Life is deeply unfair. I know this because even though I consistently wash my face, apply a four-step prescription regimen, and avoid dairy, soy, and sugar, I still get zits. Meanwhile, my best friend, who sleeps in her makeup and runs off a steady diet of Mountain Dew, chicken fingers, and stress, has marble-smooth skin that glows with the light of a thousand moons.
I am, as they say, acne-prone. But I think this label is bullshit. We all have pores and skin oils. “Why does my skin suck??” was the eloquent way I broached this question with my dermatologist friend via text. And then I posed the same question to another derm, and then another derm, until I felt sufficiently dismayed, yet clear, on what exactly makes your skin more acne-prone than your friend’s.
Fact: We All Have the Same Skin
“Everyone’s skin is, fundamentally, the same,” says dermatologist Mona Gohara, M.D. associate clinical professor at Yale. Yes, even you with your cystic acne and your friend with the face of a pearl. “Everyone has hormonal fluctuations, oil productions, and acne-causing bacteria in their skin that could, theoretically, cause massive breakouts at any time,” she says.
But the reason the entire world isn’t one giant walking zit is because “some people are genetically more prone to their sebaceous glands getting inflamed by hormones, oil, and bacteria,” says Dr. Gohara. So even though we all have the same acne-triggers—i.e. a raise in stress hormones, or a sweaty summer day, or a late-night pizza binge—we don’t all have the same sensitivities to those triggers. Which means the way you and your best friend’s skin react to the same trigger could be as minimal as getting one tiny blackhead for you, or as severe as a full-blown breakout of cystic acne on your BFF.
The Actual “Why” Is Still Unclear
“This is a tough question,” says dermatologist Julie Harper, M.D., of the Dermatology & Skin Care Center of Birmingham. “The real answer is that we don't quite know what makes one person more susceptible to acne than another at a ‘nitty gritty’ pathogenesis level.” Yes, I know; that sucks to hear. “We know that there’s a genetic predisposition—you’re more likely to have acne if your parents had acne—and it may be that we're ‘inheriting’ certain strains of acne-causing bacteria that induce more inflammation than other strains,” she says.
But as for why your skin is more sensitive to inflammation than your friend's? Dermatologists still aren’t sure, but they think it has something to do with the TLRs (toll-like receptors) in your skin, which are little receptors that assess a threat (like a gallon of wine) and tell your body how to react (with a zit).
“We don’t have evidence, but it’s a theory that the TLRs in acne-prone skin are naturally more sensitive, causing a larger and more frequent inflammatory response to triggers,” says dermatologist Melissa Kanchanapoomi Levin, M.D., clinical attending at NYU Langone and Mount Sinai Hospital. Basically, you’ve got some air-traffic controllers in your body going a little overboard with their job, sending you into zit territory.
In the End, It’s Not Your Fault
“Your risk of acne only partially has to do with how you take care of your skin,” says Dr. Gohara, which is kind of the worst thing to hear when you’ve spent the last year perfecting your skincare routine. But try to let it be a relief, because it means there’s really only so much that you can do.
“That’s why Accutane works so well for acne—it shrinks the gland, so the gland can’t function even if you have a sensitivity to triggers,” says Dr. Gohara. “It basically just closes the door so you can’t break out.”
Of course, Accutane isn’t right for everyone, and most people with mild acne find they can easily treat their breakouts with over-the-counter treatments. So until doctors find a magical cure (with zero side effects) for acne, try taking deep breaths, not hating your friend for her perfect skin, and one of these spot treatments, below.