If you have been using a skin care regimen religiously and you feel like you are still breaking out, this may not be due to ineffective treatments but rather habits and actions that can counteract a treatment’s efficacy, such as failing to regularly see your dermatologist or not strictly adhering to a treatment. Below we have detailed some common reasons why your skin care may have been giving you issues.
You Have an Underlying Condition that Isn’t Being Treated
Breakouts aren’t just due to hormonal fluctuations or bouts of stress – they can oftentimes be side effects of underlying conditions. For example, those with eating disorders such as bulimia often suffer from dry skin, hyperpigmentation, breakouts, and delayed wound healing, among other dermatological symptoms (American Journal of Clinical Dermatology, Canadian Journal of Psychiatry). Those suffering from rosacea, oily skin, outbreaks, stinging, and sensitivity may suffer from papulopustular rosacea. Papulopustular rosacea (also known as subtype 2 rosacea) is most commonly found in middle-aged women, and can also physicalize itself as skin plaques and broken blood vessels (American Academy of Dermatology). Those with subtype 2 rosacea usually see their symptoms begin as inflammation, redness, and a few dilated blood vessels. As the condition becomes more severe, the eyes may feel gritty and small bumps/pimples may appear as the skin becomes more inflamed (National Rosacea Society). Since it is easy to dismiss these outbreaks as a normal case of pimples, it is important to consult with your dermatologist or physician so as to determine the best treatment.
Those women who produce too many male hormones may suffer from polycystic ovary syndrome (PCOS), which is characterized by excessive hair growth, infertility or compromised fertility, irregular menstrual cycles, weight gain, and breakouts (Center for Young Women’s Health, UC San Diego Health Obstetrics and Gynecology). Research published in the Journal of Pakistan Association of Dermatologists found that 27.5% of those with breakouts in their experiment also had PCOS, whereas research published in Best Practice and Research: Clinical Obstetrics and Gynecology reported this figure as high as 45.37%. Given that PCOS is most prevalent as breakouts, it is important that women who suffer from sudden outbreaks meet with their dermatologists as soon as possible (Journal of Pakistan Association of Dermatologists).
You Are Using the Wrong Ingredients and Concentrations
While ingredients like salicylic acid and glycolic acid are great for treating pimples, certain concentrations are better at treating certain symptoms (i.e. scarring, erythema) than lower or higher concentrations. Additionally, if you have been using a certain concentration for a long time, then this may signal that your skin has become tolerant to the treatment and needs either a higher concentration, or needs to be treated by a different set of ingredients. For example, while topically-applied tazarotene is effective in concentrations of 0.05% and 0.1%, research suggests that a 0.1% tazarotene serum is more effective in treating outbreaks than tazarotene in lower concentrations. Research published in Cutis found that a 0.1% tazarotene solution greatly improved the number of non-inflammatory lesions and the total number of lesions throughout a twelve-week trial when compared with 0.05% tazarotene. This study also found improvements in the number of inflammatory lesions in the twelfth week of the experiment. Other studies have similarly noted the efficacy of 0.1% tazarotene in treating pimple lesions (Clinical Therapy). If you have been using long-term antibiotic or antibacterial therapies, it is possible that the microbes that you are attempting to overcome have in fact evolved to become antibiotic/antimicrobial-resistant (Journal of Drugs in Dermatology). In these instances, it is not recommended to increase the dosage, as this may incur the microbes to become even more resilient to treatment; rather you may wish to discuss changing treatments with your dermatologist.
Even if you are using all of the right ingredients and concentrations, you may be pairing them with other ingredients that can counteract their improvements. Comedogenic substances are those ingredients which can clog the pores when applied topically, and can include alcohol, sugars, pigments, and oils. Even worse, certain comedogenic ingredients can irritate the skin by inducing edema, erythema, and scaling – all symptoms that can exacerbate the appearance and pain of comedones in some individuals. For example, poorly-refined mink oil and avocado oil, coconut butter, cocoa butter, and mid-length-chain alcohols demonstrated significant comedogenecity when applied topically to rabbit ears in a study from the Journal of the Society of Cosmetic Chemists. For those of you who enjoy lounging in the sun but suffer from comedones, you may wish to reconsider your sunbathing habits; research from the British Journal of Dermatology suggests that UV radiation can increase the comedogenecity of certain substances, such as coal tar, cocoa butter, and human sebum. However, if your favorite products contain comedogenic ingredients, don’t be so quick to toss them aside; this source notes that as long as comedogenic substances are not listed within the first 7 ingredients of a product, then they are probably used in a such a small concentration that it should not cause any issues.
You Aren’t Faithfully Using your Treatments
Whether it’s a treatment for physical or mental conditions, it is important that you take your treatments exactly as they were prescribed to you. Otherwise, you run the risk of letting your condition worsen, becoming resistant to treatment, or spreading your infection to others (Consumer Reports Best Buy Drugs). Although the exact figures are under debate, it is estimated that between 45-55% of those taking prescription treatments either don’t fill the prescription, take it irregularly, skip dosages, or in other ways do not abide strictly by their physician’s instructions for taking the therapy. The American Heart Association posits that this figure is close to three in four, or 75%, of individuals taking a prescription treatment. In order to treat your outbreaks in the most time and cost-effective way possible, take your treatments exactly as you were instructed to by your doctor or pharmacist.
You Aren’t Cleaning Off Your Cell Phone and Other Dirty Surfaces
There are hundreds of surfaces that have contact with our skin on a daily basis – cell phones, makeup brushes, yoga mats, helmets, etc. However, these surfaces often provide hospitable environments for bacterial colonization, and worse yet, we seldom remember to give these surfaces a regular wipe down. Dr. Debra Jaliman of New York City notes that not only do cell phones collect a great deal of bacteria on their surfaces, but their pressure against our skin can lead us to sweat, which can in turn clog our pores (Dr. Debra Jaliman for Women’s Health). The same goes for sunglasses, eyeglasses, and yoga mats, which have regular close contact with our skin and whose surfaces can hide microscopic germs (Dr. Ava Shamban for Prevention.com, Dr. Robert Lahita for Fox News Magazine). Regularly wiping down these surfaces and thoroughly washing your hands after using the bathroom can go a long way in preventing further outbreaks or irritation (Dr. Ava Shamban for Everyday Health).
Makeup brushes and sponges are also a major, albeit unsuspecting, home for bacterial colonization. Many of us keep our brushes long after they are useful, and seldom give them a thorough cleansing. In fact, one study found that after 4 weeks, the number of bacteria on makeup brushes was beyond measure. To minimize the chances of bacterial growth, wash your brushes once a week in warm, soapy water (Annie Chiu, M.D., The Derm Institute).
You Haven’t Tried Amino Acids!
When skin is inflamed and breaking out, many of the skin’s amino acids also become truncated (Journal of Immunology). When you apply intact, fresh amino acids to the skin, it has been shown in multiple studies to have significant effects, ranging from antioxidant and boosted UV protection (Journal of Photochemistry and Photobiology, 1999), to the promotion of tissue repair (Journal of Clinical Investigation, 1993), to conditioning the skin (Conditioning Agents for Hair and Skin [book], 1999).
Unfortunately, some cases of pimples can seem resistant to even the most powerful treatments. In these instances, it is best to consult with your dermatologist to determine if your skin care routine, health, or lifestyle may be undermining your efforts. For example, cell phones and makeup brushes provide a welcoming environment for bacterial colonization, which can in turn irritate the skin. Similarly, breakouts are often indicative of more serious conditions that require immediate medical attention, such as polycystic ovary syndrome or papulopustular rosacea. For the best results and skin health, make sure to regularly consult with your dermatologist whenever anything peculiar arises.