Women have understood the importance of looks for ages. The earliest records of makeup usage date back at least 6000 years, and in the 1600s women used star- and moon-shaped patches to cover smallpox scars. And just as long there have been people telling others such practices are immoral or dangerous.

If you have been scouring the net for natural acne treatment information, no doubt you’ve read articles exposing the dangers of cosmetics. Makeup is said to clog your pores, prevent your skin from breathing, and make your acne worse. Oh, and let’s not forget that it causes cancer.

Of course the natural health proponents have yet to find a non-natural substance they don’t find horribly dangerous. So just because some people claim makeup is dangerous and causes acne doesn’t make it so.

I get a lot of emails from people regarding makeup, and in this post I’ll do my best to address them. We’ll cover the following:

• Pros of makeup, or why you should consider using makeup.
• Does makeup cause acne?
• Do you need to worry about comedogenic ingredients in cosmetics?
• The ‘dark side of beauty’ arguments, i.e. can cosmetic ingredients disrupt hormones and cause cancer? And should you be worried about them.

I’ll do my best to address these questions with available science. But keep in mind this comes from I’m-a-guy-and-have-never-ever-touched-makeup perspective. So hold the desire to crucify me if and when you see me making silly makeup statements.

Why you should consider using makeup

This one should be obvious. Because using makeup to hide blemishes improves your self-esteem and makes you feel better about yourself. Like it or not, as a society we value beauty and aesthetics. In a recent podcast episode the Freakonomic guys went over some advantages good looking people have over not so good looking ones.

There are studies that quantify the improvements in self-esteem and quality of life in women with skin problems who start using makeup. But I think there’s such a thing as stating the obvious, so I’m not going to go over them here. Suffice to say that covering your blemishes with makeup is the fastest and most reliable way to feel better about yourself when you are out and about.

I believe that makeup is not only good for self-esteem but also for your skin. By now it’s well established that stress can aggravate acne. And when it comes to increasing stress and anxiety, there’s nothing quite like having to go out with freshly popped blemishes on your face, especially of the cystic nature.

This puts you in the middle of a vicious cycle; acne causes stress that causes more acne. And the more you try to get over acne, the more frustrated you get, and the less effective your efforts become.

Something has to give for you to break out of this. Your options: 1) wait for acne to go away (can take a few decades), or 2) do something about stress. Since waiting for a few decades is not the preferred option for most people, it has to be stress. For most people covering pimples with makeup is the easiest and fastest way to reduce acne stress. And yes, you are faking it, but get over it; it’s good for your skin.

But makeup causes acne, right?

Dermatologists often tell patients they shouldn’t use makeup as it can aggravate skin problems. This seems to be one of those things dermatologists throw out that’s not based on any real science – much like the claim that diet does not affect acne. We’ll get to the comedogenicity concept soon, but let me first go over a few studies where scientists have studied the effect of makeup on skin conditions.

Much to my surprise, I could only find a handful of studies that touched on the topic.

In 2005 Dr.Hayashi and his Japanese colleagues asked a makeup artist to teach basic makeup techniques for 18 women with acne. The women applied makeup for 4 weeks while their acne was treated.

At the end of the study the women felt better about themselves, improved their social life, and their acne was better.

Would their acne have gotten even better without makeup? Did the makeup interfere with the acne treatment? There’s no way to know since this study didn’t include a group without makeup. Looking at the results, acne dropped by about 40%, so I don’t think applying makeup had any negative effects on acne.

I found 3 other studies that in some way looked at the effect of makeup on skin problems. None of the studies showed any indication that makeup, when properly selected and used, would aggravate acne.

Makeup selection and usage – according to scientists

Far be it from me to claim that nerdy scientists in white lab coats are your best source of beauty tips and makeup advice. However, the Japanese paper did make good points regarding selection and usage of makeup:

• They used makeup designed for acne-prone skin, meaning it was non-comedogenic and non-irritating – according to the manufacturer.
• Don’t cover your entire face with several layers of concealer. Instead, use complementary color to blend in the blemishes. For example, apply green foundation over red pimples and you should get something resembling brownish tone. Then apply light layer of concealer.
• Use makeup to highlight and create focal points around eyes, lips or cheeks to draw the eye away from the blemishes.

Note that I have zero experience with makeup and won’t take any responsibility for the above instructions. Use at your own peril 🙂

Do anti-acne cosmetics work?

Some cosmetics claim not only to be safe for acne-prone skin but to also treat acne. Is there any truth to these claims?

In principle, yes. I don’t see any reason why you couldn’t use cosmetics as a vehicle for delivering anti-acne ingredients to the skin. That said, I’m not a cosmetic chemist and can’t say if there’s something in makeup that prevents their use as delivery vehicles. It seems at least Neutrogena and CLINIQUE have makeup with salicylic acid, so it’s possible at least in some form.

Also, in 2013 Korean researchers published a study showing cosmetics containing bee venom can treat acne.

So in principle you can use makeup as an acne treatment. However, the real question is whether it’s better to use a dedicated acne treatment and then apply normal acne-safe makeup on top of it. I would assume that with dedicated acne treatment products you have a much wider choice of active ingredients.

Presence of comedogenic ingredients does NOT mean the product causes acne

For over 50 years now scientists have applied chemicals to rabbit ears in order to find out if the said chemicals cause acne. In medical terms this is called comedogenicity testing.

Some websites collect the results from such studies into long tables where cosmetic ingredients are rated by their comedogenicity.

They encourage you to be an acne detective by running around the store with that 3-foot long list and checking every product against it. If the product has an ingredient found in the list = acne, if it doesn’t = safe to use. So simple. So black and white. So utterly wrong.

In 2005 Dr. Zoe Diana Draelos and colleagues published a paper titled A re-evaluation of the comedogenicity concept. In the study they tested whether products that contain comedogenic ingredients actually cause acne. They took 6 people prone to back acne and applied products containing known comedogenic ingredients to the upper back of the participants. In total they tested 10 different products. The products were applied 3 times a week and left to stay until the next application. This went on for 4 weeks. The results were compared to both positive and negative controls. Positive control being a substance known to cause acne and negative control one known not to cause acne.

In all instances there was no difference between the negative control and any of the products. In comparison, the positive control caused 3 to 5 times more pimples than any of the products. In other words, a product with known comedogenic ingredients did not cause anymore acne than a noncomedogenic ingredient alone.

They also made some interesting points on the discussion section of the paper:

• Comedogenicity tests often use very high doses of the tested substance. Whereas finished products often contain only small amounts of the substance. Think of it this way. Claiming that any product that contains comedogenic ingredients causes acne is like saying any food that contains salt will kill you because salt is lethal in high doses. Comedogenicity, like everything else, is a matter of dosage.
• There are different ways to measure comedogenicity. Some tests label substances that irritate the skin but don’t trigger acne as comedogenic. Also, substances that dilate the skin pores, like salicylic acid, can be labeled as comedogenic. Yet, salicylic acid is used as a treatment for acne.
• Human tests for comedogenicity often use exaggerated conditions. The substances are usually applied under occlusion (meaning the area is covered) and left on for several weeks, all of which increase the effect those substances have.

This study shows that simplistic acne detective work, where you run around the story with a 3-foot long list of dangerous ingredients, is a fool’s errand. My guess is that well over 90% of the supposedly dangerous products identified this way won’t actually cause acne.

This view was echoed in another paper that reviewed various acne models; experimental conditions that estimate what happens in human skin, like the rabbit ear model we talked earlier. Talking about the rabbit ear model, the paper states this model is unable to accurately depict the acnegenic potential of chemical compounds, and is therefore only valuable for distinguishing absolute negatives. In plain English, what happens in a rabbit ear is not the same as what happens in human skin, and we can only use this information to tell which ingredients don’t cause acne.

The Beauty Brains blog seems to think that the comedogenicity ratings are of some value and suggests the following rule of thumb:

So if a couple ingredients with moderate to severe comegenicity scores [3 and up] show up on the first 5 or 6 ingredients in the formula, there may be cause for concern.

The guys who write the blog are cosmetic chemists, so I would take their word on this.

Can you trust noncomedogenic claims?

So if you can’t judge whether a product causes acne from the ingredients list, how can you tell? I’m afraid that the answer in most cases is you can’t.

Some manufacturers label their products as noncomedogenic, meaning it should be safe for people with acne. But you should take the claim more as a suggestion than a guarantee.

‘Noncomedogenic’ is an unregulated term. So anyone can slap it on their products. It just means the manufacturer believes the product is safe for acne-prone skin, but they aren’t required to verify it. I’m sure many companies do test their products. After all, it damages their brand and reputation if a supposedly acne-safe products cause acne.

Paula’s Choice gives the following guidelines while choosing acne-safe products:

• Avoid products with thick or overtly creamy texture. These are more likely to clog your pores.
• Gels, light serums and fluids are more likely to be acne-safe than thicker products.
• Oils don’t clog the pores but can make your skin appear greasy.
• Avoid products that contain irritants, such as alcohols, menthol, peppermint, eucalyptus, camphor, lemon, grapefruit, or lime as well as natural or synthetic fragrances.

Since I’m not an expert on this topic I can’t say how good those guidelines are. However, I do see Paula’s Choice as a fairly credible source of information.

The ‘dark side’ of beauty

You’ve probably ran into posts exposing ‘the dark side’ of beauty. These articles detail long lists of unpronounceable and dangerous chemicals in your daily cosmetic and personal care products. These evil chemicals are said to cause cancer and disrupt hormones. After reading such articles I can’t fault you if you believe applying makeup is akin to poisoning yourself.

The solution.. of course, is to use natural, organic and ‘chemical-free’ make up.

Now that you’ve gotten rid of all those nasty chemicals surely nothing bad can happen to you. After all, you are only using all natural, organic goodness. Like tea tree oil and lavender. Ooops.. can cause man boobs and hormone disruptions in pre-teen boys.

What about all natural nettle then? Surely there’s nothing wrong with it. Oops.. causes man boobs and hyperestrogenism in women. How about this invigorating Chinese herbal tonic called Dong Quai.. man boobs again.

By the way, if you are wondering why all these have to do with man boobs.. it’s not because or my sexual deviations, but rather because I typed “gynecomastia herbal” into the PubMed search engine. Gynecomastia being the medical term for man boobs.

And while they were bashing evil chemicals, did they also tell you that a massive study showed vitamin E supplements increase prostate cancer risk by 17% in healthy men? Or about this study that showed selenium supplements increase prostate cancer risk by a whopping 90% in men who are not deficient in selenium? Or did they talk about this rat study that showed antioxidants accelerate lung cancer development? No… well.. I suppose that’s ok.. you are still avoiding all those dangerous chemicals, so everything must be ok then.

OK, enough with the sarcasm. The point I’m making is that ‘natural’ is not the same as safe. In fact, whether something is natural/organic has nothing to do with the safety of the product. What really matters is whether the product is safe and effective. Some natural products are, some are not.

‘Natural’ and ‘organic’ are marketing terms designed to give you warm and fuzzy feelings and make you believe you are doing the right thing for yourself.

But really, is it true that cosmetics and personal care products have hormone-disrupting chemicals? And should I be concerned about those?

Yes, it’s true, sort of. Should you be concerned about them? Depends on how much of a worrier you are.

The whole issue of endocrine-disrupting chemicals in cosmetics and personal care products is very complicated. I mean like several orders of magnitude above my pay-grade.

Last night, I read a few reviews that discussed the health impact of exposure to endocrine-disrupting chemicals.

In the vast majority of the cases we are exposed to these chemicals well below established safety limits. However, there are concerns that these substances may not fit into the common assumptions in toxicology studies.

Some of these chemicals may have ‘nonlinear exposure curves’, and data from exposures to higher concentrations may not accurately predict what happens at lower concentrations. In plain English, even exposures to small amounts may have negative effects. Is this true or not? I don’t know. It’s a question for people much smarter than me to figure out.

After reading several reviews I got the impression that there’s no clear evidence that endocrine-disrupting chemicals cause any real harm for humans. That said, no evidence doesn’t automatically mean safe. Legitimate concerns exists and this area needs more research.

In 2009 both the Endocrine Society and the American Chemical Society issued statements that, I believe, capture the issue:

The Endocrine Society stresses the importance of the precautionary principle in the absence of direct information regarding cause and effect and considers the principle to be critical to enhancing reproductive and endocrine health. The American Chemical Society recommends more Green Chemistry research aimed at identifying and developing functional alternatives that do not have endocrine-disrupting activity. It remains, however, very difficult to determine which substances, at which point in time and at which concentrations, actually increase risk. Implementing the physical-chemical hygiene is in this context certainly indicated.

Endocrine-Disrupting Chemicals: Associated Disorders and Mechanisms of Action

I want to stress that these reviews go far beyond the chemicals found in cosmetics and personal care products. The chemicals covered also include pesticides, flame retardants, BPA and other chemicals found in plastics, etc. Exposure through cosmetics and personal care products constitutes only a small part of total exposure.

And you should not assume that using natural products automatically solves this problem. As I mentioned above, many natural substances also cause hormonal disturbances. For example, phytoestrogens found in soy and some other plants are orders or magnitude more powerful than the much-maligned parabens.

I should say that none of this applies to pregnant and nursing women. Exposure in the womb or infancy can have unanticipated effects later on in life.

Conclusion

This post turned out much longer than I assumed. So let’s see if we can pull everything together and actually conclude something.

So we started the journey wondering if it’s safe for people with acne to use makeup. Carefully chosen and properly used, I don’t see any reason why acne patients should not use makeup. Sure, some makeup can clog your pores and make acne worse, but that’s where careful selection and proper usage comes into play. A few studies have shown non-comedogenic and non-irritating makeup formulated for acne-prone skin is safe to use.

I would go as far as to argue that makeup is good for your skin. Anyone who has experienced it knows how stressful acne is. The shame and anxiety it puts you through, all of which further aggravates acne. Anything you can do to ease the psychological burden is going to be good for your skin, and using makeup to hide blemishes is a very effective way to do that.

It’s true that some chemicals in cosmetics and personal care products may cause hormonal disruptions. However, in the vast majority of cases these are thousands of times weaker than phytoestrogens found in soy and other plants, which are further orders of magnitude weaker than human hormones. There’s no clear evidence that these chemicals cause harm in humans, however neither can we be sure they are safe. Following the precautionary principle, it’s a good idea to minimize your exposure to hormone-disrupting chemicals – without getting freaked out about them.