A Breakout Month for Acne Info

“I learned the truth at seventeen,
That love was meant for beauty queens,
And high school girls with clear-skin smiles,
Who married young and then retired.”
— Janis Ian, At Seventeen

June is Acne Awareness Month, and you may find itself asking “Why?”  The reason is that acne is more than a cosmetic issue, but also one that affects mental health, social life and general well-being.

And here’s the twist: it’s called Acne vulgaris. “Vulgaris” in Latin simply means common. Stats say that 50 million Americans experience acne each year, but there’s no simple explanation as to why, or how to treat it. This is because, like most disorders, acne is not monolithic. There are multiple forms of the condition, and multiple causes, which therefore require nuanced treatment plans to be effective.

There’s always the fallback of genetics. Some of us are predisposed, some are not. When all else fails, blame your DNA.

We chatted with Junior Scott Pence, Co-Founder and Chief Brand Officer for Altadena-based Peace Out skincare, who shares that he and his partner Enrico Frezza founded the brand in his “man-galow” (man-bungalow) in El Sereno in 2016, seeking a solution to Frezza’s persistent adult acne. The brand proudly states “Peace Out launched the first viral gunk video and now is considered the social media leader for all things Zits and Gunk!”

Frezza had his epiphany while testing colloidal bandages from the drugstore. These wound-treatment dressings are manufactured with a gel base to keep the skin moist – directly contrary to past pimple-fixes, notably old-school Clearasil which basically took a scorched-earth approach to acne. 

The thinking circa 1960 was that aggressive drying-out of the skin was key to solving acne, as if the skin’s own lubrication, called sebum, was somehow deeply unclean. The main ingredient in those days was the bleaching agent benzoyl peroxide (BP), often combined with sulphur. Not-so-fun fact: BP is also used in rubber curing, plastics manufacturing and finishing of acetate yarns.

A round of vintage, peanut butter-colored Clearasil from the tube often left skin dry, red, hypersensitized and inflamed. Today, more skin-friendly ingredients like salicylic acid prove more effective, and more comfortable to use for acne management.

The “dot,” a tiny round sticker, has replaced the drying dab. These dots are thin, basically invisible, and may be easily covered with even light makeup.

Pence describes the Peace Out skincare product concept as “…the first-to-market microneedling patches. The dots are for all skin types, and Day Dot is an invisible dot that adapts to all skin tones and can hold make-up with a setting spray. The microneedles are a patented technology that deliver the ingredients directly into the pimple to stop it in its tracks.”

Pence and his Web site state that a dot can reduce the severity of a zit in four hours. And, the dot does keep idle hands from picking. And picking introduces bacteria that may make the blemish angrier, redder, larger, more painful and more long-lasting.

And, times change. Acne persists as a source of shame for many, and the condition may sometimes contribute to suicide.

Keeping it light, some brands like Dododots make no attempt to disguise the blemish the dots are treating. Dododots design choices include Powerpuff Girls motifs, glow-in-the-dark butterflies, and realistic-looking cockroaches.

“Pizza Face”: Cruel and Untrue

Popular culture sanctimoniously links acne with puberty, pizza, chocolate and, in some conversations, “impure thoughts” taking visible form. Each of these half-truths contains a grain of insight.

First, puberty. Yes, raging hormones can produce pimples. But not just ANY hormones: the culprit is usually an androgen, or male sex hormone.

Of course we think of teenage males as brimming with testosterone (actually, it’s dehydroepiandrosterone, a precursor hormone), but perhaps surprisingly, it’s this same masculine stuff, not the accompanying surges of estrogen, that also triggers youthful breakouts in teen girls as well as young dudes. Other hormones at other points in life also contribute to acne, much to the aggravation of pregnant women, and women in peri-menopause and menopause.

As for the pizza and chocolate, not so much, although in the few remaining places yet untouched by the ultra-processed Western diet, acne is extremely rare. Medical professionals would prefer to see us all eat nothing but organic dark, leafy greens and lean proteins, but there truly is nothing definitive on the books linking junk food with acne.

High-glycemic dietary load and resulting insulin resistance are often observed in people with acne, but researchers remain stumped by the fact that many obese people who consume refined carbohydrates and may experience diabetes and insulin-resistance are acne-free.

Decades-old studies suggested a link between acne and drinking whole milk, since commercial milk in the USA is produced by pregnant cows, adding a spritzer of bovine hormones into the mix, but these studies remain inconclusive.

On to those impure thoughts. This churchy phrase originally referred to what was quaintly called “self-abuse,” and although the Puritanical tone makes the objective reader question the premise, the association of acne with sex is not invalid. Androgens remain a constant threat to clear skin, stirred by normal hormonal shift and, as a separate issue, injected anabolic steroids. Many body-builders pay for their monster pecs and ceps with a face full of acne, related directly to elevated testosterone levels.

But newer research reveals the role of another hormone, and not a sexy one, called cortisol. It’s casually called the “fight or flight hormone,” formerly summoned in explosive bursts versus long-term duration by our central nervous system when our antecedents had to scram from saber-tooth cats or IRS audits.

In 2025, “impure” thoughts equate to anxiety. Anxiety in non-clinical terms is a constant state of elevated vigilance, nervousness, distraction, not being fully present, worrying, obsessive “checking,” always anticipating catastrophe. In extreme cases, anxiety is fear, even terror. Dermatologists concur that persistent cortisol elevation in the absence of fanged predators can result in acne, especially including adult acne.

Talk Dirty to Me

There’s a persistent tone of judgment in the acne conversation, starting with the premise that acneic skin is “dirty” skin, perhaps triggered by dirty minds. Is acne the result of being, as John Waters says, just plain filthy?

In one sense, yes, although we can’t vouch for the dirty minds. This belief led to maniacal scrubbing like that seen in Mommie Dearest (”I’m not mad at you, I’m mad at the dirt!”), repetitive mechanical trauma which the NIH posits may actually make acne worse.

One very literal example: acne outbreaks may occur purely from sweating and prolonged contact with metal or plastic. The underwire of a bra or the chin-cup of a sport helmet may create a tiny ecosystem where bacteria swarm and pimples result. Diligent cleansing of the area and the object will help.

Blackheads sound ugly and don”t look pretty. But the fact is that the dark center of a blackhead is not dirt; it’s oxidized sebum that is visible in the open follicle. This is but one example of the fact that acne is not reliably a failure of simple hygiene, since acne may visit even the cleanest of complexions.

The nitty gritty is that when genetics, medication, sunlight, circulating hormones, or some combination over-stim the sebaceous glands—those that produce sebum, our skin’s natural moisturizer and pH balancer – too much sebum pooling on the skin surface, accompanied by follicular hyperkeratinization (keratosis pilaris), the pimple-party is officially underway.

Elevated production of sebum (sebaceous hyperplasia) and/or blockage of the follicle invite a specific bacterium — cutibacterium acnes, or C. acnes, for short — to multiply wildly, disturbing dermic balance as it progresses.

In simplest terms, the bacterium feeds on the sebum and dead skin cells, devouring the skin’s protective barrier of hyaluronic acid, then secretes free fatty acids, proteins and enzymes which can trigger an immune response in the skin, resulting in inflammation and full-blown infection in the severe cases known as cystic acne.

Follicular keratinization — keratin is the protein that gives structure to our hair strands and finger-and toenails — is simply the inability of a hair follicle to shed its natural cellular lining. Without this usual shedding, the dead cells pile up, plugging the follicle opening, allowing bacteria to proliferate, and resulting in an array of skin eruptions. 

A platitude we hear a lot, often in political circles where it does apply, is that sunlight is the best disinfectant. Not so with our skin, since excessive exposure to UV may trigger acne development. Again, this runs counter to the DIY approach popular a generation ago, where basking was believed to dry up pimples.

Some cosmetics contribute. Coconut oil, cocoa butter, palm oil, and even groovy-seeming wheat germ oil and olive oil are flagged as topical comedogenics by dermatologists. This means that they plug up follicles or pores, and that blockage frequently produces a pimple. Ditto for lanolin, beeswax, carnauba, silicones found in sunscreens, and mineral-based products like baby oil and petroleum jelly. 

This is also noteworthy for people who use lots of styling products in their hair, many of which contain dense comedogenic ingredients. First, note that mousse, gel, styling mud and wax, etc., may cause eruptions along your hairline if you don’t shampoo thoroughly.

And your pillowcase may be wearing a coat of comedogenic residue, so mashing your face into that oil-slick for eight hours or so every night may trigger acne. An easy fix: change or wash the pillowcase often (or at least turn it inside out until laundry day). Along the same lines, fabric softeners including dryer sheets may contribute to acne if you launder your pillowcase using these.

More Than Skin Deep

New research, such as that conducted by Dr. Barbara Paldus, founder of Codex Labs, explores the role of the microbiome and the science of the skin-gut-brain axis and its role in acne, reasoning that topical treatments merely address the symptoms and not the root cause of acne.

Paldus developed her brand when her newborn son developed a reaction to a common preservative found in most skincare products. Codex Labs offers targeted acne care for teens, as well as separate products for adults, with dietary supplements playing a key role.

This current vein of study seems to support a much, much older understanding of acne. Traditional Chinese Medicine typically approaches acne with great subtlety, usually linking breakouts to chronic inflammation of the digestive tract and resulting blood impurities.

According to TCM, the location of an acne breakout offers insight into a person’s larger overall health picture. In this centuries-old system, different areas of the head and face are linked to the function of specific internal organs, each of which in turn houses a specific emotion. Ears link with kidneys, linking with fear. Cheeks link with lungs and breathing, and the emotion of grief.  

Following this reasoning, the area between the eyebrows may be thought of as the “wine and dine” spot, corresponding to the liver. Heavy, late-night meals with lots of alcohol, or simply angry thoughts, may cause a breakout in this area, according to TCM. Pinpointing another common danger zone, this ancient system also links the chin with the ovaries, so breakouts on a woman’s chin are thought to indicate activity or disturbance pertaining to her reproductive health.

The underlying causal factors are described using language which may not compute for Westerners: lung heat, stagnation of blood, stomach dampness.

With TCM, that may be when facial acupuncture is prescribed, as well as clearing, calming herbs, teas and topical masks.

Double X Marks the Spot

Perhaps the topper in the acne saga is the incidence of acne among women in peri- or full menopause. Sometimes women who had perfect skin at 17 find themselves confronted with a crop of angry zits. Rushes of androgens around the time of menopause may also result in balding or alopecia as in a sudden loss of head-hair, matched by an equally sudden crop of coarse facial hair — called hyperandrogenism by MDs, meaning, basically, manliness.

And, there’s a thing called PIH — post-inflammatory hyperpigmentation. This is the darkening of the skin following trauma and people with melanin-rich skin are most prone. But PIH is an issue for everyone, especially for women who are experiencing acne during menopause. Anecdotally, menopausal acne often results in lingering PIH. All of this truly seems like prank played by the cruelest Mommie Dearest of them all, Mother Nature.

Resist the temptation to touch your face at all between cleansings. Don’t squeeze, pick or attempt to pop. Squeezing a pimple generally squirts the growing colony of C. acnes further out under your skin’s surface, causing new lesions to erupt. 

It’s important to remember that getting mad at your skin because it’s breaking out isn’t helpful. Resist aggressive exfoliants, mechanical or chemical. Resist the urge to marinate your face in rubbing alcohol or hydrogen peroxide (it won’t help). Resist the temptation to use metal implements on your face!  They will do damage and leave scars, especially when used by an unskilled amateur (most likely, you). And forget the Holly Golightly fantasy that French girls treat their zits with toothpaste (it’s harmless, but a waste of good toothpaste).

In addition to the precautions we’ve mentioned — experts recommend you ditch comedogenic skin products, keep your pillowcase clean, cleanse and exfoliate regularly but respectfully, keep skin moisturized and stay out of the sun.

If you feel the building pressure and congestion of a pimple forming, dermatologists do suggest cleansing your face, then applying an ice cube wrapped in a clean cotton handkerchief to the hotspot. Sometimes, if caught early enough, the ice treatment will quiet the seething under your skin and prevent the breakout.

If acne becomes truly painful, both physically and psychologically, of course see a dermatologist who may prescribe antibiotics for rapid takedown. And — above all — remember to be gentle.