Acne myths still confuse patients

"We clearly know that many acne sufferers try to devise regimens and adjust their lifestyles in a self-directed effort to improve their acne," notes Dr. Kimball, director, Dermatology Clinical Studies Unit, Massachusetts General and Brigham and Women's Hospitals, Boston. "Therefore, knowledge of common acne myths is important in understanding what patients may be doing outside of our recommendations and so that we can counsel them about practices that may even be potentially harmful."

Most popular belief To evaluate and quantify prevalent beliefs about acne, Dr. Kimball in collaboration with Joanna Mimi Choi, B.A., a Stanford University student, surveyed 103 college students, asking them to rate the effects of 11 different factors on acne severity. The results showed the most prominently held belief was that poor hygiene worsened acne (90 percent). However, almost as many of the surveyed students believed acne was worsened by increased stress (88 percent), touching the face (88 percent), and popping pimples (85 percent).

No scientific footing Dr. Kimball observes that there is little or no good scientific evidence to confirm or refute many of those beliefs about acne.

Based on the findings of this survey with regard to the effects of poor hygiene and face washing frequency, she collaborated with Ms. Choi and Stanford student Vincent K. Lew, B.A., in another study to compare the effects of different face washing regimens on acne vulgaris. That investigator-blinded trial randomized 34 male college students affected by mild to moderate acne to wash once, twice or four times a day for six weeks with a standard mild cleanser. Existing topical and systemic acne medications had to be stable before and throughout the study and no other cleansers were allowed. All subjects washed their faces twice a day for two weeks before randomization.

Minimal difference At the end of the study, there were minimal differences in acne severity between study groups, although open comedones and total non-inflammatory lesions were improved significantly in the groups washing the face twice a day while erythema, papules and total inflammatory lesion counts worsened significantly among students washing once a day.

"Teenagers tend to think that washing more often is beneficial for acne, and that concept is usually reinforced by their parents, whereas dermatologists typically think excessive washing should be discouraged because of the potential to cause irritation," Dr. Kimball observes. "The data from this study suggest twice daily washing with a mild cleanser may be optimal, while more frequent washing may not be too problematic."

The amount of cleanser used for each washing was left to the discretion of the patient, and interestingly, the study also found that the median total cleanser used was almost identical among the three study groups.

"One interpretation is that persons who washed just once a day felt a need to use more cleanser while those washing most frequently thought it would be prudent to cut back on the amount used to minimize dryness," Dr. Kimball tells Dermatology Times.

Reviewing evidence for and against the other widely held beliefs, Dr. Kimball notes that a previous study she conducted showed a significant correlation between increased emotional stress, as experienced by college students during final exams, and increased acne severity. In that same study, there was only a statistical trend for reduced sleep to predict worse acne.

"Any potential relationship between sleep duration and acne severity appears to be a reasonable area for future study," Dr. Kimball says.

There are no data at all regarding whether touching the face or "popping pimples" exacerbates acne. However, it is plausible that manipulation of acne lesions aggressive enough to causes inflammation in the papillary dermis will lead to scarring.