Why me?

Why my skin? Why another blemish or blackhead? Why can’t I have smooth, poreless skin? Why me? Believe me, I know this feeling.

Why do you suddenly, at the age of 28 or 48, have blemishes? Why haven’t you out­grown the blemishes and oily skin that have plagued you since you were 14, and that at age 35 are worse than ever? Why, at 40, do you have incessant blackheads and breakouts that won’t go away no matter what you do, and you’ve done everything? Why do you still have acne when you’re 18 and have tried oral antibiotics, Retin-A, sulfur masks, topical antibiotics, and every cosmetic skin-care routine imaginable? These are great questions and I understand them well.

Regardless of how old you are, breakouts and oily skin are upsetting, and anyone can be a victim! The main culprits in all these scenarios are hormones, because hormones are what affect oil production, and because their levels fluctuate at different times of life.

Breaking out is definitely most prevalent during adolescence. Statistics suggest that three out of four teenagers have problems with breakouts and various forms of acne. That isn’t surprising when you consider that adolescence is a time of colossal hormonal changes that stimulate sebaceous (oil) glands and increase sebum production, which in turn increases the chances for breakouts. But acne can happen at any age. More than 40% of all women will experience some form of acne. (Sources: Journal of Pediatric and Adolescent Gynecol­ogy, August 2008, pages 171-176; and Journal of European Dermatology and Venereology, November 2001, pages 541-545.)

Anything that can raise hormone levels—stress, the menstrual cycle, pregnancy, birth- control pills, or certain medications such as corticosteroids, and lithium—can act as a trig­ger. Specific foods are not responsible for breakouts, but an individual can have allergies to specific foods which may result in blemishes. There is also speculation that foods with hormone additives (specifically poultry and beef), iodine in food (shellfish), or fluoride in toothpaste may aggravate blemishes.

There’s no question that hormone activity is the main thing responsible for oily skin and breakouts. When hormones gush, blemishes can flare, but hormones alone are not enough to create this annoying skin malady. For some unknown reason(s), something goes wrong in the oil gland, blocking the natural flow of oil. Theories about what causes acne generally focus on a genetic predisposition that creates either a defective oil gland, a malfunctioning pore lining that doesn’t shed properly, or oil (sebum) that itself is in some way abnormal (too thick or irritating to the skin). In real life, you have to address most, if not all, of these issues if you want to reduce the chances of breakouts.

There are many theories about why some people have more severe cases of acne than oth­ers. Some suggest that it’s increased levels of male hormones, while others say that a genetic abnormality of the oil gland is the culprit. Hypersensitivity to P. acnes may also account for the great variation in the severity of acne (Source: Dermatology, 1998, volume 196, issue 1, pages 80-81). There is even research showing that the actual fatty-acid components of the oil gland may be responsible. Most likely it’s a combination of all these factors that causes the differences between those with mild or severe breakouts, and so the best approach is to deal with them one by one and through experimentation eliminate the sources of the problem.

Updated: September 19, 2015 — 9:13 pm