Acne And Allergies
Do you often break out with tiny red pimples? Do cleansers, moisturizers, toners, and makeup leave your face feeling itchy or tingly? Does sunscreen leave your face looking sunburned even before you have been out in the sun?
If you answer “yes” to any of these questions, it’s possible that in addition to acne you also have allergies. Allergy-prone, sensitive skin makes treating acne difficult because skin care products could cause as many problems as they resolve1.
Frequently Overlooked Signs Of Skin Allergies
Many people who don’t have hay fever or asthma nonetheless have skin allergies. A telltale sign of skin allergies is redness where redness is not expected.
Maybe wearing a ring or a bracelet leaves your skin looking just a little irritated, or possibly more than just a little irritated. Maybe you break out when your skin comes in contact with metal (other than 14-karat gold). Or maybe your skin is itchy and dry after it comes in contact with soap, massage oil, bubble bath, or shampoo that contains herbs, botanicals, or fragrances.
There are people with acne who also have allergic contact dermatitis2, a condition that keeps the skin in a state of constant irritation. Skin cells die and are shed. Some of these skin cells find their way inside pores where they can clump and clog the pore so that acne results. Because the skin is already irritated, these blemishes quickly progress into tiny red pimples, the redness caused by allergic inflammation as well as bacterial infection. These spots on the skin would be red even if there were no acne bacteria, but bacteria can add to the problem.
If you have allergic contact dermatitis, it is likely that a wide range of substances can trigger breakouts on your skin3. If you have chemical contact dermatitis, then is it more likely that a single identifiable substance triggers your breakouts, and all you have to do is to avoid it. Avoidance also works for allergies, but only if you can identify all of your triggers and eliminate them from your environment. Most people who get allergic-type blemishes need a different approach.
Skin Allergy Treatments That Aren’t A Good Idea
For over 50 years, doctors used to tell their “allergic acne” patients to use hydrocortisone creams. They are lots of obvious reasons why steroid creams like hydrocortisone would seem to be a good idea for treating tiny red pimples on the face. They are cheap (or at least some brands are). The products are cheap (or at least some brands are), and these relieve inflammation4 quickly by “turning off” the immune system around the pimples. Using the creams doesn’t require a lot of follow-up care.
The downside of using inexpensive hydrocortisone creams like Cort-Aid or much more expensive products like Soothe as Needed Hydrocortisone Lotion and DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone is that eventually these products thin the skin. This leaves the skin even more vulnerable to allergies. When people use even more hydrocortisone, the skin thins even more, causing a vicious cycle of allergy and irritation that inevitably leads to slow-to-heal wounds on the skin.
It’s also tempting to treat skin allergies with antihistamines. These over the counter medications are also inexpensive and immediately effective. The problem with antihistamines is that they may stop itching and reduce redness, but they do nothing about the underlying problem and the older versions cause drowsiness, headache5, and loss of coordination.
There are also several treatments that require a doctor’s OK that work when appropriately prescribed:
- Doxepin is actually an antidepressant compounded into a cream for the skin. It relieves itch, but it’s usually prescribed for “24/7” skin irritation. It is found to have a negative effect on inflamed skin6.
- Pimecrolimus (Elidel cream) and tacrolimus ointment (Protopic) stop the immune system’s T cells from releasing inflammatory substances in the skin. Since they shut down the immune system in the skin, they are usually not a good idea when there is also acne infection.
- Disulfaram (Antabuse) is a chelating agent that is usually administered to alcoholics to keep them from drinking. It also binds nickel and can help resolve skin allergies when reactivity to nickel is the main problem. However, it can result in acne-like eruptions7.
Your doctor will have other options for treating your skin condition, but none of these traditional alternatives really works all that well. So what can you do if you have an ongoing problem with sensitive, allergy-prone, broken out skin?
An Apple A Day To Keep Acne Away
One approach to dealing with allergies that trigger acne outbreaks on the skin is to incorporate a natural antihistamine, quercetin, into your diet. Quercetin is an antioxidant found in most fruits and vegetables8, especially in their peels. Apple peels, for example, contain about 10 times as much quercetin as unpeeled apples. Onion skin (not that you should start eating onion skin) contains far more quercetin than the edible onion beneath it. The reason quercetin is abundant in the outer layers of fruits and vegetables is that it protects them from sun and insect damage.
Apples, onions, grapefruit juice, green tea, and red grapes are the most abundant sources of quercetin in most Western diets. A seldom-consumed vegetable called lovage, however, contains 40 times as much quercetin as apples, and capers contain even more.
In the human body, quercetin binds to receptors on the mast cells that release histamine in the skin. The chemical action of quercetin is similar to jamming the wrong key into a lock. The advantage of eating foods that rich in quercetin over taking antihistamines is that quercetin’s effects are limited to the skin. There is no warning label on apples about daytime drowsiness or precautions for driving or operating heavy machinery.
An apple a day may indeed help keep acne away. Grapefruit juice contains even more quercetin, but it contains so much quercetin that it can interfere with the liver’s ability to clear certain medications—especially prescription antihistamines. But a laboratory trial9 at the College of Health Sciences at Korea University in Seoul suggests that eating an apple day may be especially useful if you also take any kind of antibiotic for acne, greatly reducing the activity of acne bacteria while reducing allergic sensitivity of the skin.
- Duarte I., Silveira J.E.P.S., Hafner M.F.S., Toyota R., Pedroso D.M.M. Sensitive skin: review of an ascending concept. Anais brasileiros de dermatologia. 2017;92(4):521-525.
- Foti C., Romita P., Borghi A., Angelini G., Bonamonte D., Corazza M. Contact dermatitis to topical acne drugs: a review of the literature. Dermatologic Therapy. 2015;28(5):323-9.
- Litchman G., Nair P.A, Atwater A.R. Contact Dermatitis. StatPearls. 2019.
- Abraham A., Roga G. Topical Steroid-Damaged Skin. Indian Journal of Dermatology. 2014;59(5):456-9.
- Randall K.L., Hawkins C.A. Antihistamines and allergy. Australian Prescriber. 2018;41(2):41-45.
- Taylor J.S., Praditsuwan P., Handel D., Kuffner G. Allergic contact dermatitis from doxepin cream. One-year patch test clinic experience. Archives of Dermatology. 1996;132(5):515-8.
- Nair P.A., Salazar F.J. Acneiform Eruptions. StatPearls. 2019.
- Anand David A.V., Arulmoli R., Parasuraman S. Overviews of Biological Importance of Quercetin: A Bioactive Flavonoid. Pharmacognosy Reviews. 2016;10(20):84-89.
- Lim Y.H., Kim I.H., Seo J.J. In vitro activity of kaempferol isolated from the Impatiens balsamina alone and in combination with erythromycin or clindamycin against Propionibacterium acnes. Journal of Microbiology. 2007;45(5):473-7.
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