Acne Face Map

Acne Face Map

October 23, 2021

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Why does acne seem to occur over and over again in the same place on your face?


It’s true that many of my patients will state that they always get acne in the "exact same spot!"   They believe that the exact same pimple keeps recurring in the same spot or in the same vicinity. 

 

This can be from a variety of reasons.

  1. The most probable reason is that there is likely a cyst underneath the surface that swells, pops, flattens and then swells again. Cysts are like a balloon or a pocket sitting underneath the surface. When it pops, the contents of the balloon (the cheesy white stuff called keratin) may come out, however the balloon remains deflated temporarily. It can fill or inflame again in the exact same location. 
  2. Another reason could be that there is persistent friction or irritation in the area either from hands or other objects such as helmets or products.
  3. And, there is the possibility that the location or spot has a higher concentration of androgen or hormonal receptors making it more susceptible to recurring in the same location.





Explain what an acne face map is and how it can help us understand what's going on with our skin? 


The concept of an acne face map is meant to try to provide  some idea as to cause or trigger for acne based on location of the face. The traditional acne face map considers if acne is on the forehead, nose, cheeks, jaw line, eyebrow area, ears, etc. and possible triggers due to this. There is some merit to this concept, however, there are several other factors to consider. 


Location is one aspect of acne. The other aspects to evaluate are the type and morphology of the breakouts. Whether they are inflamed, cystic, pustular, scaly, scabby, crusty, tender, hair follicle based, etc can also give an indication to type of acne, trigger for the acne, as well as different modalities to consider for treatment. 

 


Explain how and why the face is a reflection of what's going on inside our body. Can things like food, environmental factors and even habits cause acne on certain parts of the face? 

The facial skin is perhaps the first impression we make. It is highly reflective of our sleep status, stress, potentially underlying health, hormonal changes, etc.  Whether it be the sunken in eyes that sleep deprivation can trigger, the lipoatrophy of the cheeks from disease states or excess weight loss or exercise, discoloration from hormonal changes or acne, flushing or blushing triggered by anxiety, stress or certain foods, there are so many ways to consider the face as a reflection of the mental, physical and emotional state our body is in.

 


What does acne on the hairline indicate? 

Acne along the hairline can potentially be triggered from hair products such as pomades and hair gels. Acne along the hairline and hair bearing areas may also have yeast or bacteria as a trigger. Yeast and sweat may trigger a type of breakout considered a yeast folliculitis or on social media circles, "fungal acne".


What does acne on the forehead indicate?


Acne on the forehead can be secondarily triggered by sweat similar to along the hair line.  Hair products can also directly clog the pores along the forehead or inflame them.  Sports gear, hats and sweat bands can also trigger acne from direct friction or irritation. 


What does acne on the nose indicate ?

 

When I see acne on the nose there are two varieties of breakouts that can occur. 

One type of breakout can be triggered by excess flushing or blushing.  If this persists, tender nodules, pustules or cysts may develop.  This type of breakout is in the category of an adult form of acne or rosacea. This type of acne is less likely satisfied by the traditional "popping of a pimple". If you try to “pop” this type of pimple, you will likely be left with a more inflamed reddish area and no improvement. 

The other type of breakout that can occur is the result of bacteria that can colonize the inside of the nose. This type of bacteria called Staphylococcus can come out onto the nose and inflame or infect pores leading to tender nodules. These can be treated by popping or draining however the "carrier state” of bacteria in the nose as well to prevent recurrence. 

And, traditional acne can also be triggered in this area as a result of clogged pores or comedones that swell become tender and inflamed.



What does acne on the cheeks indicate?



Acne on the cheeks can come from a variety of reasons. Many people look to their pillowcases, cell phones and other friction related items. Although this is possible, it is true that I do not commonly see that patients changing pillowcases or being mindful of these habits can change much. It is difficult to say why this area gets inflamed other than likely androgen sensitivities of these particular pores. The cheeks tends to include the “hormonal” territory of the beard area. It is likely that these areas are more sensitive to the impacts of androgens versus others leading to this type of breakout.

 


What does acne on the chin indicate? 



There are three main triggers for acne on the chin. Hormonal acne is the most common that we consider in this area given that it has significant androgen sensitivities. However it is also important to note that depending on the age and type of hair growth in this area, ingrown hairs can also trigger significant breakouts as well as it discoloration in this region. There is a classic pattern of coarse hair growth that can occur along the chin that can result in constant plucking or poking at the skin that results in discoloration as a result of these types of breakouts. Also consider the possibility of folliculitis triggering breakouts in this area. These hairs can be directly infected or inflamed hair follicles as a result of bacterial colonization. And, lastly, it is also possible to get ringworm or tinea faciei on the hair bearing area as well on the face that can along the edges look and resemble acne in inflamed states.


Is there anything else you'd like to share about this topic?

Understanding that not everything that looks like a pimple is a acne is the most important aspect of understanding the next steps for treatment.  Using traditional acne medications or spot treatments on rosacea can inflame or worsen the breakout.  Excess exfoliation can make folliculitis and tinea worse and spread.  Seeing a dermatologist to accurately identify the source of your breakouts is important.

 

 



 

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