I would say that as a teenager acne prevented me from getting many dates but it's not true. Being a closeted gay boy did. While I harbored affections for a handful of my male peers in secret (most of whom turned out to also be gay which, had I known at the time, would have dramatically altered my childhood narrative), I was content not to be involved in romance for the fear of being found out as gay, as well as being dishonest (I dated one girl in an atttemot not to be gay, but that ended quickly and I eventually came out). But acne persisted long after I came out, and was a constant source of mild anxiety as it is for a great deal of people both young and old across every race and religious affiliation. I would like to assure you that acne is not your problem, no matter how much you may think so. Acne might seem to be the source of your self-doubt, bad choices, and anxiety, but it is your self-doubt, bad choices, and anxiety that are the real problem. Overcoming those requires self-searching and questioning what suffering means to you personally. When you can come to find that answer that life is helping you learn, you will find relief from those things. Acne is just annoying.
I haven't really had acne in ten years, and there may be something about acne I am missing. But I remain confident in what else I know about human biology and about how I came to be acne free to understand what causes acne and thus how to cure it.
As a teenager I was put on the drug Accutane (my article Surviving Accutane talks about my experience) and while it saddled me with debilitating health problems it did not even lessen the amount of acne I continued to suffer. There are more treatments for acne than I can count, and how many of those permanently eradicate it? There are creams, washes, pastes, papers, peels, and prescriptions (alliteration!). For me and for many others the most effective treatments are antibiotics, but they only work while being used and can also come with a lot of serious side effects.
That antibiotics are somewhat effective is a clue to the cause and solution for acne, but not in the way you are thinking. Yes, acne is caused by bacteria. We all know that. But then why do treatments which target this bacteria so often fail?
When I was about 26 I did a cleanse that rid me completely of acne, but I'm not going to talk about it because it was dangerous, cleanses are bullshit, and turns out completely unnecessary. It just so happened that other decisions I made around the time of the cleanse were more important than the cleanse itself. What I did was attempt vegetarianism. Vegetarianism is not the answer to acne (hang with me—we're gonna get there I promise). In my particular choice of vegetarianism I inadvertently reduced my consumption of Iron, particularly the kind of iron found in animals which is bound to protein. The cleanse also helped clear some excess iron out of my digestive system. My life up to this point included copious amounts of Iron laden food, both from fortified wheat products and meat. Iron in meat is more easily absorbed by the digestive system because most of it is already bound to protein (although it should be noted that not all animal-sourced iron is protein bound, and that vegetarianism does not necessarily protect against acne).
IRON AND ACNE
The reason acne sets in during puberty and not before is that the iron content in the body, particularly the amount and how it is metabolized, is manipulated by the sex hormones. Estrogen in particular, which is a hormone of growth, causes cells to accumulate iron (and copper as well). In both males and females estrogen levels rise at the onset of puberty and are never again as they were in childhood. It is supposed to be like this and the problems are not with the hormones but in how they react to our food and lifestyle cultures.
Acne begins in the gut. Milk, which is naturally low in iron, is designed by nature to prevent pathogenic and bacterial overgrowth in the vulnerable intestines of newborns. For this same reason, the body does not tend to excrete used or excess iron in the intestines, as it does for many other metabolic byproducts, to avoid feeding pathogenic intestinal bacteria. Instead, the body mostly excretes iron through the skin. This is also why we tend to develop body odor along with acne when hitting puberty—the excreted iron on the skin allows more bacteria to begin growing there. But because the skin is naturally resistant to bacterial penetration, our health usually remains unaffected.
Acne does not just occur on the face, although that is usually the source of our dislike since it muddies up our appearance. One of the reasons that acne is so concentrated on the face is because of where the iron excreted on the face comes from. Iron seems to be excreted in the fastest route possible via the skin, rather than circulating through the body, and while some organs like the liver and spleen will store iron, the rest of the body does not readily release it back into the blood stream once absorbed. In the case of the head, where large incidents of acne occurs, this iron comes from our most metabolically demanding organ—the brain. Since the brain is surrounded by skull, excreting iron would be extremely slow and difficult if it traveled through bone, so it instead goes through the face. One of the reasons sulfur has traditionally been used as a remedy for acne is because sulfur strongly binds to excess iron. But using sulfur products can cause an imbalance in the acid/alkaline state of cells and would be more helpful to use sulfur containing supplements like vitamin B1, B2, and Taurine (I discuss these below).
Two of the factors which regulate iron homeostasis most are vitamins A and D. Both of them, but more especially vitamin A, stimulate the liver and other storage sites of iron to release some into the blood stream. When I was experimenting with vitamin A supplementation it caused me to have a recurrence of acne which I hadn't had in many years. This effect on iron metabolism is one of the reasons I strongly warn against using vitamin A as a supplement. It can release enough iron that subsequent metabolic processes can result. I even experienced an increase in hair loss in the thinning parts of my scalp when using vitamin A. Preformed, supplemental vitamin A is much more risky than a lot of people realize, and unless you have a specific diagnosed deficiency, I would avoid using it altogether. It is much safer to get vitamin A through dietary sources. Some people have experienced relief or reduction of acne from using vitamin A. This would be because the vitamin A has mobilized excess iron in the skin, but is not a reason to continue using vitamin A and is why vitamin A users have not found a consistent cure in its use. Milk often has preformed vitamin A added to it and may even be enough to contribute to acne in some individuals (it will say on the label if vitamin A is added). Obtaining natural vitamin A in the diet will support a better homeostasis and not risk the side effects of vitamin A supplementation.
One of the reasons antibiotics help fix acne is because most antibiotics bind iron, preventing it from use by bacteria. So does aspirin which has long been used topically (salicylic acid) to prevent acne. But since problematic iron can be avoided in the diet, avoiding excess iron is absolute best way to treat acne.
Eating a diet which is composed of low-iron foods can very quickly correct acne problems. Since iron is very important for health, however, it is not expedient to avoid all iron, just foods which have it in excess or an excess of those foods. Reducing meat consumption for a time plus avoiding any foods fortified with iron are the proper way to go.
PROPER ACNE DEFENSE
Normally the excretion of iron through the skin should not be a problem, but our diets contain an unusual excess of iron. Except in the case of iron-deficient anemic populations, which incidentally don't present with acne, iron is absorbed in amounts that make it easy for opportunistic bacteria to take hold. The body does already have a natural defense against this bacteria, however, but you wash it off very day. Sometimes two or three times. Our skin has a naturally acidic layer of oils that is supposed to sit on the skin, to help protect against moisture loss as well as kill any pathogenic bacteria which may want to set up camp. Without this protective layer your skin is exposed and vulnerable to acne. I made this realization around the time my acne disappeared and completely stopped washing my face with soaps, and except for experimenting with vitamin A I have not had acne in ten years. I have advised people of this but women especially don't want to stop washing their face out of some misguided sense of cleanliness. The oil layer is much more antiseptic than your soap. A lot of women wear makeup, but this is often being done to cover up poor skin which is caused by over-cleaning, drying, and leeching of nutrients by harsh chemical products which would go away if you stopped using these insanely toxic chemicals on your living, breathing skin. As part of this natural defense barrier humans have a fatty acid which is entirely unique in the animal kingdom. It's called sapienic acid, and it is excreted in the sebum from our sebaceous glands, which occur in a high concentration on the facial skin. The production of sapienic acid is inhibited by estrogen, though, and is another reason to maintain a diet that promotes a robust metabolic rate, as estrogen increases in depressed metabolisms. This is another reason why women see cyclical cycles of acne development along with their cycle, and males who have acne whom are experiencing an increase rate testosterone to estrogen conversion. In the case that estrogen is increased, it inhibits the conversion of palmitic acid to sapienic, inhibiting the bactericidal properties of the skin.
Excess iron can still help establish acne though, even with this natural acidic barrier, if enough of it is present, which is why it is important to avoid excess dietary iron in addition to leaving the acidic skin barrier intact.
OTHER NUTRITIONAL SUPPORTS
A few other factors influence how the body is able to manage iron. It is especially important to maintain robust metabolic health, as a compromised metabolism tends to increase the hormones which saturate the tissues with iron. A high metabolism keeps these hormones to a minimum and thus prevents excess iron accumulation. Starvation, fasting, low carb, and drinking alcohol all increase hormones which promote excess iron. If you are unsure how to promote a robust metabolism you can start with my article How to Perform Self Therapy. Some foods directly lower the metabolic rate but is too much to get into in the space of this article, but helpful information can be found in The Cure for SIBO, and Permanent Weight Loss. VITAMIN C is a two-edged sword when it comes to iron. Having vitamin C with foods high in iron will increase the amount absorbed. This means not to have an orange with your beef, or don't take a supplement of C within about an hour of having grains. But for the same reason that Vitamin C makes iron absorb more easily in the digestive system makes it easier for the body to handle, metabolize, and excrete normal and excess iron, so having as much natural Vitamin C in the diet as possible can help clear up acne as well as deal with hormonal imbalances as I discuss in The Cure for Hypothyroidism. FRUIT is especially helpful in combating acne as fructose is involved in enzymes which regulate the desaturation of certain fatty acids and whether or not they cause metabolic decline. ZINC is also helpful in combating excess Iron. But like iron, zinc is regulated by hormones, specifically the ones which work opposite of estrogen will stimulate cells to absorb zinc instead of iron and copper, which is another reason to keep a robust metabolic rate. Taking zinc without a good metabolism won't do a whole lot to prevent excess iron, but a low-dose zinc supplement can be helpful otherwise (just don't overdo it, zinc doesn't need to be taken in excess). Potatoes for some inexplicable reason clear blackheads and impacted pore issues, so instead of digging at your skin just have some potatoes, if they don't bother your digestion. COFFEE can help as well because it inhibits iron absorption (having it with a meal is nice too), and accelerates the metabolic rate (but do not ever have coffee on low blood sugar, which can cause stress and counteract your efforts). NIACIN is also helpful at increasing the metabolic rate of the skin, and can help reduce acne formation. While natural, endogenous niacin production is ideal (my article on Niacin Therapy explains this), it can be supplemented with niacinamide, although it should be noted that niacinamide greatly increases the metabolic rate and should not be taken without adequate carbohydrate and protein, otherwise discomfort and stress results can ensue. As mentioned earlier, VITAMIN B1 and B2 help manage iron metabolism, and while I strongly believe that vitamins should come from whole food, these two can be taken with some therapeutic effect on various conditions, including acne. Vitamin B1 helps to remove excess Iron from cells. This can actually cause skin odor and taking B2 along with it instead helps this reacted compound to be excreted through the feces rather than the skin. As long as the diet is changed to avoid excess iron, these vitamins can help reduce excess iron in the body in about a month or two. In a similar process but involving different organs, TAURINE also increases the excretion of excess iron but through bile. It also increases the hydration and metabolism of skin, but taking taurine comes with some gastrointestinal effects as the excess bile can cause a stomach ache when beginning and should be eased into dosages. It also helps prevent excess estrogen to some degree. Lastly, VITAMIN E is also superbly protective against acne, as it both protects against iron accumulation and excess estrogen, as long as the diet also protects against excess estrogen. As many vitamin E products are synthetic and even toxic, it is important to use an explicitly natural form of Vitamin E and should say as such on the label from what source it originates (dl-tocopherol is synthetic, as opposed to d-tocohoperol which is natural). I have found PROGESTERONE, which I discuss at times on this site, to also flush excess iron out of tissues and temporarily cause an elevation in iron excretion and acne. As long as the diet does not contain excess iron this effect should be short lived as it does not mobilize iron from the storage organs like the liver and spleen the way vitamin A and D do but rather flushes iron from other tissues where it is not generally supposed to be elevated. A healthy diet will naturally promote healthy progesterone levels and it shouldn't be required to use progesterone, but it can probably be helpful if desired (I would not use it if you are younger than 25 unless things are very severe). In addition to not washing the skin, antibiotic oils like COCONUT OIL and/or SHEA BUTTER can be used to moisturize excessively washed skin, remove dirt, and support the already antibacterial acidic layer. I would make sure to use organic sources of each, as pesticides and dioxins in non-organic sources could be problematic and estrogen promoting, and men should know that coconut oil can interrupt your libido if you use it in a large amount (which is not harmful, just annoying), in which case I prefer to use Shea butter or a combination of Shea whipped with a small amount of coconut to make it more pliable. Adding some natural vitamin E to this is a potent skin-protectic compound (vitamin E is destroyed by light so don't apply topically in the daytime).
ACNE SUPPORT LIST
AVOID EXCESS IRON
AVOID IRON FORTIFIED FOODS
DON'T WASH YOUR FACE!
VITAMIN B1 AND B2
AVOID VITAMIN A SUPPLEMENTS