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Where Your Acne Is And What It Looks Like Can Tell You What's Causing It

If you've been sleuthing around the Internet in search for a cure for your acne woes, you've probably already come across something called Chinese Face Mapping. Or maybe you've come across other beauty bloggers who have conveniently "tracked down" the root cause of acne for each section of your face and sworn up and down by face mapping. A quick Google search proves that posts on this are in no short supply.

However, every picture you come across that allegedly maps your acne will always be a little bit different.

Chinese face mapping or 'Mien Shiang' means reading the face. It is considered a part of "traditional Chinese medicine" (TCM). Contrary to popular belief, TCM does not go back thousands of years. In fact, many people are surprised to learn that the single person responsible for the current popularity of TCM was not some ancient Chinese healer, but was instead Chairman Mao Zedong.

Mao was noted as saying "Even though I believe we should promote Chinese medicine, I personally do not believe in it. I don't take Chinese medicine." Instead, his support of Chinese medicine was inspired by political necessity. People in China were going without proper medical care, and thus, Mao proposed TCM as a way to meet the needs of the people. Empirical-thinking westerners and empirical-thinking Chinese both knew that folk medicine was useless, they just believed that folk medicine was better than no medicine, as China did not have the methods or resources to deploy proper medicine nationwide. The only reason this took off in the western world was because of our fascination with the "mystical" nature of the Orient. While it's true that Chinese folk medicine has existed for hundreds of years, the phenomenon of TCM has been reinvented almost wholly by Mao. This doesn't mean that some herbs have not since proven effective in recent, placebo-controlled clinical trials (often not for what they were first purported to help in TCM), it just means that TCM as a whole is not some ancient, untapped fountain of health. Not to mention, the side effects of some herbs may be more damaging than the side effects of the problem it was intended to cure.

Enough of the history lesson. What does this mean for our skin?

Regardless of the fact that TCM is not ancient, and is largely dreamed-up and not rooted in science, some Chinese medicine practitioners still believe that when your skin starts acting up, it indicates that something else is not going well inside you. Whatever these imbalances are, they will show up on your face, and in a specific area for each cause. It’s the idea that different parts of your face are somehow connected to different organs, and that problems in specific areas of the face reflect problems in specific organs.

This is slightly rooted in the idea of reflexology, which posits that the body is divided into zones, and that each organ is somehow represented on a certain area of the hands and feet (in our case for face mapping, on the face).

Face mapping "specialists" can also be found, if you're lucky to be in their area. One such specialist in the UK offers face mapping for a fee, but even the "beauty experts" at Dermalogica offer a free face mapping service. The fact that these people read off a clipboard to diagnose your acne with no medical training should speak volumes for its legitimacy.

One blogger discusses her experience with face mapping at Dermalogica, in which the "beauty expert" put on a big magnifying glass and "diagnosed" that the blogger had combination skin with congestion and dryness. Well, that doesn't really seem all that surprising, considering most of us are already aware of our skin's needs. A quick peek in the mirror and I can tell the same thing about my own skin (although mine is congested and oily).

Like reflexology, the anatomical pathways of face mapping have not been demonstrated. It is safe to assume that they simply do not exist. I would be surprised if any of these areas of our face were actually connected to the organs that face mapping suggests they are. While they may be, this has yet to be elucidated.

Western medical practitioners of course hold that there is little truth to face mapping. "There are no medical studies to link facial mapping with specific breakout areas," says dermatologist Dr. Brian Russell. This shouldn't be surprising because even advocates of things like face mapping will make sure to tell you that these methods aren't "100% accurate" and "may not apply to your unique case". This is just their way of covering their behinds without providing any real evidence. The ol' "well it worked for diagnosing my acne problems but might not work for your skin". This is especially true for the people who, say, have acne in their "liver" area, who take milk thistle, and then their acne goes away. The placebo effect is especially strong in acne patients, likely due to how much our acne is connected to our mental health, and so these anecdotes are hardly anything to get excited about.

The problem is that traditional Chinese medicine is based on pre-scientific ideas, and scientific testing has shown those ideas not to be true. There’s simply no credible evidence for links between areas of the face and different organs. If these medical practitioners pushing TCM and face mapping have found these pathways, why not share them with the rest of the scientific community so that they can help cure all of us of our acne?


This does not mean that persistent or recurring facial acne in specific regions should be ignored, or that acne on your face in certain areas can't tell us something about your habits or lifestyle. This simply means that there's little evidence to suggest that acne on your chin is related to your kidney or your bladder, or that your spleen is resulting in acne under your eyebrows. There is definitely a cause, and it must be properly treated.

So then why is that you always tend break out in acne over and over again in the same areas of your face?

Where acne shows up on your face can tell you about what might be causing your skin problems, but it's not as easy as a link to your bladder or spleen.

We are most likely to have acne on our faces due to the fact that we have more pores on our face. Your hands and feet, for instance, don't have many sebaceous glands, but your back, forehead and chin have the most -- anywhere from about 2,600 to 5,800 sebaceous glands per square inch (400 to 900 per square centimeter). Even your ear canal has some sebaceous glands (some of us are unlucky enough to even get the occasional pimple in our ear!). Some people are more prone to developing pimples in certain areas of their face due to skin texture, sebum production, pore size, etc. Where you get acne depends largely on the distribution of oil glands on your face, and possibly also on whether you treat different parts of your face differently.

For example, areas such as the forehead, nose and chin consistently show higher casual sebum levels than the rest of the face (Wa & Maibach, 2010), while perioral and nasolabial areas showed the highest amounts of transepidermal water loss (Marrakchi & Maibach, 2007). This can explain why areas like the forehead, nose and chin are especially susceptible to breakouts because sebum production can affect our likelihood of developing acne. This is particularly true of dietary changes which affect our sebum production, as well as levels of inflammation in the body which can change the composition of our sebum (a particularly big problem in areas where high sebum production is already the norm). These areas are generally deemed "hormonal" because hormonal changes can also affect sebum production and composition, which may result in acne in these areas. However, stress can also increase inflammation and sebum production, so it may not be entirely hormonal (although hormones and inflammation can definitely work in concert).

Acne in the hair line is usually fairly easy to diagnose, and - surprise, surprise - it has nothing to do with your liver, your kidneys, your gallbladder, or any other organ for that matter. Acne in the hair line (although it may also be a form of dermatitis) is almost always related to your hair care products, or not cleansing your skin into your hair line. What you use in your hair can affect your scalp, as we know (think: dandruff). Similarly, your hair care products can also result in acne via comedogenic or irritating ingredients. Detergents can irritate the skin to some degree. SLS is one such common irritant, and is even used in many medical trials as a skin irritant. They literally apply it to skin to develop an irritation in an attempt to test products to treat skin irritations, and we can even develop contact allergies from these irritants. Or, if you have a dry scalp, the dead skin can also increase the likelihood of pimples in this area. We also tend to itch and scratch and touch our hairline, adding insult to injury.

You'll have to narrow down the ingredients for yourself. Try new shampoos, new hairsprays, and make sure to keep your hair away from your face. The best things we can do is avoid ingredients in our hair care products that we find irritate our skin, make sure our scalp is properly nourished, and keep our hands off. Make sure to wash your hair brushes, also, as these can also harbour and spread dirt, bacteria and dead skin. And ensure you're washing about a quarter inch into your hair line when you wash your face also,

Acne on your cheeks could be various things. It could be from touching your face a lot (if you rest your face on your hands at work, or in class, while you're reading, or even at night if you sleep on your hand), it can be from sleeping on a dirty pillowcase (you should change your pillowcase every second day to prevent dirt, debris, sweat and dead skin cell buildup), and it can be from holding a phone against your skin for prolonged periods of time (if you're a telemarketer or you talk on the phone a lot). More often than not, these are the primary culprits for cheek acne, especially if it is localized on one side of your face. In some people, anecdotal evidence suggests that eliminating dairy can reduce cheek acne, although this has not been conclusively proven. Cheek acne can also simply be the result of distribution of sebaceous glands and an internal imbalance like those resulting from systemic inflammation, hormones, excessive keratin production, etc. Cheek acne may also be genetic in nature, and notoriously resistant to treatment and prone to scarring.

Acne on the lower half of the face, chin, jaw, and neck, are almost always rooted in hormones. This is called the muzzle or beard area. This is a common area for acne to manifest in PCOS patients, but also in patients with hyperandrogenism without PCOS, or just simply with an increased sensitivity to hormonal changes.

Acne around your mouth is usually hormonal, but can also be linked to any products you use around your mouth, or if you're constantly touching your mouth. Toothpaste, lip chap, concealer, foundation, lip liner, lipstick, floss residue - it can all aggravate the area. The most likely culprits are a new toothpaste or lip product. Or, if you're like me and are wearing braces, or a retainer or mouth guard, these may also be the dirty culprit. Hormones, however, seem to be the winner in this area, especially if (you're a female) you notice breakouts in this area at different times during your cycle. In my book The Clear Skin Recipe I discuss menstrual cycles at some length, and how our hormones act during this time which can lead to breakouts.

Overall, there are a few things that you can eliminate from your routine to determine if they were a contributing factor. If they make no difference, your acne is either rooted in hormones, diet, inflammation, sebum production, bacterial overgrowth, sebum composition, hyperkeratinization, etc. (or any combination). Acne from a poor diet can pop up anywhere on your face, and so can acne from bacteria or hyperkeratinization. These usually have distinct causes, which I talk about more in my book.

There are also different types of acne.

A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. These can be called "cosmetic acne" as they sometimes manifest based on topical factors. Comedones can develop into bumps called whiteheads and blackheads. Acne like the type seen in the above photo is symptomatic of improper use of cosmetics (cosmetics being anything and everything you put on your face, not just your makeup). It can result from sunscreen, concealer, foundation, blush, hair products, our phone, etc.

The comedones can be uninfected - non-inflammatory acne - or they can become infected and inflamed, leading to papules, pustules, nodules, or cysts.

Blackheads are comedones that are open at the surface of the skin. They are filled with excess oil and dead skin cells. It's not dirt that causes the comedone to turn black; the oil's reaction to air causes the black color. Blackheads can frequently be treated with over-the-counter medications, like salicylic acid. Thus, the problem here could be an over production of oil and keratin, caused by hormones, inflammation, diet, stress, etc.

Comedones that stay closed at the surface of the skin are called whiteheads. This happens when oil and skin cells prevent a clogged hair follicle from opening. Many of the same over-the-counter medicines that treat blackheads are also effective against whiteheads, because they are caused by similar problems.

Papules are comedones that become inflamed, forming small red or pink bumps on the skin. Papules occur when the P. acnes bacteria lead to irritation of the hair follicles. This type of pimple may be sensitive to the touch. Picking or squeezing can make the inflammation worse and may lead to scarring. A large number of papules may indicate moderate to severe acne.

Pustules are another kind of inflamed pimple, and are quite common. They resemble a whitehead with a red ring around the bump. Pustules occur when the P. acnes bacteria lead to inflammation of the hair follicles, causing swollen red bumps. The bump is typically filled with white or yellow pus. Avoid picking or squeezing pustules. Picking can cause scars or dark spots to develop on the skin. Again, these can be caused by any variation of hormones, stress, diet, inflammation, etc.

Nodules are large, inflamed bumps that feel firm to the touch. They develop deep within the skin and are often painful. A nodule may be filled with inflamed tissue or a mixture of tissue and fluid. The collection of colored fluid within a nodule may indicate an infection. A nodule can grow within any level of skin, which includes the subcutaneous layer, the dermis, and epidermis. Over-the-counter treatments may not be powerful enough to clear them up, but prescription drugs can be effective. Some people find relief in using a warm compress to bring the nodule to a "head" so that it is more easily treated with spot treatments. Nodules can also be treated by a dermatologist. These are like pimples-gone-wrong. The most common causes of nodules include:

  • injuries

  • over-functioning hormones

  • overgrowth of tissue

  • abnormal bunching of cells

  • mineral deficiencies

Cysts are large, pus-filled lesions that look similar to boils. Cysts occur when the inflammation leads to a rupture of the hair follicles (which can also be caused by squeezing the spots, or by harsh scrubbing), releasing matter that triggers wider inflammation, and deeper, hard, painful cysts. Like nodules, cysts can be painful and should be treated by a dermatologist. Generally speaking, people with cystic acne can control their acne and put it into remission with lifestyle changes that keep inflammation and keratin and sebum production under control, but many people with cystic acne require a course of Accutane for long-term relief. This is because people who develop nodules and cysts are usually considered to have a more severe form of acne. While Accutane can rid people of their cystic acne, it is up to them to change the contributing factors that led to cystic acne in the first place to prevent it from coming back.

Common causes of cysts include:

  • Genetic conditions

  • Infections

  • A defect in the cells

  • Chronic inflammatory conditions

  • Blockages of ducts in the body which cause a fluid build-up

  • Impact injury that breaks a vessel.

Acne conglobata is one of the most severe forms of acne. It involves many inflamed nodules that are connected under the skin to other nodules. It can affect the neck, chest, arms, and buttocks. It often leaves scars. This type of acne is more common in men and is sometimes caused by taking steroids or testosterone. Timely treatment by a dermatologist is essential.

Acne mechanica is caused by heat, friction, and pressure against the skin, often the result of wearing sports gear such as a helmet, sweat band, headband or baseball cap, or pressing a hot phone against your face for extended periods. It is sometimes called "sports-induced acne" because it occurs frequently in athletes. Preventive measures include wearing an absorbent material under sports equipment and showering immediately after activity.

As you can see, where the acne shows up on our face and what it looks like can tell us a story about our health and what we may be doing wrong. However, face mapping is not a useful tool in determining the root cause of our acne, because it isn't rooted in any biological plausibility, and it diverts the attention away from real, treatable issues and onto money-grabbing, unproven herbal remedies. It is always best to have your acne assessed and treated professionally, rather than trying to diagnose it and treat it via some face mapping method. But, hey, if you want to believe that a face full of acne means your entire body is toxic and you need to do a full-body "cleanse" rather than listen to real, scientific logic, that's your prerogative. Consider yourself forewarned.


Marrakchi, S., and Maibach, HI. (2007), Biophysical parameters of skin: Map of human face, regional, and age-related differences. Contact Dermatitis, 57(1): 28-34.

Wa, CV., and Maibach, HI. (2010), Mapping the human face: Biophysical properties. Skin Res Technol, 16(1): 38-54.

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