Dietary and Lifestyle Considerations
Evidence suggests that high intake of fats, sugars, and proteins, which typifies the Western dietary pattern, may promote acne in a manner similar to excessive androgen production. This is thought to occur via molecular pathways involving a protein called mTORC1 and insulin-like growth factor-1 (IGF-1), which ultimately increase sebum production in sebaceous glands (Kumari 2013). Therefore, limiting meats and foods high in fats and sugars in favor of low-glycemic, plant-based foods may help alleviate acne for some individuals (Danby 2011; Melnik 2012; Veith 2011; Ismail 2012; Burris 2013; Melnik 2011; Melnik 2010; Veith 2011).
Intriguingly, the antidiabetic drug metformin and the natural compounds resveratrol, found in red grapes and Japanese knotweed, as well as epigallocatechin gallate (EGCG) found in green tea, all inhibit mTORC1 signalling. Thus, complementing a healthy, plant-based diet with these agents may confer additional support for healthy skin, although trials are needed to investigate this hypothesis (Melnik 2012).
Excess oils on the skin, either naturally-produced or derived from oil-based moisturizers, cosmetics, or hair products can exacerbate acne. Contact irritation from clothing or equipment such as helmet straps can worsen acne (First Consult 2013). Scrubbing or excoriation of acne is not advised, as it could spread P. acnes and increase the probability of more severe symptoms (Mayo Clinic 2011b). There is some evidence that stress and other adverse mental health issues could lead to a breakout or worsening of the condition (Bowe 2011; Saitta 2011).
Gently washing affected areas twice daily with a mild cleanser or gel is suggested for all forms of acne. Many preparations used for cleansing acne-prone skin contain substances that are proven effective in treating acne. Many cleansing products on the market have 'scrubbing' particles incorporated; however, if acne is moderate to severe this may not be a good course of action as it may worsen lesions and increase the risk of scarring (Picosse 2012). Scrubs may be more of a preventative measure to ensure follicles stay free of sebum and dead skin cell debris (Mayo Clinic 2011b).