Seth’s blog

This review article — comparing several commonly-prescribed treatments for acne — ends up close to what I figured out as a graduate student via self-experimentation: that benzoyl peroxide works much better than antibiotics.

I like to think that in 100 years people will look back on current treatments for acne (and a hundred other things) as medieval, like leeches. If Weston Price had been a dermatologist, we would now have evidence, I’m sure, that certain traditional lifestyles produce very low rates of acne. Examination of those lifestyles would provide good clues about what aspects of our way of life cause acne. That would be a good starting point for experiments to zero in on what matters. Once we knew the environmental causes of acne, such as caffeine or soap, they could simply be avoided; no need for powerful dangerous expensive medicines. At the moment, however, determination of what aspects of modern life cause acne isn’t even close to being studied. You might think it is better to study safe cheap cures than dangerous expensive ones but you’d be wrong. At least now.

This post from the self-experimentation forums deserves to reprinted in full:

After being plagued with acne for years, I took a job which caused me to work in remote bush camps for short periods in the far north. My acne would invariably disappear within a few days of exposure to this. When I returned to the city, the acne would return with a vengeance. Did not know why.

My theory: Soap residue left after washing my face with hardwater was the true acne culprit. Washing my face with ultrasoft lake water in bush camps leaves little or no soap residue, so no acne. Soap residue stimulates excessive skin oil secretions which leads to increased acne. A rich diet aggravates the problem by feeding the oil secretions.

My self-experiment: I experimented with different types of soap and different concentrations of soap in hard and soft water.

Conclusion: Soft and slightly soapy water only (a very mild soap) produced the least amount of acne. Never apply soap lather directly to your face! If you have only hard water to work with, then no soap at all is the best choice by far. Compensate for the lack of soap with hotter water.

Added benefit: Washing your face with no soap causes acne lesions to heal much faster - a couple of days compared to a week or more with soap.

Great work!

The same technique applied to cold sores.

When I was a teenager, my dermatologist gave me a long list of foods that might cause acne. It wasn’t any help at the time but later, when my acne was better, it helped me realize that drinking Diet Pepsi caused me to get acne 2 or 3 days later because “cola drinks” was on the list.

Now I learn from Tucker Max that it was probably the caffeine that did it:

I had bad acne in high school. I cut all caffeine out of my diet–cola, chocolate, etc–and about 90% of the acne went away. I got the rest with Accutane.

Very useful information. The list my dermatologist gave me was too long and too homogenous. “The acne caffeine link is well-known to dermatologists,” Tucker added. Except those who claim acne has nothing to do with diet.

The highlight of my recent trip to New York was a talk I gave at Landmark High School, a public high school near Columbus Circle. The students paid close attention. Afterwards, a student named John Cortez told me what he’d figured out about what causes his acne. His skin was clear so I had to believe he knew what he was talking about.

He has three rules: 1. Eat less greasy food. 2. Work out hard. 3. Wash face extremely well, especially after working out. The last rule is surprising because one of Allen Neuringer’s students found that acne got better when she stopped washing her face. John explained his reasoning like this:

When I was little I got something because of the lack of hand washing. Nothing serious — it went away — but it caused me to become sort of a neat freak. When i started to get pimples I thought it was because i didn’t wash my face well. When i started to wash my face better, my acne stopped getting worse. One day i got lazy and from there on I stopped washing. Then I noticed that I was almost covered with pimples. When I got in a gym I realized that when i sweat and as soon as possible, washed my face got less pimples and prevented those nasty huge acne.

Amount JC figured out about acne while in high school: A lot. Amount SR figured about acne while in high school: Zero.

Addendum. Another unexpected aftereffect of my talk was that Shangri-La Diet forum traffic went way up. That evening, at one point there were 307 people simultaneously reading the forums, a new record. The average daily maximum during the days just before was about 150. There were about 50 people at my talk. Go figure.

Two years ago I guest-blogged at the Freakonomics blog about diet and acne. I wrote that the claim of dermatologists that there is no link between diet and acne was absurd, not only because I had seen for myself such a link but also because it was an impossibly broad generalization.

In an article in the Boston Globe, Cynthia Graber, a science journalist, describes quite a bit of evidence that yes, diet affects acne. The research on which the no-link claim was based tested only two foods (chocolate and sugar)! From which committees of dermatologists generalized to all foods.

SO WHY HAVE DOCTORS been taught for so long that there’s no link? The anti-diet hypothesis . . . arose solely from two studies from the late 1960s and early 1970s. . . . One compares real chocolate bars with fake ones and was conducted at the University of Pennsylvania School of Medicine with funding from the Chocolate Manufacturers Association. . . . The other study examines sugar in the diet of a small group.

It’s like that scene in the Wizard of Oz where the Great Oz is revealed to be an ordinary man behind a curtain. All those knowledgeable-sounding claims by dermatologists, based on nothing more than this.

Conventional research on the subject is difficult, both because of funding problems — drug companies won’t fund such research; and dairy farmers won’t fund experiments to find out if dairy causes acne — and because it’s clear that many different foods are involved. On the other hand, determining the effect of Food X or Y on your own acne is easy. I wonder why someone doesn’t build a website to gather information from such self-experiments. If I had superpowers, I would.

More about diet and acne.