Why acne comes back (what the research actually says)

Can I ask you something?

When a client comes back to see you - months after their skin finally cleared and it's all started again... what do you do?

If your answer involves a slight internal panic and a lot of "let's look at your routine again," you're not alone. This is one of the moments skin therapists describe to me most. The one where they feel most out of their depth.

And I get it. Because you were taught how to treat acne. You weren't really taught how to prevent it coming back.

I've been deep in research lately, preparing for an advanced acne training I'm currently delivering to nutrition professionals. And while I was down a very long research rabbit hole, I came across a paper that stopped me in my tracks.

Not because it surprised me. But because it validated so much of what I practice and teach. 🌿

The study followed 218 patients after acne treatment. Nearly half (48%)  relapsed within 12 months. And when researchers looked at what predicted that relapse, it wasn't about which treatment they'd had.

It was about how they were living afterwards.

The independent risk factors for recurrence were: higher BMI, smoking, alcohol, poor eating habits, staying up late, prolonged screen use, and higher anxiety and depression scores.

The one thing that was protective? Changing their pillowcase weekly. 🙃

I know. At least there was one thing they found easy to stick to!

But here's the detail that really struck me. The researchers treated "post-treatment" as a single uniform starting point — regardless of which route each patient had taken to get there. The treatment itself wasn't the variable that predicted relapse.

The patient's lifestyle was. 👆

Sit with that for a minute. Because what this research is telling us, with an 88% sensitivity rate, is that acne coming back is largely a lifestyle and nervous system story. Not a skincare story. Not even primarily a treatment story.

And this matters beyond the science. If you're the kind of practitioner who doesn't want your clients endlessly reliant on monthly treatments or an expensive skincare routine just to keep their skin stable, this is exactly why lifestyle education belongs in your work. Not as an add-on. Not as something you refer out. As a core part of what you offer.

The research is essentially saying: treatment helped them clear their acne. Understanding how to live is what keeps them clear.

And you can be the person who teaches them that. ✨

Clearing acne is one thing. Maintaining the result is something else entirely. And holding it means looking at the whole person — their sleep, their blood sugar, their stress levels, their relationship with their phone at 11pm. Guilty!

This is exactly the kind of thinking Taryn found inside SBS:

"This course has helped me connect the dots between skin, hormones, gut health, and the nervous system in a clear, easy to understand way. It's informative, empowering, and full of lightbulb moments — a must for any skin professional wanting to elevate their practice."
— Taryn, @taryn_rule

The levers that prevent relapse are the same levers we work with inside SBS — blood sugar stability, nervous system regulation, gut health, and skin. This research is essentially a peer-reviewed version of that framework.

So what does this look like in practice?

Next time a client comes in with returning acne, try asking these three questions before you change a single product:

• How's your sleep been lately?
• Have you noticed any changes in your stress or mood?
• What does a typical evening look like for you?

You're not diagnosing. You're listening for patterns. And those patterns will often tell you far more than their cleanser ever will.

One of the things I see inside SBS, over and over again, is the moment therapists realise the conversation itself is doing something. That asking the right questions isn't just rapport building — it's actually part of the work. That shift is a big one.

Clearing skin is the beginning, not the end. And if you're ready to build the framework that makes the whole journey make sense — for you and your clients — SBS is opening for summer.

Waitlist members hear first and always get something the general list doesn't.

→ Join the summer waitlist here

Until next week,
Chloe x