Rachael Pontillo

Got Stubborn Acne? Here Are 5 Less Obvious Root Causes

Acne is a skin issue that plagues millions of people, from adolescence to post-menopause, to the point that many feel it is inevitable. Sometimes acne is easily managed with simple changes to one’s skin care routine, or by cutting down on common triggers such as dairy, gluten, and sugar. However, many people struggle with stubborn acne that, despite healthy topical skin care, diet, and lifestyle choices, just won’t clear.

Here are 5 things to consider if you have stubborn acne:

1. Genetics

People with stubborn acne often blame genetics. We now know that “bad genetics” can be overwritten by epigenetic factors–a nutrient-dense diet and healthy lifestyle factors such as rest and regular movement. However, it is true that some people are genetically predisposed to acne itself–but others have genetic reasons that explain why that is.

Fortunately, genetic testing–namely nutrigenomic testing–is now widely available and can provide very helpful guidance. Nutrigenomic testing looks at your genetics–often specifically single nucleopeptides (SNPs)–to uncover reasons that explain WHY someone is predisposed to acne. Some examples are nutrient deficiencies or the inability to metabolize specific lipids or substances like caffeine and alcohol. Research also shows how certain foods can actually turn genes “on” or “off” in our bodies. For example, certain compounds found in broccoli have the ability to “switch on” a specific gene that helps some people detoxify some of the harmful chemicals we’re exposed to.

With that information, more targeted choices can be made for foods, supplements, and even topical skincare ingredients for maximum bioavailability.

2. pH Balance

“pH” stands for “potential of hydrogen,” and is a measurement of how acidic or alkaline a substance is. 0 is the most acidic, and 14 is the most alkaline. Distilled water is considered “neutral” at 7. Did you know that most mass-produced skin care products on the market that claim to be pH balanced are not balanced to the natural pH range of the skin? They would more accurately be labeled as “pH neutral,” since most have a pH of 7.

Our skin’s pH is slightly acidic, typically ranging from 4.5 to 5.5. This slightly acidic environment is a necessary part of the skin’s immune function, as the beneficial microbes that live in and on the skin’s surface require it. The skin’s lipid matrix (also commonly referred to as “lipid barrier,” “acid mantle,” and “natural moisturizing factor”) also requires this slightly acidic pH to stay intact. Repeatedly applying leave-on skin care products that are too alkaline (even though 7 is neutral on the scale, it is too alkaline for the skin) can adversely affect the skin’s lipid matrix by neutralizing its naturally occurring fatty acids, and thus creating an uninhabitable environment for the skin’s microbiome, leading to dysbiosis. It can also negatively affect sebum production and cause dryness and irritation. Look for topical skin care products that are pH balanced to the skin’s pH–not the pH of water, such as the products in The Spa Dr.® Daily Essentials 4-Step System.

3. Toxic mold

Sometimes stubborn acne is stubborn because it has a less obvious root cause. One common, overlooked potential cause is fluoride in water. Another that is equally as problematic and may be even more hidden is toxic mold.

Mold exists everywhere–in our homes and offices, in our outdoor environments, in the foods we eat, and even inside our bodies. If we maintain a healthy and diverse microbiome and take measures to make our home and work environments less habitable to toxic mold, it doesn’t have to be problematic. However, for many people–especially people who struggle with high stress, chronic illness, or autoimmune disease–that is not the case.

Mold produces mycotoxins, which are secondary metabolites capable of causing disease and death in humans and other animals. Some mycotoxins or mycotoxin derivatives have been found to have useful properties, but others are highly toxic to humans and can trigger local and systemic infections. Mycotoxins can also trigger rosacea, hyperpigmentation, and eczema flares, as well as certain types of acne. If your acne hasn’t cleared after making other positive changes, check to see if you’ve been exposed to a water-damaged, damp, or musty-smelling building. If you have, mold could be the culprit, and mold treatment could eradicate the problem for good.

4. Unbalanced Skin Care Routine

A long-held myth about oily and acne-prone skin (AKA the Olivia skin type, as described in Clean Skin from Within) is that it can’t handle oils. This is why so many acne products are oil-free. Let’s bust that myth today because the truth is that all skin types need both water (hydrating and humectant ingredients) and oil (emollient ingredients) to support healthy sebum production and barrier function.

The skin’s microbiome also requires both water and oil to maintain biodiversity, since some bacteria and microflora are hydrophilic, and others are lipophilic. Too much or not enough water or oil in one’s topical skin care regimen can disrupt the skin’s microbiome, killing off beneficial microbes and allowing others to become opportunistic.

The Spa Dr.® Daily Essentials 4-Step System is a well-balanced system, providing both hydration and emollient protection with humectant ingredients like aloe vera and hyaluronic acid and protective oils such as cranberry seed, raspberry seed, and apricot kernel oil.

5. Stress

Unmanaged stress adversely affects every organ and system in the body. The effects are so significant that stress can undo the benefits of eating clean, exercising regularly, getting enough sleep, using high-quality natural skin care products, etc. Unmanaged stress is one of the greatest reasons why some people’s acne just doesn’t clear, even when it seems like they are doing everything else right.

As Dr. Cates writes in Clean Skin from Within, “Stress is not the only cause of acne, but it is a big culprit. When we’re stressed, the adrenal glands release the hormone cortisol. A surge in cortisol causes increased sebum production, which triggers acne. Chronically high cortisol levels can lead to sugar cravings, and eating sugar also triggers acne breakouts.”

We all have stress, and not all stress can be eliminated. It is essential to learn to manage it using mindfulness, journaling, listening to guided meditations, taking dance breaks, going to therapy, and spending time in nature. Other stress management practices may seem obvious, but most people don’t do enough rest and say no. Overworking is an epidemic here in the United States. It has not been good for our collective health or happiness. We also don’t say no often enough. Most people (women especially) aim to please and want to avoid conflict. They sacrifice their own time and needs in order to say yes to please or appease others. This is inherently stressful, and that stress accumulates.

Even the most stubborn acne can be managed holistically. Doing “everything right” doesn’t necessarily mean that that particular “right” is right for you, or right for right now. Sometimes we need to re-evaluate, take a deeper look into root causes and lifestyle factors, and make adjustments to achieve lasting results.

Soft Exfoliation

For decades, the “gold standard” skincare routine went something like this: cleanse, tone, exfoliate, and moisturize. Daily exfoliation may still be the norm in many conventional skin care routines, but our understanding of the skin’s structure, function, and microbiome have made it clear a conservative soft exfoliation approach is needed. 

Exfoliation Basics

The two categories of exfoliation — chemical & mechanical 

Chemical Exfoliation involves using a low pH product such as alpha-hydroxy acids (AHAs) products, a group of plant and animal-derived acids used in various skincare products. AHAs such as glycolic or mandelic acid; or enzymes synthesized fruits such as kiwi, pineapple, and papaya. These exfoliants can be applied as controlled, single treatments by an aesthetician; or incorporated into products such as cleansers and serums. Chemical exfoliants work by dissolving corneocytes (the “dead” skin cells on the skin’s surface) that fall off in their own time. Chemical exfoliants also dissolve some protein structures in the epidermis’ deeper layers, stimulating the skin, and activating a healing cascade to develop new dermal collagen and elastin.

Mechanical Exfoliation involves using physical tools or topical abrasives. Physical tools include brushes, sponges, or a rough washcloth. Topical abrasives include pastes and scrubs that contain tiny granules, such as salt, sugar, or even coffee grounds. The idea is to use motion to gently slough away dead skin cells (corneocytes) from the skin’s surface. When done softly, mechanical exfoliation has the added benefit of stimulating blood flow to the skin’s surface to support healthy blood and lymph circulation – too rough, and the skin’s inflammatory response can be triggered. 

More Is NOT More With Exfoliation

Unfortunately, a “more is more” attitude has become the industry trend. The goal is no longer to improve the skin’s glow by only removing the cells about to fall off on their own. Instead, the goal is to remove enough surface proteins to the point it inflicts an injury to the skin’s deeper layers. This approach triggers an inflammatory response within the dermis. The intention is to encourage fibroblasts (the cells that provide structure to the skin) to produce more collagen and elastin. 

The visible result of activating more fibroblasts is firmer, smoother, plumper, more youthful-looking skin. However, the plumpness you see due to this harsh approach is not an increase in fibroblasts producing younger, healthier-looking skin, but in fact, it’s swelling — skinflammation. Unfortunately, this industry technique is excessively triggering the skins’ inflammatory response and overworking fibroblasts. 

You see, the skin naturally regenerates itself every month. However, by triggering an excessive inflammatory response, fibroblasts can become overworked and damaged. In the long run, damaged fibroblasts will lead to a prematurely thinned dermis and slower collagen production. Harsh and excessive exfoliation can lead to a compromised skin barrier function, disrupted skin microbiome, and hyper- or hypopigmentation.

How To Exfoliate Gently & Safely

Many people benefit from periodic, gentle exfoliation. To safely and gently exfoliate, you want to feel the granules, but it should not feel like you are “sanding” your face. Nor should it leave your skin feeling chafed, dry, or tight. When applying the exfoliant, use very little pressure and minimize friction by applying water as a light lubricant. All you need to do is use soft circular motions and let the scrub do the work.

It’s best to use a scrub no more than once or twice a week. The goal is to support the skin’s natural exfoliation function — not to take it over. Think of exfoliation as a supplement to your daily skincare routine. It should be done in a way that feels good during and after the treatment. If your skin is extra sensitive, you may want to start by only exfoliating once every other week. 

Choosing A Gentle Exfoliant

When choosing a mechanical exfoliant, like a scrub, look for one that includes tiny, non-jagged granules. Look for ingredients such as powdered flower petals, clays, or even pearls. It should also contain soothing and emollient (moisturizing) ingredients like natural plant oils and aloe vera gel to protect as you polish.

An excellent exfoliant such as The Spa Dr.® Pearl and Rose Petal Facial Exfoliant is a very soft scrub that contains antioxidant beet root extract, powdered rose petals, and finely milled freshwater pearls to delicately & gently exfoliate and leave your skin feeling smoother and more radiant looking. 

When choosing a chemical exfoliant, choose skin care products with a low concentration of fruit enzymes, such as the organic pineapple fruit extract in The Spa Dr.® NOURISH Antioxidant Serum. A very gentle enzymatic exfoliant you can use is raw honey — check out the DIY skin care recipes in Dr. Cates’ book, Clean Skin from Within, for inspiration.

Bonus tip: the best way to help your skin naturally and gently exfoliate itself  is to drink enough water on a daily basis! Dehydrated skin tends to want to hold onto its “armor”. In contrast, hydrated skin is more expansive and willing to let the armor go.

For truly nourished, hydrated, and protected skin, it’s important to care for it both on the inside with healthy food and lifestyle choices, and on the outside with natural skin care products and treatments. The great news is that you can cultivate or supplement your daily skin care routine (inside and out) with foods that you likely already have in your kitchen. 

Today, we explore 5 of our favorite natural ingredients for skin from your kitchen.

1. Avocado

Avocados are quite nutrient-dense, offering a combination of healthy fats, protein, vitamins, and trace minerals. Avocados provide monounsaturated fatty acids (which are healthy fats) that help regulate blood sugar, support healthy HDL cholesterol, and nourish skin cells. 

Avocados are also a source of complete protein (about 2 grams in one avocado half), as well as the minerals iron, magnesium, and potassium which nourish and fortify the skin’s acid mantle, and aid in nutrient absorption. They’re also an excellent source of vitamin E, vitamin C, and carotenoid antioxidants that protect and repair skin. Avocados have a creamy texture, which make them ideal for DIY face masks, as well as a delicious addition to salads, grain bowls, and smoothies. For these reasons, we love using avocado for skin.

2. Honey

Honey is one of the most ancient and powerful remedies that nature provides. Using honey for skin and wellness dates back to Ancient Egypt ,Greece, India and Sri Lanka (it’s a well known Ayurvedic remedy), and has also been used extensively by indigenous peoples in the Americas, Africa, Australia, and New Zealand. Honey is rich in natural sugars, which serve as prebiotics to nourish the skin’s microbiome, in addition to 18 free amino acids, B vitamins, flavonoid antioxidants; calcium and phosphorus as well as other minerals. 

Honey’s main skin benefits, however, are its naturally occurring antimicrobial properties which can help balance the skin’s microbiome, and its naturally occurring enzymes and alpha hydroxy acids to support gentle exfoliation and a healthy skin pH. It’s important to use raw honey for skin, since the pasteurization process in conventional honey destroys the enzymes, antioxidants, and other beauty nutrients. You can use honey as a standalone facial cleanser or treatment mask, or incorporate it into another single-use DIY skin care product such as Dr. Cates’ Organic Honey and Tea Tree Cleanser on page 178 of Clean Skin from Within.

3. Oats

Oats are known for their soothing and calming skin benefits for irritated or angry skin. You may remember soaking in an oatmeal bath when you had chicken pox or poison ivy as a kid for those reasons. Oats are highly beneficial for the skin, and contain different types of phenolic and flavonoid antioxidants, minerals, amino acids, and naturally occurring saponins which assist with cleansing. 

However one of the best reasons to use oats for skin is due to its demulcent property. Oats produce mucilage when they come into contact with water, which is a gel-like substance that soothes, nourishes, hydrates, and protects the skin. To use oats for skin, you can grind them into a fine powder or flour and mix them with honey, aloe, tea, or water as a gently exfoliating cleanser or face mask. You can also steep the oats in hot water as you would a tea, let it cool, strain out the oats, and then use the mucilaginous liquid leftover as a DIY toner or soothing facial compress.  Dr. Cates offers several DIY recipes using oats for skin in Clean Skin from Within as well.

4. Yogurt

Aside from honey, yogurt is one of the most ancient natural ingredients to be used for skin care and to promote health and longevity. Using yogurt for skin (for cleansing and moisturizing) dates back to 2000 BCE, while consuming it as a food dates back to at least 8500 BCE. Yogurt is a fermented milk product, rich with the main probiotic strains Lactobacillus bulgaricus and Streptococcus thermophiles, though sometimes additional strains of beneficial bacteria and yeast are added. The fact that yogurt contains live, intact, and bioavailable probiotic strains (assuming it hasn’t been pasteurized) makes it ideal to nourish the microbiota both in the gut, and on the surface of the skin. The normally harder to digest proteins and sugars found in milk are broken down into soluble and easier-to-digest forms, which make yogurt easier to digest for people with dairy sensitivities, than milk. 

In addition to its probiotic benefits, yogurt is also a natural source of lactic acid, a larger molecule alpha hydroxy acid that gently exfoliates, while also increasing skin hydration and supporting a healthy pH. It is very easy to use yogurt for skin. Some options include blending it with other natural ingredients such as honey and powdered oats as a cleanser, or simply applying a thick layer of yogurt on its own as a hydrating, exfoliating, and moisturizing mask. The DIY skin care section at the end of Clean Skin from Within includes several recipes that incorporate yogurt. We recommend using organic, whole milk yogurt–raw if possible. 

5. Papaya

In the worlds of nutrition and aesthetics, papaya is considered most useful for its main enzyme papain. Papain is an enzyme that digests proteins, both internally and topically. On the skin, papain is used in products intended to exfoliate, improve the appearance of scars and overall skin texture, and brighten dark spots and uneven pigmentation. It is important to note that the papain found in conventional skin care products is often synthetically made and far more concentrated than that found in raw papaya. However, even in its whole food form, papain is a powerful enzyme that may cause irritation for more sensitive skin types; so we don’t recommend applying straight raw papaya to the skin if you have a Heath or Emmet skin type. However, papaya is often fine for Amber, Olivia, and Sage skin types. 

Take The Skin Quiz to learn your skin personality type. 

When in doubt, either juice it or mash it up, and mix it with some of the other natural ingredients mentioned today for a highly nutritious DIY treatment mask. Using papaya for skin also helps to deliver a potent dose of Vitamins C and K, and carotenoid antioxidants that the skin can store and then convert to usable forms of Vitamin A when it needs it. In addition, papaya’s natural sugars function as prebiotics that feed the skin’s microbiome.

What natural skin care ingredients do you already have in your kitchen?

Your kitchen is chock-full of beauty nutritious fruits, vegetables, grains, and other highly beneficial foods to use topically, and consume internally for glowing skin. We encourage you to head to your refrigerator and pantry and take a quick inventory. Do you have any of the five foods from today’s blog post? If not, add them to your shopping list and pick them up on your next grocery run–they are all easy to find in most stores.

What foods do you already have in your kitchen that you can use for skin care? Tell us in the comments below!

For nearly 15 years, public awareness that many mass-produced, conventional skin care products on the market contain ingredients that carry health risks has spread mainstream. It all started with findings from a 2004 study by Dr. Phillipa Darbre, which identified intact parabens in breast cancer tumors, which was suspected to have come from repeated usage of an underarm deodorant product containing them. When that initial study came out, the industry was turned upside down. One could say that this study really was the birth of the green beauty industry, since before that, most consumers would have not even considered that there would be skin care ingredients to avoid. 

Cosmetic chemists were all of a sudden asked to reformulate products, manufacturers dealt with an unprecedented amount of product returns and complaints, and the internet took off with blog posts and articles, with angry debates in the comments about whether there was actual need for concern, or if this was instead, just fear-mongering and hype. List of toxic skin care ingredients to avoid (the Dirty Dozen, Dirty Thirty, etc) were widely circulated.  Organizations such as the Environmental Working Group, Made Safe, and the Campaign for Safe Cosmetics mobilized to further explore the issue of ingredient safety in cosmetics and personal care products, since the Federal Food, Drug, and Cosmetic Act has not been updated since 1938.

Years later, much has changed in the industry, due to the rapid growth of the green beauty movement, and green chemistry industry. While when the paraben debate first began, there were not many viable alternatives, that is no longer the case. While we could still list pages of skin care ingredients to avoid, today, we’re going to keep it simple and focus on the top five highest priority ingredients (most of these are categories of ingredients) to avoid in skin care.

The 5 Top Priority Ingredients to Avoid in Skin Care

1. Parabens

The most common “gold standard” preservative in cosmetics, for the majority of the existence of the industry up until 2004 was the family of parabens. Methyl-, propyl-, isobutyl-, and other prefixes of the paraben family offered cosmetic chemists extremely effective broad spectrum protection, ease of formulation, long shelf life (sometimes longer than 3 years), at a very low percentage in just about any emulsion, gel, or water-based product. They are also extremely inexpensive.

There are still chemists, companies, and practitioners who staunchly defend the use of parabens in cosmetics; claiming the it is in such a small amount that it doesn’t make an impact, that parabens are found naturally occurring in plants so they must be safe, that the study itself was flawed, and that there are no good alternatives—therefore products that don’t contain them are dangerous. However, further studies began (studies continue to this day) to clarify the findings of the initial study. While a definitive causal link between parabens and cancer has not been found, the evidence has shown that parabens are endocrine disrupting chemicals, which contribute to body burden, and do pose health risks when used over time–even in tiny amounts. Rather than squabble about parabens, now that we have so many viable alternatives, it just makes more sense to use them instead!

The Spa Dr.® skin care products do not contain parabens.

2. Fragrances

Synthetic fragrances (listed as “fragrance,” “natural fragrance,” or “parfum” on product labels) are the most likely ingredients in products to cause allergic and irritant reactions, and many of them are toxic. According to the Environmental Health Association of Nova Scotia’s Guide to Less Toxic Products, in 1989 the US National Institute of Occupational Safety and Health evaluated 2,983 fragrance chemicals for health effects. They identified 884 of them as toxic substances. The US EPA found that 100% of perfumes contain toluene, a toxic volatile organic compound (VOC) that can have developmental effects. Besides toluene, some of the other chemicals used to make fragrances are phthalates, synthetic musks, formaldehyde, and several neurotoxins.

Fragrance blends might contain up to 900 individual constituents, which do not have to be disclosed as per the FDA’s current trade secret law. Even “natural fragrance” contains synthetic constituents (which would also not be disclosed). Look for fragrance-free products, or products scented only with botanical extracts or essential oils (which will be noted on the label with its Latin botanical name).

The Spa Dr.® Skin Care products are either fragrance-free, or naturally scented with essential oils.

3. Anionic Surfactants

Surfactants are detergent ingredients that work by separating oils from water, so the oils in dirt, sebum, and debris can be washed away. They are most commonly found in facial cleansers, body washes, and shampoos; however milder types may also be found in certain moisturizers and conditioners.

Anionic surfactants are the strongest, harshest type of surfactant on the skin. They strip away the skin’s lipid barrier, which contributes to inflammation, a compromised barrier and skin immune function, a disrupted skin microbiome, as well as skin dryness and sensitivity. Anionic surfactants are also known for skin and eye irritation and potential toxicity—yet they are still the most commonly used surfactants in conventional skincare and personal care products.

Ammonium lauryl sulfate, sodium lauryl sulfate, and sodium laureth sulfate are examples. Instead, look for cleansers and body washes that use gentler surfactants that do not pose the above mentioned risks. Examples include (but are not limited to) sucrose laurate (found in The Spa Dr.® Daily Essentials Step 1 – CLEAR: Gentle Cleanser), lauryl glucoside, decyl glucoside, or cocamidopropyl hydroxysultaine (all found in The Spa Dr.® CLEAN Body Wash).

4. Phenoxyethanol

This is one of the preservatives that was commonly used to replace parabens in skin care products after the 2004 study rocked the industry. Chemists liked (and still do like) it because it can still be used at a low percentage, is inexpensive, and is very effective at inhibiting the growth of gram positive and gram negative bacteria, mold, and yeast. However, one of the earliest indicators that phenoxyethanol was problematic was reports of eye irritation (it is commonly used in eyeliners and mascaras), as well as skin irritation.

Phenoxyethanol is also used in the fragrance industry as a fixative, and thus has also been linked to respiratory irritation and allergies. Other potential problems with phenoxyethanol include potential contamination with 1,4 dioxane, which is a carcinogen; as well as potential adverse effects on the nervous system. It’s important to note that Japan has banned phenoxyethanol’s use in cosmetics for the above concerns.

The Spa Dr.® Skin Care does not contain phenoxyethanol.

5. Coal tar dyes

Colorants in skin care are not all toxic–many green beauty brands have chosen to use natural plant and non-toxic mineral pigments. However coal tar dyes and lake colorants are still the most commonly used synthetic colorants in skin care, personal care products, hair dyes, and color cosmetics. Coal tar dyes are “made by combining various aromatic hydrocarbons like toluene, xylene, benzene, which are obtained from the distillation of bituminous coal. They are also made from petroleum distillates.”

Coal tar dyes are carcinogenic when used in concentrations higher than 5%–which might not occur in a single skin care product, but if a person is using a lotion, makeup, and shampoo that contain coal tar dyes daily, it is possible that they might consume that 5% cumulatively. In addition to this very serious concern, coal tar dyes also increase photosensitivity–meaning the skin’s susceptibility to sunburn and skin cancer. They are listed on product labels as a five-digit Color Index (C.I.) number, or as “FD&C” or “D&C” followed by a color name and number.

The Spa Dr.® Skin Care products do not contain synthetic colorants.

When transitioning to an overall healthy lifestyle, simple changes in products you use on a daily basis can make a huge impact in your overall wellbeing.

We hope this list of ingredients to avoid in skin care was more user-friendly than some of the giant lists out there. The Spa Dr.® takes great care to make sure that all the products in the skin care line are safe and non-toxic, and has worked with the Environmental Working Group to make sure of it!