacteria to clear up your skin<figure><img src="https://images.theconversation.com/files/115027/original/image-20160314-11292-yqnlxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antibiotics can help, but at lower doses and shorter durations than doctors tend to prescribe. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-182957342/stock-photo-acne-skin-because-the-disorders-of-sebaceous-glands-productions.html?src=pyNEB5JOBn2Ujs5daJMJxA-1-78">Acne via www.shutterstock.com.</a></span></figcaption></figure><p>Acne is one of the most common dermatologic diseases, affecting <a href="http://www.sidnet.org/files/Burden%20of%20Skin%20Diseases%202004%20Final%20Sept%2005.pdf">40-50 million people each year</a> in the United States. While best known as a bothersome part of puberty, affecting approximately <a href="https://www.aad.org/media/stats/conditions">85 percent of young people</a>, acne can persist (or even start) in adulthood, causing emotional and physical distress and sometimes permanent disfigurement. </p>
<p>Many people with acne will be prescribed antibiotics for treatment at some point. In fact, about <a href="http://www.ncbi.nlm.nih.gov/pubmed/11100021">five million prescriptions</a> for oral antibiotics are written each year for the treatment of acne in the United States. While dermatologists comprise 1 percent of physicians overall, they are responsible for <a href="http://dermatologytimes.modernmedicine.com/dermatology-times/content/tags/acne/dermatologists-contribute-overuse-antibiotics">5 percent of all antibiotic prescriptions written</a>. </p>
<p>Even though national recommendations say that a course of antibiotics to treat acne shouldn’t <a href="http://dx.doi.org/10.1016/j.jaad.2015.12.037">last more than three months</a>, a study published in the <em>Journal of the American Academy of Dermatology</em> found that the average amount of time a patient is prescribed an oral antibiotic is actually <a href="http://dx.doi.org/10.1016/j.jaad.2015.09.046">over 300 days</a>.</p>
<p>Antibiotics may be prescribed at higher doses than <a href="http://dermatologytimes.modernmedicine.com/dermatology-times/content/tags/acne-treatment/derms-slow-embrace-subantimicrobial-dose-concept">what is really needed to treat acne</a>. While antibiotics can kill the bacteria associated with acne, it’s their anti-inflammatory effects, not their antimicrobial effects, that yield the biggest skin-clearing benefits. </p>
<p>The result is that the bacteria associated with acne are <a href="http://dx.doi.org/10.1016/S1473-3099(15)00527-7">becoming resistant to common antibiotics</a> – and this overuse also contributes to more harmful bacteria, like <em>Staphlycoccus aureus</em> and <em>Streptococcus</em> becoming resistant. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=246&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=246&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=246&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=309&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=309&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115046/original/image-20160315-17748-f66dp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=309&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What is it exactly?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/practicalcures/23388045145/in/photolist-BCHQZF-685ncS-eEwbU5-4E6Nka-oxjsH6-f5eaoH-9azsfQ-jzDZVi-77hWkd-jMxLbd-CMkwV-77hDHC-5w9Nho-cSb68Q-eh86mE-681cAP-77hGxh-4U7EJF-9qaXgM-8NgCMx-BCHQHD-B5cRPx-5FhKxZ-5FhKfg-nqqAwA-a63Kq-a63Kp-8sXWN1-9nH3We-bB17Yq-4dJgUX-7g6Ydv-brxmTP-PC9bN-4CoUJa-edzEW5-9wVGPe-czh3KE-rBtepJ-cTptMJ-2qiGz-o2buPN-e3ba6Z-a63Kn-a63Ki-a63Kk-82orWz-4CfWGn-fSR22k-a63Km">Practicalcures.com/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What is acne anyway?</h2>
<p>Acne is a chronic inflammatory skin condition, characterized by blackheads and whiteheads (called comedones), pimples, and deeper lumps (cysts or nodules). They are caused when hair follicles are clogged with oil, bacteria and dead skins cells, and can occur on the face, neck, chest, back, shoulders and upper arms. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115468/original/image-20160317-30203-1drggxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whiteheads, blackheads and pustules! Oh my!</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-248595325/stock-vector-types-of-acne-pimples-healthy-skin-whiteheads-and-blackheads-papules-and-pustules.html?src=byWggq37ITai9CYfWs_1lQ-1-4">Acne diagram via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<p>While once thought to be a direct result of overactive sebaceous oil glands, now we know that inflammation <a href="http://dx.doi.org/10.1111/j.1600-0625.2009.00890.x">is the driving force behind acne</a>. In fact, this inflammation can be seen in the skin even <em>before</em> a pimple pops up. And clogged follicles can also stimulate more inflammation. </p>
<p>The bacterium that lends its name to the condition <em>Propionibacterium acnes</em>, is just one of the factors that stimulates this acne-causing inflammation.</p>
<p>Hereditary and genetic factors, hormones, emotional stress and even diet can also bring on the zits. For instance, foods with a high glycemic load such as white grains (bread, rice, pasta) and sweets have been <a href="http://dx.doi.org/10.1111/exd.12898">linked to acne</a>, as they can increase oil production and skin cell turnover. This ultimately causes a backup in the pores and follicles on our skin – creating a nice environment for the inflammation-inducing <em>P. acnes</em> to flourish.</p>
<p>Treating the inflammation can help prevent acne from developing, and the potent anti-inflammatory effects of antibiotics can help to treat acne, much more than their ability to kill bacteria. For instance, the tetracycline class of antibiotics, such as doxycycline and minocycline, <a href="http://dx.doi.org/10.1155/2015/329418">can inhibit the production of pro-inflammatory signaling molecules</a>.</p>
<p>They also inhibit overactive demolition enzymes called matrix metalloproteinases. Normally, these enzymes help keep our skin healthy, breaking down old and dying structures to allow new ones to be built up. But when they’re overactive, these enzymes can <a href="http://dx.doi.org/10.1038/sj.jid.5701188">damage the hair and oil gland</a> unit as well as surrounding supporting structures in the skin. </p>
<p>When that happens, these enzymes contribute to the formation of the big, angry, red, cystic acne lesion, and they can also contribute to the creation of pitted scars. </p>
<p>This is why antibiotics are used to treat acne, but also rosacea, razor bumps and scarring hair loss, to name a few other dermatological conditions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115172/original/image-20160315-9272-14qakpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antibiotics also have anti-inflammatory effects.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-312461384/stock-photo-drug-pill-and-capsule-of-antibiotics-in-blister-packaging.html?src=J9dQi_H4p-z8On1_kIgYEw-1-15">Antibiotics image via www.shutterstock.om.</a></span>
</figcaption>
</figure>
<h2>We need to change how we use antibiotics</h2>
<p>Thanks to using higher-than-needed doses of antibiotics and keeping patients on them for longer than recommended, the <em>P. acne</em> and other skin bacteria, like <em>Staphlyococcus aureus</em> (MRSA, the multi-drug resistant strain of staph bacteria) have developed <a href="http://dx.doi.org/10.1016/j.jaad.2015.12.037">resistance to multiple topical and oral antibiotics</a> used to treat this disease chronically. For instance, 20 or 30 years ago, the antibiotic erythromycin was used frequently to treat acne, but now both bacteria are uniformly resistant. </p>
<p>So far we have not seen too much resistance to the tetracycline class of antibiotics used today, but they too will be on their way out if we do not change our prescribing patterns. </p>
<p>This is frustrating because antibiotics don’t need to kill bacteria to treat acne. Clearing <em>P. acnes</em> from the area can be helpful, but the bacteria is just one stimulus of inflammation, so removing it is an assist, not a win. And research has shown that the desired anti-inflammatory effects <a href="http://jddonline.com/articles/dermatology/S1545961615P0581X">can be achieved at sub-antibacterial dosing</a>. This means that the needed dose is so low that it can’t kill good bacteria or challenge pathogenic bacteria to become resistant. </p>
<p>And antibiotics should never be prescribed on their own to treat acne. In fact, treatment guidelines always recommend that antibiotics be <a href="http://dx.doi.org/10.1016/j.jaad.2015.12.037">combined with a nonantibiotic topical treatment</a>.</p>
<p>An oldie but goodie is benzoyl peroxide in a relatively low strength (2.5 percent, compared to the 8-10 percent that you get at the drugstore). It can kill <em>P. acnes</em>, but because it’s not an antibiotic, bacteria can’t become resistant to it. It can also break down the skin overgrowth <a href="http://www.ncbi.nlm.nih.gov/pubmed/8204465">covering the pore</a>, which leads to blemishes. </p>
<p>Retinoids, derived from vitamin A, are by far the <a href="http://dx.doi.org/10.1111/jdv.13190">most effective topical anti-acne drugs</a>. They limit pore clogging, inhibit inflammation and matrix metalloproteinases. Retinoids also affect the various genes involved in producing the structural components of the skin, such as collagen and elastin, improving the appearance of scars.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115475/original/image-20160317-30219-cct6pg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Better treatments on the horizon?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-301072340/stock-photo-young-white-skinned-girl-with-wet-hair-without-makeup-is-in-disbelief-in-front-of-cosmetic-products.html?src=csl_recent_image-1">Woman image via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>The future of acne treatment</h2>
<p>A future direction in acne treatment development is utilizing agents that can kill <em>P. acnes</em> but that don’t lead to microbial resistance. </p>
<p>For instance, there are studies using synthetic antimicrobial peptides, tiny strings of amino acids that can physically destroy <em>P. acnes</em>. This remedy would likely be used in conjunction with other therapies that can treat other causes of acne.</p>
<p>Even more promising is the use of nitric oxide, one of the most important and potent biological molecules, which can both kill <em>P.acnes</em> without the risk of it or any other bacteria developing resistance <em>and</em> inhibit multiple elements of inflammation involved in the formation of the vicious pimple. The limitation to date has been delivery, as nitric oxide is highly unstable.</p>
<p>But nanotechnology might provide a way of delivering nitric oxide to treat acne. I, along with collaborators at the Albert Einstein College of Medicine and the University of California, Los Angeles, have shown that a nanoparticle capable of generating low levels of nitric oxide over time <a href="http://dx.doi.org/10.1038/jid.2015.277">could hit all the key pathologic elements</a> that lead to acne. </p>
<p>In the meantime, if you are prescribed antibiotics for acne, ask your doctor how long you need to take them and if the dose is appropriate. And try to avoid popping those zits.</p><img src="https://counter.theconversation.com/content/56188/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Consulting/Ad board: Sanova works, Oakstone institute, Loreal, La Roche Posay, Galderma, Amgen, Onset, Aveeno, Valeant, Microcures, Nano Bio-Med, Biogen, Pfizer, Nerium, G&W Laboratories, Novartis, Occulus, Intraderm, Encore, Ferndale. Speaker: Amgen, Valeant. Grants: Valeant
</span></em></p>While antibiotics can kill the bacteria associated with acne, it’s their anti-inflammatory effects, not their antimicrobial effects, that yield the biggest skin-clearing benefits.Adam Friedman, Associate Professor of Dermatology, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/291432014-08-04T04:51:22Z2014-08-04T04:51:22ZHealth Check: why do I still get zits?<figure><img src="https://images.theconversation.com/files/55558/original/3h2gxsrf-1407027449.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Adult acne is very common and usually affects women women in their 20s, 30s and 40s.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-33920470/stock-photo-portrait-of-teenage-girl.html?src=e9CwqJtygtn3EwVfvZb3Rg-1-111">alri/Shutterstock</a></span></figcaption></figure><p>You may have battled blemishes in your teens, or made it through puberty and early adulthood with relatively clear skin, but it always feels particularly unlucky contending with zits in adulthood.</p>
<p>Adult acne usually affects women in their 20s, 30s and 40s, though <a href="http://www.ncbi.nlm.nih.gov/pubmed/17945383">men are</a> certainly not immune. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22171979">One study</a> found 40% of women in their 20s, 25% of women in their 30s and 12% of women in their 40s suffer from clinical acne.</p>
<p>Acne is the most common skin disease globally. While some people get numerous pimples, blackheads and whiteheads over their face, chest and back, others may only have a few pimples now and then. </p>
<p>Adult-onset acne <a href="http://www.ncbi.nlm.nih.gov/pubmed/23302006">commonly flares</a> around menstruation, and is most likely to appear around the jawline, and in those with darker skin types. </p>
<h2>Causes</h2>
<p>While hormonal factors play a key role in adult-onset acne, other factors such as family history, medications, make-up and certain hair-care products may also impact the skin. </p>
<p><a href="http://med.monash.edu.au/sphpm/womenshealth/docs/androgens-in-women.pdf">Androgens</a> are male hormones present in both men and women. Elevated levels of androgens over-stimulate the sebaceous glands (oil glands), causing them to produce excessive amounts of sebum (oil) and increased numbers of acne-causing bacteria (<a href="http://emedicine.medscape.com/article/226337-overview">propionbacterium acnes</a>) on the skin. </p>
<p>Fluctuations in hormone levels occur during ovulation, menstruation, pregnancy and menopause and can even be caused by certain oral contraceptive pills. Some types of oral contraceptives, on the other hand, <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0053061/">can be helpful</a> for the skin but if stopped later in life, the underlying acne may be unmasked. </p>
<p>If other symptoms – such as irregular or infrequent periods, or excessive facial or body hair – are present, hormonal blood tests may need to be taken. This will help determine if there are underlying medical conditions such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Polycystic_ovarian_syndrome">polycystic ovarian syndrome</a> that are contributing to the acne problem. </p>
<p>Your treating dermatologist will then determine if hormonal therapies are necessary and safe for you.</p>
<p>Acne tends to run in families. If your parent battled acne at any point in their lives, it <a href="http://www.ncbi.nlm.nih.gov/pubmed/23210645">increases your risk</a> of developing adult-onset acne. </p>
<p>Cleansers, moisturisers, make-up and hair care products can all impact negatively on the skin if not chosen carefully. Look for oil-free products that are marked “non-comedogenic” (meaning they don’t block pores) and ensure that all make-up and other creams are washed off thoroughly with a gentle, oil-free cleanser before you go to bed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/54976/original/9vrqckkd-1406509186.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Popping zits can lead to problems such as scarring and discolouration.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jaredeberhardt/4539620662/in/photolist-5b4PDi-7gX6q5-G51d5-dnyM5-xcqFE-jhZYpf-jhZMHA-jhVD48-jhXoU1-jisBPJ-vEus-5xme3N-7V9K4L-5BxySH-chr9Hh-jhZEd2-92Uxnz-92Uy1g-jisCvU-jhXf1Z-jhVMdK-wXNAg-5zoes5-jhXB7h-92Uywz-jhZYiU-dLEWKG-ji3mnE-ji19SQ-jiopP8-7qQ9UU-9VykpB-7gwWaQ-75WTng-7vQaGd-5fagvk-5Pv7Me-7G1AVM-5mhxvS-9HrTJ8-a8CA7A-6sQor3-7uqeJ3-5tnerh-7V6uPz-5Dh479-6sLfBk-aE57V-o77ja-2n36ys">Jared eberhardt/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Try to avoiding oil-based haircare products. Select silicone-based products instead. Alternatively, only use these products on the ends of your hair and again, make sure you wash it off before bed. </p>
<p>Foods with a high glycemic index (GI) (refined carbohydrates) have also been blamed for the increasing incidence of acne. Though this <a href="https://theconversation.com/mondays-medical-myth-chocolate-causes-acne-6934">remains controversial</a>, there is certainly no harm in maintaining a well-balanced diet and minimising high-GI foods. </p>
<h2>Treatment</h2>
<p>Many over-the-counter products are available to help control oily skin and mild acne including oil-free acne washes, cleansers and moisturisers. But those who experiencing more than just a few, rare pimples, should seek medical advice from a general practitioner or dermatologist.</p>
<p>Dermatologists will consider your skin colour, skin type, acne severity, complications, other conditions such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rosacea">rosacea</a> and pigmentation as well as pregnancy and breastfeeding before recommending an individualised treatment plan to suit you.</p>
<p>Topical <a href="http://www.ncbi.nlm.nih.gov/pubmed/18973403">retinoid</a> (vitamin A-derived) creams or gels are often used as first-line treatment for all types of acne, including adult acne. These agents are also useful for pigmentation problems that may occur after acne has settled (post-inflammatory hyperpigmentation). This phenomenon is noted mostly in those with non-Caucasian skin.</p>
<p>Hormonal therapies, including certain types of <a href="http://www.ncbi.nlm.nih.gov/pubmed/22648217">oral contraceptives and anti-androgen medication</a>, such as spironolactone and cyproterone acetate, can be used if required. These medications may have side effects and are not appropriate for all patients, so discussion with your treating dermatologist is critical to ensure the best treatment is chosen for you. </p>
<h2>Six skin-care tips</h2>
<p><strong>1. Simplify your skin care regimen.</strong> Throw away the facial masks, essential oils, harsh scrubs and exfoliators and “magic serums”. Acne is not due to a build up of toxins or dirt on the skin and these products often do more harm than good. </p>
<p><strong>2. Choose non-comedogenic products</strong>. Use a mild non-comedogenic cleanser twice per day with cool water and ensure make-up is washed off thoroughly before going to bed. Don’t forget oil-free hair products.</p>
<p><strong>3. Less is more.</strong> It’s important to use only the recommended amount of medicated cream; more cream doesn’t mean it will work more quickly or give better results. In fact, over-use may result in irritated, dry skin.</p>
<p><strong>4. Control the urge: refrain from “popping zits”.</strong> Picking and squeezing pimples may cause secondary infection, scarring and pigmentation problems.</p>
<p><strong>5. It won’t happen overnight.</strong> No acne treatment will be an overnight miracle. But sticking to your treatment plan will give your the best chance of conquering post-pubescent spots.</p>
<p><strong>6. Seek treatment advice from your dermatologist early.</strong> This will ensure you have the best information on how to control your acne and avoid complications.</p>
<p>While there is no “one treatment fits all” for acne, treatments have significantly improved over the years and in nearly every case, the acne can be controlled. </p><img src="https://counter.theconversation.com/content/29143/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Michelle Rodrigues is a consultant dermatologist at St. Vincent's and the Royal Children's Hospital and is co-founder of the Vitiligo Clinic at the Skin and Cancer Foundation. She also consults in private rooms at Laser Dermatology, Box Hill and Frankston Dermatology. </span></em></p>You may have battled blemishes in your teens, or made it through puberty and early adulthood with relatively clear skin, but it always feels particularly unlucky contending with zits in adulthood. Adult…Michelle Rodrigues, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.