Make yourself healthy: Searching for the cause of acne

Martha Rotter, a software engineer, grew up near St. Louis. She did not have skin problems in high school or college. After college, she spent six years in Seattle. Her skin got a little worse. In 2007, she moved to Dublin to work for an Irish branch of Microsoft. Six months after the move, she noticed her skin was worse than it had been in Seattle. In Seattle she would get a little acne or blemishes for a week or so and then they would go away. In Dublin, they weren't going away.

Her skin got worse. A year after moving to Dublin, it was always bad. The spots and sores were always uncomfortable -- "a headache on my face," she says. They were painful to touch. At one point Martha got a massage. Forgetting her warning, the masseuse rubbed oil on Martha's face. She screamed. "One of the most painful things ever," she says.

Is my job making my skin bad? she wondered. She was working a lot, taking clients out, losing sleep. She started to go out less so that she could get more sleep. She stopped working on weekends. This didn't help.

She tried many skin creams and face washes. "Neutrogena and Clearasil make a lot of products," she says. "On a bad day I could easily drop $50 on two or three things." For several months, she spent $100/month on creams, astringents, and soaps trying to find something that worked. Nothing did.

She tried fitness. She went to the gym four or five times per week. She took yoga. Maybe this would help her relax and improve her mood, she thought. Her skin stayed bad.

In the summer of 2008, she read The Acne Prescription (2003) by Nicholas Perricone. The book says that certain foods, such as salmon, blueberries, and spinach, will make your skin better. It had many before and after pictures. "Now people would be more cynical because of his skin care line and vitamins," she says. "Back then they weren't around or I didn't know about them." Perricone's advice didn’t help.

In December 2008, she went home for Christmas. She hadn't seen her family for nine months. "They were surprised by my face," she says. They asked about it. "When a family member mentions something, that makes you realize it's obvious to everyone." She had been pretending to herself that other people didn't notice. After her family's comments, she didn't want to leave the house or have any pictures taken.

Her mom suggested they see a dermatologist. Martha hadn't done this. In Ireland, she had medical insurance but the strangeness of the system was daunting. Another problem was that she didn't know anybody who saw a dermatologist and she didn't want to pick one at random. In the United States, she didn't have insurance but maybe it would be worth it. She went with her mom to a dermatologist who had helped her sister with eczema. A 5-minute visit cost $150. The doctor was reassuring. "This happens sometimes," he said, giving her hope it might be temporary. "It's not your fault." He meant there's nothing she could have done to keep it from happening.

"Do you think it's something I'm eating?" said Martha. He dismissed the idea. We all know what you eat doesn't affect your skin, he said. Don't worry about that. We'll take of this. (The American Academy of Dermatology Guidelines of Care for acne, published in 2007, says "dietary restriction (either specific foods or food classes) has not been demonstrated to be of benefit in the treatment of acne.") Martha left with a year's worth of three prescriptions: 1. An antibiotic (minocycline, a pill). 2. An astringent (a cream). 3. A Retin-A-like drug (a cream). At a pharmacy, Martha learned that the prescribed medicines would cost about $300/month. She didn't want to spend that much. She just got 1-2 months worth of the antibiotic.

She didn’t want to take antibiotics, but she was desperate. "In a week I could tell they were working," she says. Her acne went from 100% to 10-15%. There was still some redness, but no more painful blemishes. The biggest problems were gone. But it wasn't a long-term solution. She didn't want to take antibiotics for a year, much less forever. She knew that women who take antibiotics for a long time often have trouble with yeast infections. (She was told to eat yogurt to prevent yeast infections.) If she stopped the antibiotics, presumably the acne would return. When she finished the jar of pills, she didn't refill it. As she feared, the acne came back. A month after stopping the antibiotics, her skin was just as bad as it had been before she started them.

Am I allergic to something? she wondered. At Thanksgiving, she had met her brother's wife's nieces, who had discovered they were allergic to gluten. What a difference it had made to give up gluten, they said. They had more energy, no longer felt bloated. The Dublin health food store she patronized had an in-house food allergist. In 2009, she had a test ($60) in the back of the store. The allergist had 20 little tins in front of him. He did a test (called a vega test) that measures the electrical resistance of your skin. "He would touch your skin with a little metal thing. It would light up if you were allergic," she says. It took an hour. The results implied she had strong allergies to soy and chicken and a few other things and slight allergies to dairy and caffeine. (This study of the test found it worthless for detecting mite and cat dander allergies.) The allergist recommended she start taking primrose oil, a probiotic, and wheat grass shots, drink a caffeine-free coffee replacement rather than coffee or tea, and stop eating chicken and soy. The recommended products cost about $40/month.

She stopped eating chicken and soy. She didn't eat much soy to begin with. She had been eating a couple of chicken breasts per week and would roast a chicken once or twice a month. She replaced chicken with fish. She also followed the rest of the allergist's recommendations. She took the wheat grass, primrose oil, and probiotic. She drank the caffeine replacement. She waited two months. "Nothing really changed," she says.

Should she try Accutane? That was her dermatologist’s recommended next step. Try antibiotics again? Or something else? “Reading your blog made it easier for me to stop trusting experts,” she says. “To realize my doctor is not the be-all end-all. That it was okay to try other things.” At CureTogether and other forums, she found “lots of people trying lots of solutions to lots of problems.” They encouraged her to believe she could do something besides follow her dermatologist's recommendations. “Your blog made me aware that the answer might not be obvious,” she says. “There’s lots of experimenting we need to do.” She started cutting foods out of her diet one by one to test the allergy idea. She got ideas about what to test from forums. She also asked herself: What could I cut out that would make a pretty big difference in what I eat? She tried each change for a month. Here, in order, are the foods she cut out:

1. gluten
2. meat (including eggs but not fish)
3. carbs (rice, lentils, quinoa, barley, couscous, grains in general, wheat)
4. alcohol
5. caffeine (she drank a lot of tea)
6. sugar (including honey and artificial sweeteners such as saccharin and aspartame)
7. soy (more thoroughly than before, when she had only cut out obvious soy products such as soy sauce)
8. starches (potatoes, corn, bananas, beets, and squashes)
9. seafood and shellfish (there is a lot of farmed fish in Ireland -- was it that?)
10. nothing (on vacation)
11. salt
12. dairy

She decided to cut out dairy because the food allergist had mentioned that breakouts around the jaw and chin are often due to hormones. “You hear about hormones in American cows,” she says. She drank “a good amount” of milk. She also had lattes, added milk to coffee, cooked with milk (e.g., béchamel sauce), and ate yogurt and cheese. She cut out all dairy at the end of November 2010. In two weeks, she could see her skin was getting better. It was entirely clear by the end of the year.

She waited a few months before testing the boundaries. She really missed cheese and lattes. She tried goat cheese. That was okay. Sheep cheese was okay. Goat milk was okay. “Every so often over the last year when I'm at a restaurant I'm tempted by a dessert with cheese. Sometimes I eat it just to try it. Or I have coffee with regular milk. A few hours later I can tell there is going to be a spot,” she says. She recognizes the feeling.

Martha had eaten lots of dairy in Seattle without much trouble. Since she figured out that cow dairy was the cause, she hasn’t tried American dairy so it's unclear if American and Irish dairy differ in an important way. Before she realized dairy was the cause, she went to Nepal for a month and had lots of milk tea. “My skin was horrible the entire trip,” she says, which implies it’s not just Irish dairy.

Here are several stories about the effect of cutting out dairy on acne. Sometimes it had a big effect, sometimes no effect. If there are large differences from one person to the next, self-experimentation is vital.

I have not encountered an expert who recommends self-experimentation for acne nor has Martha. The Acne Prescription, for example, says nothing about cutting out foods. In an interview about acne, Loren Cordain, author of The Dietary Cure For Acne (2006), says "What you don’t want to eat is processed foods, refined sugars, salts, cereal grains or dairy products.” Many paleo advocates say something similar. In Martha’s case, the list of forbidden foods is much too long. Almost all of them turned out be okay, including goat and sheep dairy. Cordain's forbidden foods would have been a good place to start -- a good source of ideas to test, one by one -- but not a good place to end. Among non-experts, cutting out foods one by one and waiting a few weeks is sometimes recommended. In this Paleohacks discussion about acne, someone says "I would try the supplements first for at least a week or 2 if you get no results then start eliminating foods." In this one, a woman says she learned a lot about what caused her acne from "a ton of n = 1 self experimentation stuff."


  1. Since she figured out that cow dairy was the cause, she hasn’t tried American dairy so it’s unclear if American and Irish dairy differ in an important way. Before she realized dairy was the cause, she went to Nepal for a month and had lots of milk tea. “My skin was horrible the entire trip,” she says, which implies it’s not just Irish dairy.

    American dairy generally comes from cows who principally eat corn.  Irish (and, I’d guess, Nepalese) dairy generally comes from cows who are grass-fed.  You can taste the difference.  Whether it’s significant for these purposes I don’t know.

      1.  Shouldn’t that be “an UNhealthy dose of antibiotics”?

        That the anti-b’s were there might (or might not) have been good for Martha’s face, but they’re not good in any wider sense.

        1. yeah of course I know not all antibiotic are the same, the ones given to cows are broad spectrum so it doesn’t mean it wasn’t a factor.

          acne is often treated with steroids, so it could have been the steroids often found in non-organic milk as well.

          as another poster pointed out, cows the the US are primarily corn fed, but in other locations they are primarily grass fed, so it could have been related to the cows diet.

          of course this is all speculation.  we know there was a difference, we can only speculate as to why.

          1.  When broad spectrum antibiotics are given to cows, the milk is not allowed to be sold for human consumption in the US.
            All milk is tested and tested again to make sure there isn’t ever any mistake that a treated cow’s milk gets put in the tank.
            All milk has hormones, as do many many foods.

      2.  No it doesn’t! No milk for human consumption in the US is allowed to have antibiotic residue.
        Cheese will not set if there is any antibiotic in it.
        It’s a red herring that organic claims to be antibiotic free when all milk in the US has to be antibiotic free.

        1.  Thanks for the info.  I just looked it up as saw that you are correct, this was passed in 2005 and tightened again in 2009.  Maybe her story was before then, maybe it was due to steroids or one of the other factors that are still allowed in the milk.  maybe it was related to the cows diet, as another poster pointed out the diet of us cows is drastically different then that of cows from other countries as us cows are primarily corn fed.  like i said all we know is that she is saying there was a difference for her, everything else is speculation.

    1. I love Irish cheese. I buy mostly cheeses from Ireland and New Zealand now. Just for starters you can look at the color of it and tell the difference. They don’t have to add anything to it, it’s gorgeous, delicious, and more nutritious (just an opinion). I also have less reaction to it in regards to skin issues.

  2. Interesting. I have somehow reached the conclusion (by trial and error as well) that mine was being caused by anti-dandruff shampoo, but I WAS eating lots of pizza then – that is 30 yrs ago. Nowadays I do use anti-dandruff products albeit sparingly, and cheese and “heavy” dairy such as sour cream is nowadays a major cause of discomfort as it causes extreme drowsiness . So it looks like dairy products do cause health issues and from several conversations – to a significant part of my friends (20-30%).

    I postulate, for the lack of better methodology, that cheese would cause a predisposition to acne (among other health related issues), and anti-dandruff products (which are very “caustic” – strong on the skin) cause skin irritation and henceforth acne.

      1.  It is, but the cheesing process not only retains some of the milk products it can concentrate them, depending on the cheese. Since cheesing is very much a process reducing the original dairy by volume (for a mild cheddar I think it’s like 10/1) and while the bacteria may consume some of the problematic components the end result still may have more of them by volume.

    1.  There are a lot of different anti-dandruff formulas out there too, you might have been reacting to something in a specific formula and are either using a different type or over 30 years the company changed formula. I used to use the typical advertised kinds (Selsun Blue, Tegrin, Head and Shoulders, etc. which use selenium sulfide) and now I use coal tar shampoos (I also like tea tree oil but that tends to be found in more expensive shampoos).

      1. Head and Shoulders doesn’t use selenium sulfide. I imagine it once did, as there’s a reference in an old movie about Head and Soulders having Selenium as the active ingredient, but for the past several years at least it’s been Pyrithione zinc. No selenium anywhere on the ingredients list.

        1. David Duchovny’s , Evolution. I remember that quote, it was from his “sidekick” in the film played by Orlando Jones.

          1. Deputy assistant back-up courier Stanley Tweedle resorts to ingesting dandruff shampoo to cure his selenium deficiency in Lexx.

      2. Have you tried baking powder and vingear? Seems to work wonders for me. The only other thing that really works for me is swimming in the sea every other day.

        Take a spoon of baking powder in a glass. Fill it with water and stir. Pour over head and massage. Rinse.

        Then take a spoon of vinegar in a glass. Fill with water to dilute. Pour over head and massage. Rinse.

        1. I’ve had good results with just plain white vinegar, diluted 1:1 with water. I put it in a bottle with the kind of top you see on sports drinks, where you pull up on the nozzle to open it. After shampoo/conditioner and rinsing that out, use the nozzle to apply the vinegar to your scalp (like, part your hair with the nozzle while squeezing the bottle, and repeat in various locations on your head), massage in, and let sit for at least a minute or two. Then rinse.

          I have to use this kind of nozzle because my hair is really long and thick, and if I just poured the vinegar solution on my head, it would run off my hair and never touch my scalp.

          I’ve heard people insist on apple cider vinegar, but white seems to work fine. It feels really nice on your scalp. Just don’t get it in your eyes.

  3. UGH. This to me underscores an enormous frustration with modern medicine. It seems that, unless something is debilitating somehow, doctors often don’t seem to want to address it. Perhaps they assume that people are just angling for pills. Providing suggestions on how a person might be able to adjust their lifestyle in order to get rid of a persistent chronic condition would be much more helpful. 

    I suffered with bad acne until I was in my early/mid-twenties. I took antibiotics and Accutane, but in the end, the most helpful thing was finding a facial soap that didn’t irritate me too much, yet washed off cleanly. 

    Experimenting with lifestyle to solve long-standing problems feels like shooting darts blind when you don’t know where the board is.

    1. While I’m at it, I have to convey another story:

      Like Cory, I suffer from gastro-esophageal reflux disease. I’ve been taking medication like Prilosec to control it for years. The Prilosec doesn’t always help though; I have to be careful about what I eat. Coffee, some alcohol, certain candy, certain spicy foods, can all inflame the reflux.

      After years of taking pills, I followed a very simple home remedy of drinking peppermint tea after dinner. It’s made a huge difference. I strongly believe that medication and traditional medicine are the first line of treatment, but I also believe that there’s a certain amount of lifestyle adjustment that can make the difference between coping and thriving. 

      1. I’ve had a similar success on the “coping vs. thriving” front with ginger supplements. I get nausea with reflux, and even if I manage something to calm the acid, the nausea stuck around. So, now I have a ginger-chew or take a powdered supplement, and it seems to calm things down most of the time. 

    2. Beats past medicine.  Back in the old days you’d be getting bled, dosed with mercury or antimony, covered in skin blistering plasters…

    3. Doctors also get a lot of criticism for over-medicalizing things, so maybe they want to avoid that.  Personally, I’ve picked up a few habits re: supplements and diet that probably aren’t completely free of the placebo effect, but I figure if it’s not making a huge dent in my pocketbook, and doctors are happy, it’s basically harmless.

  4. like alot of teenagers i had lots of acne, i tried all kinds of soaps and cremes and medicines none of which made any real difference.  I gave up on the medicines first, then the over the counter cremes and such, but i was still washing my face with soap once in the morning and once in the evening.

    Then I gave up soap, and almost all my acne went away, I wash my hair with shampoo, i wash my armpits and tingly bits with bar soap but i just rinse my face with water, and i almost never get blemishes any more, and when i do they are minor blemishes.

    1. YES! I had bad acne as a teenager, and accutane solved it, but then when I started working my professional job a few years ago, which required showering every day, I started getting acne more regularly. I stopped washing my face with soap and it went away. I think all the caustic soaps and astringents people use simply make things worse.

      1. Depends on the person.  I don’t have problems with almost any soaps.  I used to have skin problems after shaving but since I’ve used an alcohol based aftershave I’ve never had a problem.  Got to sterilize all those tiny scrapes.

    2. I had the same experience, but because I wear make up I use a mineral oil based cold creme (everything supposedly bad) and it works wonders. My skin feels clean, it takes the makeup off better than anything else, and it doesn’t cause me to break out. 

      I’ve also nixed a lot of food from my diet, and have had mild to severe problems with dairy all of my life and so eat very little of it if any.

    3. Just as a counterpoint to the people agreeing with you; this did not work for me. Neither did cold cream (as per @blueelm:disqus ‘s suggestion).

      Definitely something to try, though, if nothing else has worked so far. As in the story, you really do have to try as many different things as you can to figure out what works for you.

      I haven’t found a solution myself… I’m 25, had very mild acne in high school and through college and didn’t worry about it too much, but then it started getting worse. It’s not terrible, just constantly there and quite noticeable (I cover it up with acne-medicated makeup if I’m going to leave the house). Since it started getting worse I’ve lived in quite disparate climates (New York, Southern California, and Thailand), eating vastly different types of foods in each place (though dairy is a constant), and that hasn’t made any difference.

      I think I will try minimizing dairy because of this story… I don’t drink tons of milk or eat cereal with milk or anything but normally do eat a lot of pizza. I haven’t had any for a few weeks and my skin has been relatively clear. I kind of hope that this isn’t it… man, I really like pizza.

      1. Good luck. Just a suggestion if you try dairy go for as little as possible for a set period of time. It will be hard, but you will have more reliable results if you see no improvement and know you totally eliminated it for a month. Obviously different people’s acne is caused by different things, and skin response must be really variable. For me the worst thing I did to myself was use Retin A. Turns out I have a bad reaction to it and I had six weeks of raised sores in the one place of my face that had been nice and clear. I didn’t even know you could have acne and eczema at the same time. But then I’ve known people for whom retin a worked wonders.

        1. Yeah that’d be my plan, completely eliminate it for a set period, which with my current diet will be easy enough. That’s my standard procedure for trying different treatments (though this would be the first diet change I’ll have tried).

          Luckily I haven’t had anything I’ve tried make things worse or cause other problems like that. I did try something with “retinol” but despite some quick wiki-research just now I’m not sure if that meant it contained the same thing retin a does or not. In any case it didn’t do anything.

      2. Try not to touch your face when necessary.  I started getting acne on my forehead when I grew bangs that I was constantly pushing out of my eyes.  

      3. its definitely different for everyone, i eat tons of dairy and i never have a problem with it, but as soon as i wash my face with any kind of soap im sure to have a deep zit (usually on my nose or chin) by the next day

    4. Baby wash (liquid soap formulated for babies) works exceptionally well for people who have oily enough (or dirty enough) skin that pure water isn’t sufficient.

  5. I instantly distrust anyone advising against eating “processed foods”. If you think I shouldn’t eat foods containing sulfites, say so; if you’ve got an issue with EDTA, then say that. Lumping so many dissimilar things together makes so-called experts sound like their advice isn’t coming from a scientific mind.

    It’s the same thing for “organic” food. If some pesticides are bad, that’s one thing, but entirely too much unrelated crap gets bundled together under the same label.

    1. I also don’t care for people who say “This worked for me so it must be the same for everyone!”.  Just because you saw a change with diet item X doesn’t mean everyone else is a fool for eating it.

  6. This is a great story. This food elimination diet method is how I found out that I had a “food sensitivity” to high fructose corn syrup. That’s right, the sweetener that was in EVERYTHING.  

    What were my symptom? It made my joints ache. There is a connection with my rheumatoid arthritis and the food I eat. I really stumbled on this when I was trying to treat my “hay fever”.  I never would have tried this food elimination to treat my arthritis, so I really stumbled on to this trying to fix another problem. 

    I didn’t have a violent reaction to the corn, like people do peanuts, so I didn’t think it was a problem. And also my diet had not changed. But what had changed was my bodies response to it. I figured out that I was eating corn in every meal without even noticing it because of HFC in all sorts of products.   My body was getting it over and over so I developed a sensitivity to it.

    I don’t remember the name of the book I used to eliminate different foods, but it was interesting because they suggested a lot of ways to use food elimination diets for other problems. It makes sense to me that what we eat or don’t eat will impact our health and that people’s body chemistry deal with foods differently from each other as well as over time.

    I’m now lactose intolerant. I didn’t used to be. My body changed so I needed to change my diet.

  7. So, it seems that antibiotics was the only thing that worked somewhat for her, and even though they caused her no problems she decided to quit using them.

    Since then she has found that various quack approaches don’t help.

    1.  No, she said cutting dairy worked. Could be that dairy was causing more acne, the acne was becoming bacterial, and the antibiotics got rid of the bacteria, but new acne kept coming.

      1. All acne is bacterial. It’s cause by the blockage of the sebaceous glands in our pores/hair follicles. If memory serves the blockage is caused by an over abundance of bacteria which feed on skin oils or skin cells in the pore. The article seems to be claiming her acne was caused by allergies/food sensitivities. Which is ridiculous allergies are an autoimmune reaction and cause contact dermatitis and hives (in terms of skin rashes). Acne is a bacterial infection. The 3 are easily distinguishable.

    2. It says antibiotics can cause yeast infections. I’d take a face full of acne over a yeast infection any day. Diarrhea is also a common side effect of antibiotics, and yogurt is often touted as a way to avoid these side effects but it doesn’t always work. It also says she didn’t have health insurance in the US so she’d be paying for antibiotics out of pocket. I’m assuming that’s why she decided to quit using them. 
      Once you’re in that kind of situation, a situation which is quite common, alternative approaches are your only option. 

      1. I took them for years, and it was not good. I’m very glad not to be on them anymore, and glad that I found something else that worked (yes, like a lot of people I really found that changing my diet had the same results and allowed me to stop taking antibiotics which only halfway helped anyway). I don’t think it is good to be on antibiotics constantly for several reasons. In my case they caused side effects, other illness, and made me more prone to opportunistic infection from other things.  It was hard to get off of them to because after having been on them for so long, every time I would stop taking them I’d get sick.

      2. I can’t imagine it would be good.  They are not free from side effects.  The worst thing would be the disruption of intestinal bacteria and opening yourself up to things like c-diff infections.

      3. It doesn’t work anyway. Antibiotics are effective against acne for a year or two, and then your face breeds a resistant strain of P. acnes and you’re back where you started.

        Isotretinoin (“accutane”) has some unpleasant side-effects, but you only have to take it for a couple of months and the effects are semi-permanent. Worked for me.

        1. Yes, I was surprised she didn’t mention trying it. Accutane was a miracle drug for me. It sucked not being able to drink (what with the megadose of Vitamin A being hard on one’s liver), but my skin changed permanently for the better after taking it for 3 months.

    3. Only her symptoms were begin treated, not the cause, that’s like using a square tire as a spare. 

  8. I just read Detoxification and Healing by Dr. Sidney Baker. Basically, he recommended self-experimentation for just about everything, with lots of interesting cases along the way. I’m not ill and don’t have any chronic issues, but the book was interesting regardless as it took that exact kind of approach–it’s pretty easy to try these kinds of things out, so do it, as you don’t have anything to lose. I came across it through one of Mark Bittman’s Times columns, in which he wrote about giving up dairy. One of the fundamental points was that personal health is very different from public health. Obviously the book is rather general and has a few suggestions for different issues, but I think the message is excellent, and along the lines of what you’re discussing here. Martha’s is a good story to know, though it’s sad that these kinds of simple fixes aren’t routinely tested, and the health authority figures in our lives tend to just throw a pill at whatever comes their way.

  9. Dairy was what caused my Acne. Every time I see someone struggling with their skin I want to ask if they eat a lot of dairy. I have helped a few people eliminate acne by suggesting they cut out dairy, it really worked for me…

    1. Same here, specifically milk. I switched to soy milk in high school and my moderately-bad acne went away very suddenly. Of course high school is the time when you’d expect it to get better, but not that suddenly. I still have backne, and I still eat a little bit of cheese here and there, and if I eat a lot of cheese at once, like having pizza more than a couple days a week, my backne gets worse and I get acne inside my ears.

  10. I’m always impressed when people self-experiment and reach a successful resolution. I know several acquaintances who are on a perpetual treadmill of experimentation, going from one diet/supplement to another, starting with things that make some sense when you think about them to things which are increasingly nutso.  
    And seeing that is why would be hard for me to launch into a self-experimentation of my own or recommend it for my friends. There’s so much out there from questionable sources in the general field of “change things which are not obviously diet related by varying your diet’ that I have a high degree of skepticism even when purportedly legitimate claims are made. I’ve developed a ”if it works for you, that’s awesome, but I wouldn’t recommend it to anyone else” mentality, same as when someone at the gym tells me about the awesome diet/exercise plan they read about on a blog somewhere.I’d probably feel different if I had a condition like that. I do have tumor-forming disease (fortunately stable, and partially corrected with surgery) so I do have some sympathy when it comes to this sort of thing, but my condition is so well established as genetic I never even saw hope in trying to control it with diet.

    1.  I’m really lazy and have poor self-control, so staying off things I love (dairy, alcohol, Doritos) for long enough to notice if it made a difference would be nigh on impossible.

  11. So she went to a dermatologist, only followed some of the regime he prescribed, and she took antibiotics for a month (which partially worked!) and her symptoms cleared up some time later.

    There may be something to her approach, but this hardly qualifies as any sort of good science.  For all we know the round of antibiotics lead to her subsequent remission.

    1. It’s been covered in other comments but in case you didn’t see them, there’s no claim here that it’s good science (or even science at all, though it sort of is). It’s not a peer-reviewed study with statistically significant results.

      Doesn’t matter because that isn’t the point. Science can’t provide a peer-reviewed study for each individual person to figure out how to treat them – and that is the point; everybody’s different enough that you simply can’t figure out a cure-all for many things. 

      Doctors don’t try to figure out what’s specifically wrong with someone if it’s not immediately dangerous or debilitating because it’s just so much easier to try a bunch of different things until something (hopefully) works. 

      With acne, you can do that yourself without the help of a doctor, and if you read up about it on the internet you can find new things to try if you get frustrated. It causes no harm to try these sorts of things (you can avoid the obvious quackery and snake oil) and if it works then awesome and if not, doesn’t matter, you’ll just have to try something else.

      I’m not advocating not going to a doctor or ignoring their advice, but for something non-life-threatening like acne it doesn’t hurt to self-experiment if the doctor doesn’t have a good solution.

      1. Some of the treatments attempted seemed like a tour of quack medicine.  And then for some reason going to trouble of writing a book about the experience and publishing lends some authority to the whole process.

        It’s a great starting point for an actual study.  Anecdote and especially with so many treatments tried here, it’s kinda like saying I tried chemotherapy for my cancer but I couldn’t pay for it, so I tried hypnotic ray guns next, and they cured me!  Even if the aborted chemotherapy was actually responsible for the outcome, even delayed by weeks or months.

        But I do agree, if experimentation is really the only way to do this. It would just be really nice if that could be extrapolated through some research into finding a better solution.

        1. Considering the non-quack cause she believes she found, I’m glad she went through all the shitty quack treatments first. That’s what people do when they can’t afford proper medical care or they cannot tolerate brute-force medical solutions to problems that could possibly be treated in other ways. Anyway, she did the quack remedy tour and concluded that the treatments she was offered sucked. That’s useful to me!

          As for your chemotherapy argument, I know that it works as a good reason to not seek bullshit quack remedies in general (and I’m with you there), but in this case, it’s a straw man and you should be ashamed of yourself for using it in this case.  Acne is not life-threatening. Give this writer some credit for doing their best to find a solution to their acne and sharing their story. Imagine what you would have done in the exact same situation.

          As for the research, yeah, everyone wants thorough well-conducted research for their problems. Tell us something new.

          1. It’s not a perfect straw man, but was only meant to illustrate that people are really bad at cause and effect most of the time and really has nothing to do with cancer at all.

    2. The drugs the dermatologist recommended for her would have been far more hazardous than her self-experimentation, she was right to explore alternative routes of treatment. I took most of the same drugs myself and they had significant side effects.
      Retin-A and other similar drugs cause drying and peeling of the skin, and also makes it tender, as if raw. Minocycline is a broad spectrum antibiotic that can cause yellowing of the teeth, nasty gastrointestinal disturbances (which can suddenly appear after years of normal use), and in a small number of users sudden irreversible deafness. Accutane can cause serious liver damage, inflammatory bowel disease, and trigger serious clinical depression; accutane is a remarkably dangerous drug to use for a condition like acne.

      These are all drugs that are, as my primary physician put it, “big guns”. It is a good idea not to embrace them before you have exhausted other options. She made a good choice in being wary of taking them if she did not absolutely have to.

      Also, no, the first round of antibiotics did not lead to the following remission. The antibiotics do not have a lasting effect. They are not eliminating the microorganisms responsible. Those live and thrive on the surface of the skin, where antibiotics are not disseminated by the body. The antibiotics simply prevent those flora from forming large cysts within the skin (though not entirely, as the cysts can form structures that limit penetration of the drug).

  12. I thought it was known that acne is caused by a particular bacteria on the skin? Greasier skin just gives the bacteria more opportunity to build up. Most treatments work by reducing oil on the skin. Maybe diets work this way too?

    1.  Problem is that the greasy bits on the skin are a plethora of other bacteria and fungi that are in a constant give and take relationship, self balancing and adapting to new environments, diets, etc. When you simply remove all the microflora/fauna on the skin, you are essentially creating a blank slate for the first flush of whatever bacteria has the most immediate foothold to launch from.
      This is the same problem with antibiotics.

  13. I had bad acne into my mid-20’s. Then I visited a dermatologist in Seattle (very nice Swiss woman with a small upstairs office on the Ave) and she gave me this bizarre mud of her own concoction to wear as a mask once a day. When I washed it off and water dropped onto my t-shirts, it stained my shirts, but, man, within a couple weeks, my skin had never been so clear. I’ve basically not had problems since. 

    That said, I think diet is HUGE and am never surprised when people find a strong connection between what they eat and how they feel or look.

  14. Wow, I had a very similar experience with dairy. I had terrible acne as a teenager and I drank almost a carton of milk every day. Unfortunately, neither my family, my doctor or myself made the connection at the time so I also resorted to several prescribed creams, pills, etc, with little results.

    When I moved  out on my own, I no longer had milk delivered at the door and I fell out of the habit of drinking it altogether, switching to tea and water instead. My face cleared within weeks. At first, I thought it was because my 20 year-old hormones were treating me better than my teen’s, but I noticed that whenever I indulged in cheese, the break-outs returned. All I need to do to keep my face clear is to avoid milk and only eat cheese twice a week or so.

    I really wish I had known this in high-school: I could have used having one less cause for anxiety back then.

  15. People forget sunlight as a treatment for acne. Mostly because we’re so skin cancer scared now. But there’s a happy medium in all things.  It’s the only thing that works on my adult acne…and I’ve tried them all.  It’s a vicious circle tho, you don’t want to go outside in the sun with acne–but it does help clear it up. You rarely see people that swim outside a lot with acne.

    1. Sunlight did nothing for my acne and I worshipped the sun god during my acne era.

      Unfortunetly I had cystic acne (the Bukowski-Poat Office kind) and Accuatane was the only thing that helped.

    1. Peer Review has absolutely bloody all to do with whether or not something is science, it’s just a way to tell the rest of us that it’s science we can trust. It’s perfectly possible to do an amazing amount of good science without any peer review, though it’s not exactly easy and it’s definitely risky.

    2. Who said it was science? 

      It’s about a person trying different ways to get rid of her acne.

      1. Well,  the OP did go thru a careful one-at-a-time dietary exclusion test.  Further, after suspecting dairy, she went *back on* dairy and had a return of the acne.   That’s a pretty solid example of the scientific method of investigation.   The only thing she can’t test for is physical maturity (it’s kind of hard to make yourself younger again).

    3. People’s bodies(ie genetics) vary greatly. What works for one person, like a dairy free diet may not work for a second person who is sensitive to gluten or corn. 

      It would be very hard to do a peer reviewed study on say 2000 people with acne with regards to their diet unless it was narrowed down to a greater specific ie a study on people with a documented sensitivity. The outcome within that group for those who included or excluded this from their diet, and whether that improved or worsened acne would be much more concrete .

      And who the peers doing the reviewing are is also important. Are they scientists, dermatologists, nutritionists, cosmetologists ? How tightly controlled is the study ? On what basis is the outcome reported ? Study participants self reporting v.s. scrutiny from a dermatologist with a camera and magnification ?

      Food sensitivities are extremely difficult to uncover, as most of us eat and drink processed food that has many ingredients. Is the sensitivity due to a particular spice, preservative, coloring agent, or a major group of food like dairy — or possibly an ingredient in an OTC medication or supplement ? Speaking from experience I can say that uncovering the food culprit for my symptoms happened only by complete accident and was quite a surprise…

        1. My symptoms weren’t skin related. I had been having terrible intermittent bloating in the last 5 years which I assumed to be hormonal. It was painful enough to disturb my sleep. Suspected food culprits were carrots, oranges, chickpeas and peanuts. I started a low carb diet — and suddenly with no pasta and no bread or pitas (ie processed white wheat flour)there was zero bloating. I never got stuffed up sinuses, or rashy around my mouth, or had a rash on my chest — or felt nauseated, had diarrhea or other GI upset — none of the classic food allergy symptoms.

          That said I had a mystery acne like rash on my neck and chest that came and went for years that I never could get to the bottom of. Sweet red peppers and hot chili peppers were suspected but never confirmed, but I have no answer for what was going on there. I tried keeping a food diary but after several weeks I felt overwhelmed since in an average meal, like spaghetti or curry, there could easily be 15 or more ingredients, including spices. It wasn’t enough of an issue to begin eating a very strict diet (ie plain vegetables with plain unspiced meat with plain rice).

    4.  “Science” doesn’t appear in the post anywhere.  She wasn’t looking for “science,” she was looking for a solution.  Seems like she found one of those just fine.

  16. I have had strikingly similar experiences with a very particular form of acne, for years. Multiple doctors with no results until I got frustrated with it. I heard that the four most common causes of skin reactions can be wheat, milk, peanut butter and eggs – so I took all of them out *and* meat.

    And watched my skin slowly return to normal.

    After playing with my food by putting one thing in, seeing what happened, and then taking that out and trying something else, I found that wheat in particular is the trigger for me with dairy as a close second.Your mileage will always vary. But you can’t rely on doctors when they say “that’s all you can do”, because they are focused on quick solutions. You should empirically experiment yourself until you find what works.

  17. Too bad she never went to  an endocrinologist. Fluctuations in hormones from a variety of causes can result in acne. She could have a thyroid problem, for example and the acne might be a symptom of that.  Or, she could have a problem with an ovary. She won’t know until she gets tested.

    1. I’ll agree with that.  As a teenager I had the standard acne, but whenever I was under a lot of stress it always got worse.  End of semester exams were bad, but a week or two later everything was back to my normal.  That has followed me somewhat into adult hood, but most of my acne now is probably from not washing my face enough.

      I grew up drinking milk and eating tons of dairy, and I still do.  So I doubt that has little to do with it.

  18. Good grief, people, a little skepticism is healthy, but I would recommend READING the article before jumping on her.  She did see a dermatologist, and the antibiotics did help, but at 100-300/month for them she decided it wasn’t worth it.  

    Her process was to eliminate a food and give it 2-4 WEEKS to work.  Dairy was the 12th thing on the list of eliminations, so that means 6-12 months after she quit the antibiotics, she found that eliminating dairy helped.  I dare you to find me _any_ data that shows an antibiotic can prevent re-infection – or spontaneously remit an infection – that far after the fact. 

    Further, this sort of self-experimentation is only dangerous if you reach the point that you are being mal-nourished.  Short of that, it has few risks, and significant potential upside.  The plural of anecdote is indeed not data, but metabolic science is a poorly understood field, and 2 years ago, the idea that something as ubiquitous as gluten could be unhealthy for certain people was widely derided.  

    1. Skepticism would point out that acne’s connection to diet has been disproven over and over. A skeptic would point out that the “allergy test” she took uses a well know quack device, and doesn’t operate by a sensible mechanism. Given there were no controls here we have no way of knowing which, if any, intervention she under took cleared the acne. Or if it simply resolved itself (this is called regression to the mean). So whether her elimination diet “worked” or not is simply something we can’t tell.

      Also 2 years ago the idea that gluten could be not just unhealthy but greatly harmful to people with celiac and wheat allergies was not only well known, but  basic medical treatment. The idea that celiac is widely harmful to a great many or all people has little basis in fact. The present gluten terror has more to do with marketing than reality.

      1. Skeptics should also acknowledge that results are evidence. It may be that a connection between acne and diet hasn’t been made for a majority of people – but there can be and is a wide variation between different people’s own individual chemistry. And this can change even within the same people over the course of a few years.

        I can only speak from my own experience: I took wheat from my diet, and my skin cleared up. If I allow wheat back in for one day, the next day I have acne. Pretty clear to me. Maybe more people are avoiding wheat than need to. However, considering how fat Americans are anyway and how much crappy bread is linked to colon cancer among other problems, I don’t see how that’s a horrible downside.

      2. Diet and connection to acne is pretty poorly studied I think.  For instance, a study was done where one group got a non-chocolate candy bar, another got a chocolate bar.  Nothing else in the diet was controlled.  For years this was the basis of the claim that diet  has nothing to do with acne.  One poor short term study is not great science, I think we can agree on that.

        Someone above made a great point, which is that when diet is involved, it is not always the same dietary component.  Hard to design research to test that on a large scale, it’s complex, and science prefers simple effects.  You may not get a statistical improvement in acne if you do a study about dairy elimination, because it might only really help a small percentage.  But for those people it is huge.

        And I think that’s the point: that science has limitations.  That sometimes doing some individual experimentation can help a particular person find a solution.

        Here is my favorite example: for years women noticed that cranberry products relieved UTIs.  So someone designed a study, cranberries must work by acidifying the urine, fed a bunch of people varying amounts of cranberry and discovered no change in the PH of the urine.  “Cranberries are an old wives tale!  They don’t work.”  Later it turned out that there is a sugar in cranberries that blocks e-coli from attaching to bladder membranes, cranberries do in fact prevent/help UTIs and the mechanism is well understood.  

        Science is a process, and any intellectually honest person can only say at this point: diet doesn’t seem to be a large factor at this point, but more research needs to be done.  We do not have all of the answers yet.  This idea that skepticism means ignoring people’s real experiences only creates an anti-scientific divide and causes people to ignore the “skeptics.”

  19. I was one of the lucky few who visited  Dr. Bastyr. I was an infant to 7 years old then returned as a young adult to his Institute in Seattle. 

    I remember my Mom asking Dr. Bastyr about her acne, she would have been 25. He said she was “too wet”, or “mucousy”, and that acne was like mushrooms. I remember this so vividly, because it caused me to think about a wall in my grandmother’s basement laundry that had mushrooms growing on it. He told her Americans drink too much milk and it makes them “wet”. He told her to quit drinking orange juice too, the pulp, which cause mucous build-up,  was just as bad as milk. Her acne disappeared in a couple months. 

    I brought this up again when I returned as an adult. First, the students were amazed to meet someone who actually visited Dr. Bastyr. Milk produces mucous which in turn coats our internal workings, thus, making us “wet”. That’s why Arizona was so popular for TB patients, so they could “dry out”. 

    Water = Hydrated
    Mucous = Wet/Moist environment

  20. I very much empathize with the financial problems associated with even a minor skin problem. I, fortunately, don’t have a lot of acne issues but I do have eczema and my particular case makes it torture to shower in warm climates. I itch so badly that I’ve given up full-body bathing more than once a week during the summer (whore’s bath has to suffice). Perhaps in 2014 I’ll look into my options Rx-wise but for the time being since the issue is my entire dermis it’s just too costly to treat with any ointments that actually work.

    1. Sean Bonner posted this awhile ago, it worked wonders for me. Sloughing off our skin in a hot shower? NOT GOOD. Sean talks about our “horny layer”, rinsing off instead in warm/cool water for a couple minutes and using soap only (if you want) in our nether regions. 

      Sweat, sweating is great for our skin.  

      If you haven’t tried it, cool oatmeal baths work great for eczema, my partner gets much relief from them.

      1. Sweat, sweating is great for our skin.

        Dermatologists that I saw always recommended avoiding sweating because the more that you put through the system, the more likely something will clog.

  21. Advising people to ignore professional medical advice and to self-experiment is a disservice to your readership (even though you say no one is advising self experimentation, that’s exactly what you are doing). Experimenting on yourself leads to confirmation bias and confusing correlation with causation since your sample group is 1. Nevermind that trying something for a week or two just because you read about it on a message board could lead to serious side effects (the least of which is draining your wallet).

    1. On the other hand, implying that professional medical advice is actual likely to lead to a solution for a non-life-threatening and not easy to fix problem is a disservice as well, since medical professionals are busy people without the time or knowledge to deal with these “minor” problems, and many of their “cures” lead to serious side effects in addition to being expensive as hell.

      The fact is, they often don’t know what will help you, and no matter how much you push them (or at least now matter how much I pushed the last four I had for my own problems), that have absolutely zero interest in helping you out once it becomes clear the easy solutions wont.

      Because after a certain point for certain problems, only science can help you out, and doctors are not scientists and have no intent on becoming so. If you don’t fit into an already researched hole, your options are either to wait for someone to discover and inform your doctor of the solution, or to look for it yourself.

      1. I want to add, I don’t think doctors are bad. But ultimately, you have to be responsible for your own help – they are only people, usually very very busy people, and they don’t know everything or have the time and opportunity to figure it out. They are absolutely crucial, and are the first ones I’d go to in an emergency, but never simply accept what they say without doing your own research as well and asking questions, because they deal in statistics due to limited data, and it’s remarkably unpleasant to be the exception when your knowledge and observations could have discovered it in time.

        1. This. They also tend to be rather focused in certain areas. Doctors depend on science, and then you depend on the doctor. But if science doesn’t even have a good solution then you’re out there on your own. An awful lot of doctors will even tell you this, and the best of them are even mildly interested in your anecdotes. 

          They also prioritize. Ugly skin is upsetting, but it isn’t a heart attack or a dangerous infection.

    2. Experimenting on yourself leads to confirmation bias and confusing correlation with causation since your sample group is 1.

      Are we ignoring that fact that physicians frequently tell their patients to change their diets and see if it works?

      1. They’re typically doing this for things that are known to be connected to diet. If your back hurts a decent doctor is not going to tell you to eat fewer cheese sandwiches. 

        1. They’re typically doing this for things that are known to be connected to diet.

          Dermatologists give dietary recommendations to people with acne.

          Is there some reason that you’re bombing this thread with misinformation?

        2. I have had doctors tell me to attempt changes in diet and see if it helps with acne. They don’t have evidence to prove a link but a clever doctor remains aware that this leaves it open as a possibility until the day it’s proven not to be.

          Behavioral and dietary changes are the first choice treatment for any condition because they have such small potential for side effects.

    3. She didn’t ignore professional medical advice. She tried it and it worked but was too expensive and had other potential serious side effects. She then experimented with something that can absolutely not cause any harm (simply eliminating specific things from her diet).

      I think we can all agree that trying quackery and snake-oil you read about on message boards is a bad idea, and I agree that there’s a danger of confirmation bias and all that. But we’re talking about treating acne, here, an obvious and visible problem that doesn’t really cause any physical harm to begin with and which is obvious when it clears up. We’re not talking about treating cancer with this kind of thing.

    4. Do doctors ever tell patients to try something and see if it helps? If so, is it a disservice to their patients?

    5. She’s not trying to write a paper, she’s trying to solve her own problem.  Accutane and antibiotics both have side effects more significant than eliminating a single dietary family. Budget was also an issue.  Her solution was largely harmless and much more affordable than her medications.  If her solution was to jump off the empire state building, we (probably) wouldn’t all do it.  I have personal friends who are physicians who have told me that they felt that nutrition and diet was something that was neglected in their training.  I think MD’s are nice people who will help you with a lot of health issues, especially emergency life threatening ones.  Expecting them to be the end and all be all of health knowledge is childish.

  22. This is, of course, anecdotal evidence, but my wife and I  found the only thing that worked reliably–even including a couple of different kinds of antibiotics–was “the regimen” as described on Basically you use a low-strength (2.5%) benzoyl peroxide every day and moisturise like mad afterwards. I gather this is basically what some of the commercial acne prevention products do, but’s store will sell you a giant bucket of the stuff for much less. Their cleanser is very good too. All their stuff has a minimal list of ingredients to cut down on potential things for your skin to react to. Anyway, I’m a happy customer, so I thought I’d pass it on.

    I also found switching to a zinc-oxide-based sunscreen/moisturiser stopped my skin from reacting to the chemical sunscreen they put in most SPF moisturisers. It’s really hard to find them though as the manufacturers are always changing their formulas, and the zinc-oxide formulas are always more expensive.

    Of course none of this is remotely scientific, but I suspect there isn’t a one-size-fits-all solution to acne anyway.

    1. I tried the method and while it sort of worked, it was far from 100%, and it didn’t seem worth it to me to keep up “the regimen” if it wasn’t going to work that well. Also, the benzoyl peroxide bleaches your clothes and you have to be extremely careful to wash your hands thoroughly after applying it and to not touch your face to anything. Just accidentally brushing your hand against your face and then against your clothes can be enough to cause a bleach spot.

      I was extremely careful but still managed to ruin a ridiculous amount of clothing (and pillow cases and other things) while using it (and yes, it was the 2.5% stuff bought from

      1. Yeah, if it doesn’t work for you it’s not worth the trouble.

        These days I seem to get by OK most of the time just using their cleanser (which is relatively cheap and doesn’t irritate my skin) and a decent moisturiser. I think the generally improved self-esteem from not looking gross all the time helps with the occasional break out.

  23. My sister struggled with acne and learned finally she was sensitive to iodine. Now she avoids iodized salt and products containing them and she is “cured.”  I think it’s accurate to say dietary modifications haven’t  been proven to treat acne but what is generally applicable isn’t going to hold true for a given individual. Taken across a large sample, maybe only a few statistically insignificant people will be sensitive to dairy or iodine or corn or peanuts but to that specific person, it matters a great deal and really, that isolated sensitivity is all that matters to the one-of case.

      1. It is important, but unlike earlier ages, we get plenty of it through our modern diet.  Prior to the early 20th century it was a very commonplace deficiency.  However,  iodine deficiency is now vanishingly rare in first world countries unless it is caused by some other metabolic or parasitic issue.

      2. The whole class of autoimmune diseases is about your own body having an issue with a part of yourself that you need.  The fact that Iodine is neccessary does not preclude some individuals having a reaction to excess.  She also may not have a direct reaction to molecular iodine, it could be a reaction to a secondary metabolite that’s formed when higher levels are ingested. 

  24. Not all health care professionals are unwilling to look at alternatives, or adverse to trying different options. Unfortunately in the US, it is often difficult to impossible to shop around for someone who fits your needs, and be able to afford them if you do. My dermatologist? Recommended cleaning my skin with oil (and rinsing with a castille soap,) which stopped my acne in its tracks. I’ve had clear skin for 5 years.

  25. Cutting out gluten fixed my eczema and other things I was dealing with. How funny for an ‘expert’ to say the food we eat doesn’t affect our skin.

  26. The formula for comments regarding non-traditional solutions:

    • The thing that worked for you cannot have worked for you because it didn’t work for me.
    • The thing that worked for me must work for you because it worked for me.


    see also:

    1. Similar to the formula for comments regarding ‘traditional’ solutions:

      • Trying anything that isn’t a mainstream-medicine method is anti-science

      • Thinking anything that isn’t a mainstream-medicine method actually worked means you are mistaken

  27. this whole thing is very triggering for me — warning, pity party ahead.

    i’ve struggled with acne since i was 12.  i’m now 36, and it’s showed no signs of relenting.  retin-a only puts a minor dent in it.  other topicals, i may as well just not bother; they do nothing.  antibiotics help, but i can only take them for so long at a time (and to counter an poster above, i’d take a yeast infection over a faceful of nodular/cysctic acne anyday).  birth control pills help, but give me near-daily migraines and make me even more depressed.  i’ve recently (as in, a couple of months ago) started a mild diuretic to further reduce testosterone, but it’s not helping. 

    i did accutane once in my 20s, and it was the best thing that ever happened to my skin — though i permanently lost some of my night vision as a result, a fact i hid from my parents and the dermatologist so i could continue taking it.  i had a few blissful clear years, but it came back almost as bad as before.  i’ve been offered a second course, but i’ve declined.

    i am allergic to absolutely nothing except penicillan.  of this i am 100% certain.

    so i’m glad for whoever finds some wacky alternative way to get clear — and i mean that with only a bit of bitterness.  but here i am stuck looking like an extra from the walking dead.

    i’ll go back to my stabby fantasies about the people who are blissfully free of acne now. the type that give me That Look while looking at my face, as though i only look like this because i don’t wash or something.

    maybe i’ll try switching to soy milk and reducing dairy and see if that helps, though. can’t hurt.

    1. That may be your only allergy, but it not be the only thing you ingest that causes problems (the person in the post was obviously not /allergic/ to dairy, even if it somehow caused the issue). The diet modification does seem to have a chance of working for people – it might at least be worth a try to see it helps. Give a go at giving up the big three for a month or two and note the results. If there’s no luck, unfortunate, but trying might be worth the effort here.

    2. What was your dosage while on accutane?  Have you spoken with a dermatologist (and, after your reduction in night vision – would you be willing to consider) about trying low dose accutane – specifically in the 10mg  a day range, or less?  I’ve been on 10mg a day accutane for the past 6 months and it will be an ongoing thing for me because of my particular skin condition (sebaceous hyperplasia).  Overseas dermatologists often use lower dosages for longer durations as opposed to the massive short-term shotgun blast approach by doctors in the US.

      1. i’d never heard of that, so i looked it up — my condolences.  hope the accutane therapy works out well for you!

         as for dosage, i don’t remember, but i think it was just about the max they could give me for my weight (though that ain’t much).  my dermatologist recently mentioned the possibility of what he called “pulse therapy” with accutane, at a lower dose, off-and-on over a longer period.  he said it’s harder to dispense it that way these days, though, thanks to ipledge (this forced registry crap for accutane users because some women were too dumb not to form babby while taking something pretty much guaranteed to cause birth defects).

        i’m still scared of it, though.  i kind of like having what’s left of my night visin, oh, and i forgot to mention — my cholesterol went up over 300 while i was on it, too.  and the NOSEBLEEDS.  nothing like having a nosebleed so bad you tip your head back, swallow a metric crapload of your own blood, get nauseous, then vomit said metric crapload of blood.  and it can get worse for some — i had a coworker who lost his hair from it, poor guy.  it’s just really scary stuff.

        i know i waxed pretty dramatic about my skin, and it really is the one thing i’d change about myself if i could, but i just don’t know that i could do that drug again.  i’ve done some research off of what i’ve read here, and i’m willing to give no dairy a shot, even though i do love me some dairy.  i’d even try no soap if that doesn’t work, sincei wear no cosmetics (though i already use pretty mild/naturla stuff in that deprtmant; no parabens or sulfates, which did actually help me be less dry and inflamed).

        i’m also a prtty high-strung individual (like that ain’t obvious), so that doesn’t help, i’m sure… ;)

        1. For me, the accutane cured my condition  (well, cured in the sense that it supresses it as long as I continue to take it – unlike acne sufferers who go on a 6 month, high dose regime and often have a long term or permanent elimination of their problem albeit often with some additional long term side effects (joint/bone problems, impotence/reduced libido, etc – you know all about it I’m sure)).  

          At 10mg, I’ve encountered none of side effects that you (and so many others) had to endure at such higher levels, where accutane can be so toxic to so many different organs of the body.  I completely understand your reticence based on your experience, I can only suggest that you really look into low dose therapy on the net.  There are alot of people to ask on the boards.  The kind of side effects you encountered really don’t happen at these lower levels.  I will say – and this is common among accutane users as you know from experience – that my triglycerides are higher than I’d like and it’s something that I’m trying to adjust for with diet and supplements.   And I’m no longer a red cross blood donor, unfortunately.   (oh, btw, have you ever gone to a naturopathic doctor?  If not, another thing you might consider)

      2. I took it ~ 25 years ago.  Worked fine.  I did sleep for most of the five-month course.

    3. I would heartily suggest removing everything you can from your diet except vegetables and fish. Not even coffee, not even sugar, no bread of any kind, not even crackers, no nuts or peanut butter. 

      Making sure you get enough calories and protein of course. And then see how you are in a couple of weeks. If you see a change for the better, ride that out as far as it goes. And then start putting 1 food back in at a time, until you find something that triggers acne.

      Worked for me.

  28. I suffered from moderate acne (it felt severe to me, but wasn’t as bad as some severe cystic acne I’ve seen) from the age of 13 through 34.  But it’s clear to me what stopped it dead – when I was 34 I regularly visited a tanning salon, giving myself a basic (not freaky) tan.

    It stopped my acne in its tracks and it’s never returned, regardless of my diet or anything else.

    I realize that tanning beds are problematic for all the reasons that we know, and I didn’t continue past that Summer to use them.  But two half-hour sessions a week for that Summer forever got rid of my acne.  There’s no doubt in my mind whatsoever.

    1.  there’s a kind of laser therapy that works on a similar process.  my brother’s girlfriend is an aesthetician, and she’s recommended it.

  29. Dermatologists, being in business, like to sell subscriptions for multiple laser treatments and offer expensive prescription drugs that require lots of followup monitoring. When I read the 300+ reviews of non-prescription Salicylic Acid 20% Gel Peel on, there they were, glowing reviews that all claimed they had spent months and hundreds of dollars per visit to dermatologists who never even mentioned this wonderful substance that normalizes the invisible flaking off of single dead skin cells that formerly stuck together to clog pores. The first time I used it and again if I forget for several weeks, a thick layer of tough skin puffs up white with swelling before the moisture lifts it off. No more chronic dry skin. I asked girlfriends over two decades for advice, based on their beauty magazine reading. I guess they were just shopping for shoes because they never mentioned this stuff either. Having now read a couple thick academic books on skin science, I scoff at the ingredients of popular moisturizers. There should be ceramides, vitamin C and E and, the demon molecule itself: cholesterol! CeraVe brand is pretty good for a non-greasy product. Adding some glycolic acid to the weekly mix helps retain water too, a sister molecule of salicylic acid. -=Nik=-

    1. I’m interested in your regime with this 20% BHA Gel Peel.  How frequently do you use it?  What are the immediate and short term effects (first few hours to several days) on your skin in terms of inflammation and so forth – that is, how long until your skin is “back to normal” after a treatment such that you can go outside or to work and nobody would know you’d had it done?  (I’m assuming that your skin would still look red or sunburnt for several days after?)

  30. Two things got rid of my acne.

    1. Cutting down on milk and sugar. 
    2. Quitting aggressive topical meds like abrasive cleansers and benzoyl peroxide. (In fact, slathering on “greasy” stuff like jojoba oil helped improve my skin.)

    I suspect that I never really had acne. I just have that ruddy rosacea-ey British complexion with super sensitive skin, and the mess was just symptomatic of counterproductive skincare and bad diet.

  31. YOu keep calling it “dairy” when in fact the problem was with cow dairy, not all dairy.
    Goat and sheep milk and products were fine, it was the cow milk that the problem was with.
    “Dairy” doesn’t mean cow.

  32. I had massively bad acne in college. The soaps and cremes did little to nothing to help it. Eventually I was at my doctor for another reason and he almost leaped out of his seat asking why I’d not come to see him about the acne earlier.

    A very small dose of tetracycline cleared my skin up within a month, and it stayed (more or less) clear as long as I stayed on the medication (being in the UK, the Rx price was about a tenth of what the soaps and lotions had been). Bone loss can be treated with Fortical or good old Calcium. For me, it worked.

    When I moved to the US, and problems returned (no health care, no tetracycline) my dermatologist recommended some Philip Thomas Roth products (like the BPO Gel 10% benzoyl peroxide) which helped significantly, but at $60 for 3OZ it wasn’t exactly cheap.

    Thankfully, I grew out of the problem in my early forties, just as all the babes were starting to  look old…

  33. Rookie mag had a selection of reviews, products and tricks that have helped different female acne sufferers. some of it sounds counter intuitive — like washing an oily face with oils (except that oil is a solvent for oils, right ?). Anyhow — it was a pretty good run down on some different ways of dealing with this, many of which I had never heard of before:

    P..s. Not a bunch of product shilling by advertisers, either.

  34. What helped my acne was a combo of antibiotic cream and a cream that’s a mild acid that burns away a very thin portion of the top layer. Duac and Finacea. I use them on alternate nights. 

    If you’re female and don’t mind being on the Pill, the hormones can help acne tremendously.I did an allergy elimination test a while ago that involved stopping eating practically everything (I ate a LOT of rice and veggies) and slowly reintroducing things. I found that soy is the major culprit in some lifelong skin issues and cow’s milk gives me heartburn. Off the Prilosec I’ve been on for years and enjoying goat cheese. Gluten makes me congested, but that doesn’t stop me from eating the occasional slice of cake and then blowing my nose a lot for the next two hours.If you have nagging issues, you might try an elimination diet, and I think it widened my culinary knowledge anyway since I was casting around desperately for rare foods. Of course, a friend of mine tried it and it did absolutely nothing. But at the worst, you missed out on pizza for a few weeks. 

  35. I’d never thought about milk being a contributing factor but I’ve dealt with mild cystic acne most my life. I guess I have cut a lot of that out of my diet lately and it might be a difference. But one of the biggest things I think have made a difference is to stop using dandruff shampoo with pyrithione zinc and anything with silicone products. I think I was inhibiting my pores from flowing normally and something with the silicone compounded the issue. I tend to not wash my face at all with any soap products now and only use soap to wash other areas, not detergent products. I’m doing great now and hope my experience helps.

  36. At no point did anyone say “Ignore the doctors, sheeple!” But diagnosing allergies is a real bitch, and any honest allergist will tell you that often they have to keep throwing stuff at a problem and then see what works. And very often still fail.

    And it also boils down to asking the right questions. To whit: my husband broke out in massive hives a few years ago, that refused to clear up. He was on steroids (very bad to take long term) and we changed all our soaps, etc. And nothing worked. His allergist basically shrugged him off and told him to keep taking steroids.  He had repeatedly asked his allergist if the vitamins he took were a problem, and they guy pooh-poohed him. One of the things he was taking for digestive problems (which later turned out to be celiac) was pumpkin seed extract. Which is very high in Vitamin A. Which accumulates in your system if you take too much, and the result is often…giant hives. Once we figured this out, by ourselves, he stopped taking it, and within a month they cleared up. Hasn’t had a hive in 1o years.

    We still go to doctors and take meds, but we also understand their limits and that they have blind spots.

  37. This kind of strategy is particularly important because of how dermatology for acne often works.  It’s not diagnostic-based medicine, it’s treatment-based.  If you go into a dermatologist for acne, that person will almost invariably recommend a prescription cream of some sort alongside antibiotics.  If those things don’t work, they may switch to a different cream or a different antibiotic.  If that doesn’t work, they will either keep throwing different creams at you, or they may look for a hormonal solution.  If that doesn’t work, they may try Accutane.  

    Perhaps a doctor or dermatologist here can explain this to me: I have never understood why it’s not possible to have an initial “acne diagnostic” panel of tests that people get if they come in for acne-related issues.  Maybe test the oils on the skin or the sebum/pus within the blemishes to see exactly what kinds of bacteria are (or are not) present, do full blood hormone workup to see if hormonal imbalances are an issue, do an allergy panel to see if there are untreated allergies or inflammatory reactions that are causing problems, etc etc.  I have little patience for any doctors who, if there are myriad treatments for a specific issue, cannot tell me why they are choosing one treatment over another for my particular case.   

  38. Different variables trigger the different types of acne for me and each gets it’s own solution. Washing with baking soda paste takes care of the white heads and pimples. Good mechanical scrubbing and no makeup for blackheads & ingrown hairs. Staying away from soy and nuts for the boils and cystic. Various stress managements to keep hormones in check. The only thing I can’t do anything about is air pollution. City air increases my acne, country air reduces it and I just don’t have the income to go rural full time.

  39. My name is Elaine Mummery, I own an Acne Clinic in Glasgow and London and have treated 100’s of acne sufferers.  I just want to place some information here today that will help you to identify dairy spots.  Dairy will only ever case one type of spot, a large pustule with a very deep root to it. Dairy is not the cause of small pimples, blackheads, nodules, cysts or papules. Dairy does not have to be eliminated either as the only reason dairy is a problem is because the body is unable to absorb the lactase enzyme being produced by the small intestine. By taking a lactase enzyme supplement just prior to eating, dairy can still be eaten without any spots appearing. It should be noted that it is not the hormones in milk that is the issue, despite the theories that I have read on this put forth by some dermatologists, it is the lactose only. 
    I will also add that from time to time I treat doctors for their acne and they have come to me because they know that Roaccutane damages the liver and they are seeking a safer solution and each case I have cleared their skin.
    Dermatologists work to a theory that all spots start with bacteria/sebum that block the pore and this forms into different types of spots.  This is incorrect. One spot does not turn into another. There are many pathological processes at play which is why what works for one doesn’t always work for another, because each person can suffer from different types of spots.  If you are suffering therefore only from large pustules, ones that you have to press down hard to release the pus, these are dairy spots and as soon as you start taking lactase enzymes these will stop.  
    I work with each of my clients to stop spots then to address the root cause of the problem therefore reversing intolerance issues. Acne should always be treated on an individual basis.
    I hope you will find this helpful.

  40. Another folk remedy to put out there:

    Put a clean towel over your pillow before you go to bed. Replace it every night.

    1. or simply wash your face, and neck before going to bed.  better, take a quick shower to clean your hair too.

      The fresh towel is keeping you from accumulating multiple days worth of dirt and oil on the pillowcase which is then rubbed back onto your face/neck/shoulders as you sleep, clogging up your skin. 

      So the towel idea is not so much a folk remedy as it a way of staying cleaner. its just common sense. You can do the same thing by changing the pillow case every night. 

      But – if you have a face/neck/shoulder problem  wash them -gently- with mild  soap and lukewarm, not hot, water before going to bed, ifyou can’t take a quick shower. 

    2. That does help! Or instead of using a fresh towel, have an ample supply of pillowcases and use a fresh one every day. Keeping your skin clean can never hurt.

      In my case, I discovered that whenever a spot seems to be starting up, dabbing the area with hydrogen peroxide once every few hours drastically reduces the outbreak. Sometimes you end up getting away with just a bit of redness instead of a full zit.
      You just gotta resist the urge to do anything else to it at that point. Dab clean, leave it alone even if it hurts, it will be gone in a day.

      Disclaimer: I am not a doctor or anything like that.

  41. Is this story supposed to be about science? An n of 1? And the story says that sometimes it works, sometimes it doesn’t. Wouldn’t that imply at least the possibility that dairy in the diet is not actually the important factor? Please re-write this when there is some actual tested data to report. 

  42. For a website that has a clearly expressed devotion to and admiration of the scientific method, this article is a real disappointment. I mean, we could read all about the various approaches this person took, or we could read actual peer-reviewed research on whether isotretinoin (Accutane) is effective.

    Spoiler alert: while isotretinoin certainly has side effects, at a mean of 9 years post-treatment, 61 of 88 patients were still virtually clear of the disease, and it was deemed a “safe and effective therapy”.

      1. I’m fully aware of the severe side effects of isotretinoin. That’s why I wrote that it “certainly has side effects”. For the vast majority of people who take it, however, the side effects they experience will fall into two categories: anaemia and other related problems, which are monitored using regular blood tests that enable the physician to halt treatment if called for; and skin that is extremely dry and sensitive to sunlight. Other, more severe (and notorious) side effects are much rarer, on the order of 1/1,000 or 1/10,000 or less.

        I would never advocate isotretinoin as a treatment for mild cases of acne. But for people who suffer from more severe forms of acne vulgaris, as the Wikipedia article to which you link puts it, “Nearly all patients achieve initial clearing of acne during high-dose isotretinoin therapy. Furthermore, about 40% observe complete and long-term remission of the disease following one course of isotretinoin, while another 40% eventually develop less severe recurrent acne, which is treatable with less invasive medications. The remaining 20% relapse significantly enough to warrant an additional course of isotretinoin. Each additional course, however, has a higher probability of cure.”

  43. A couple of years ago, heck even a few months ago, I would have recommended Paleohacks as a good resource.  But not any more.  The SNR on Paleohacks has gotten so bad that it’s too much trouble to pick up any decent information.  Even long-time PH moderators are backing away.

    It seems that PH is now overrun with folks who want their science spoon-fed to them.  The sad thing is that this sort of thing seems to be happening everywhere.  Critical thinking anyone?

  44. So there’s actually complicated, nuanced thing here, around “what can you actually learn from an n of 1?” And it depends at least a couple of things. For example, if you think that x is causal by an “if and only if” kind of pathway, and you’re sure you’re not exposed to x now, then if you expose yourself to x and afterwards you see result y, it’s actually quite good evidence (see ulcers, smallpox, etc.). That is NOT what is happening here, it’s just to point out that statistical, or probabilistic causality, is not the only method of proof. But what is happening here?

    Suppose ideopathic [“of no known common cause”] diseases exist. What should science do? We might proceed down two paths — first, assume that a common cause exists but is unknown, and test  large pools of people in solid experimental designs (e.g. randomization) with specific therapies, e.g., in the treatment arm not allow them dairy, or give them Accutane. From this we get generalizable results from probabilistic causal tests, and therapies that work, at least more often than not.

    There is another way, though. Suppose that the observed grouping of conditions truly has no common cause, perhaps because it’s different in each person and grouped incorrectly, or it’s a constellation of conditions that varies by person, or there are funny hidden interactions across a large number of potential causes like stress, soap, hormones, protein sensitivities, etc. Now what should we do? What is the nature of evidence?

    The answer, I think, is that you as an individual should experiment broadly, particularly in restricting exposures in ways that are not themselves detrimentall (first do no harm). Make adjustments in areas where one might think there is some possible logical pathway (detergent, clothing fibers, foods, beverages, pillow towels, etc). Give each one time to act. When something appears to work, ratchet back until you can figure out what combination is enough for you. What you get from this is NOT a generalizable finding, but a generalizable PROCESS.  What crowdsourcing provides are alternative *pathways* or models that you might otherwise not have considered, not alternative *therapies*.

    Where this goes over a cliff is when people take their specific therapies from their idiosyncratic experience, often a result that is peculiar and without a logical link to any known biological mechanism, and generalize from that. Homeopathy comes to mind. But that is quite different and readily distinguishable from the above.

    There is actually a really interesting debate going on right now in development economics around just this — when should you use clinical trial approaches, and when should you use trial and error experimentation, see e.g. Angus Deaton and Abhijit Banerjee ( 

  45. At 21 I suddenly became very sensitive to shellfish (major bummer on the shrimp and lobster front!!) The symptoms were itchy back, wheezing,  stomach upset and pimples on face and body. Not the epi-pen kind of reaction – but a real reaction
    Later, I figured around age 30 that eating beef would end in stomach upset and enough spots on my face to frighten small dogs and children. Fish, dairy, chicken, pork and lamb are not a problem. I had washed my face twice daily with rubbing alcohol for almost 20 years, by then.
    By 32, I stopped my alcohol washing routine. And yes a hamburger will sprout all kinds of pimply nasties within 24 to 36 hours if I backslide, still (25 years later)”Standardized Medicine” that says that diet has no significant effect on acne is a total crock. The idea of universally or even majority significance of sensitivity or allergy is how pharma makes money. “Don’t find the cause, continuously treat the symptom.!”
     Managing my diet has made it much easier to avoid symptoms without medication or cosmetics.By being aware of what is unique in our own metabolism and sensitivities we can live a happier, healthier and less medicated life. 

  46. I had bad acne as a teenager and still have mild acne at age 50.  My main dietary trigger is peanuts.  I don’t have any standard allergic reaction to peanuts, but eating as few as 5-6 will cause me to break out in cystic acne within 2 days, the severity depending on the quantity eaten.  I can eat cashews and almonds in large quantity with little effect.

  47. After reading this comment thread, I have to say: God save us from the science/medical fundamentalists! Just as arrogant and hectoring as their religious counterparts.

  48. I’ve long wondered why humans get acne in the first place. What is its role? Is it merely a reaction or is it a response that the body generates in order to set up a low grade infection in order to pre-activate the immune response system during that time in early adulthood when contact with potential infection is most likely? Why is it always in the places it seems to occur; the face, the shoulders, chest, the back, buttocks …but rarely on the stomach, or the back of the calves or arms? I have read that it is the body’s mechanism to make the body more resistant to other infections. I wonder if her autoimmune system is messed up due to a lack of natural parasites such as the sort postulated, and for which some evidence is emerging, in the helminthic therapy field. 

    1. There is no reason to assume acne was selected for. It may just be a random side effect of other things that were selected for. If acne was selected for as a health improvement, as you suggest, then you would see it in a lot of animals – which I’ve seen no evidence for.

      But one possibility is that human acne was selected for as a way of marking adolescent as “off bounds” because they exhibit a sign of disease. The effect would be to keep adult looking adolescents away from such adult activities such as sex and fighting and thus prolong adolescence, with the upshot that those who delay such activities winding up being fitter.

  49. Huh. I had acne on/off for years. I never had the classic red volcano with a snowcap – instead I had the super-painful but almost-invisible pea-sized cysts that stayed below the surface until they ruptured and scarred. I could never make the connection – I didn’t wear make-up, I stayed out of the sun, I didn’t touch my face, I washed all of my bedding very frequently, et cetera ad nauseam.

    In my mid-thirties, I tried the Retin-A at night, antibiotic gel for day regimen for about 2 years – no effect. No redness, no peeling, no sensitivity to the sun, no reduction in my acne – just no effects at all.

    Then, I was talking to a co-worker whose daughter was taking ‘modeling classes’ to become a teen model. She casually mentioned her acned daughter had to give up rice, potato chips, and bread, all of which are high-glycemic index foods. My quack-radar went off, and I looked around for something scientific behind that advice.

    Huh. I guess those  nutrition-bashing dermatologists actually did a study and published the scientific results in a peer-reviewed journal. I stumbled across the first reference to the study in Men’s Health, a rather mainstream magazine, so it’s not like this data was squelched.

    My acne disappeared completely as soon as I eliminated rice and potatoes. I tried substituting brown rice and limiting potatoes, but I immediately and ferociously broke out. Pasta has to be limited but bread doesn’t bother me at all, strangely. I also quit drinking skim milk. I had switched to it from whole milk because it was supposed to be a culprit in my cholesterol problem, but my blood levels didn’t budge at all. So, I switched back to delicious, creamy whole milk. The better satisfaction of taste reduced my consumption from two gallons of skim per 10 days, to one gallon of whole every two weeks. I now struggle to finish the last inch before it ‘goes off’. Then, Dr. Oz told me that skim milk isn’t recommended for reducing cholesterol because it’s entirely carbohydrates, while the negligible milkfat in whole milk slows down the absorption of the milk sugars, and therefore lowers the glycemic index and resulting triglycerides. BAM! Less acne for me, even when I use the milk to wash down sourdough bread. I never got in the habit of drinking alcohol or pop, so two big dietary baddies weren’t a factor.

    Will this work for everyone? Well, check your gene pool – it could be a clue to what your sensitive to. Diabetes can run in families, and so can celiac disease. Aren’t big family reunions just  your gene pool’s convention to compare data?
     “Oh, my arthritis feels so much better when I swim…”
     “The doctor told me I have lose 50 pounds or else…”
    “You know, she was taking the pill, then her gall bladder blew like a bald tire…”

    1. I used to get those invisible cysts, too.  Particularly pleasant when I’d get one under an eyebrow and my eye would swell shut.

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