All About Acne

All you need to know about acne - the why & what to do about it.

Acne is a common concern that I see in my practice. In my opinion, acne itself is not a disease or condition but rather a symptom of another underlying cause that often needs to be addressed. At least this is the case for the majority of individuals. So let's discuss what different processes can cause or contribute to acne, how to potentially figure that out & what to do about it!

Possible causes/contributors of acne:

• Nutrition

  • Food sensitivities: if we consume the foods that we are reactive to, then we initiate inflammation in the gut. When the gut is inflamed, the lining of the gastrointestinal tract may become more permeable to larger molecules than it should. This can cause symptoms throughout the body including acne, eczema, joint pain, digestive issues and headaches to name a few. The food that is most commonly associated with acne, especially cystic acne, is dairy. Dairy has inflammatory substances in it and also naturally contains estrogens. This isn't a great combination for skin health.

  • High sugar intake: sugar itself is quite inflammatory as well so this can cause inflammatory processes in the gut and the skin. If you have higher blood sugars or develop insulin resistance, this can contribute to acne formation or worsening of acne.

• Hormones

  • Testosterone & Dihydrotestosterone (DHT): if these are higher than normal, they can cause acne formation. Testosterone increases sebum production, causing oily skin. Your testosterone may be completely normal, but your bioavailable testosterone (BAT) may be higher due to low sex hormone binding globulin (SHBG), see below.

  • Estrogen: estrogen actually reduces sebum production and can help counteract testosterone & DHT on the sebaceous glands. When estrogen levels drop, like they do right before menstruation or during ovulation, then we don't get that balance between estrogen and testosterone.

  • Sex hormone binding globulin (SHBG): SHBG's action is in its name, it binds sex hormones (estrogen, progesterone, testosterone) and renders them inactive and unable to stimulate their receptors in the body. So you can imagine that when this is low, there's more active testosterone that can stimulate receptors which may cause more acne formation.

• Inflammation:

  • Inflammation directly on the skin, or in the GI tract can lead to acne formation. The skin is an external manifestation of what is going on in the gut, so it's important to make sure this is in check when dealing with acne. Inflammation can stem from nutrition, gut inflammation, toxins and insulin resistance.

• Imbalanced skin or gut microflora

  • We know that there are certain bacteria that increase the risk of acne and certain bacteria that may help reduce acne formation. The happier your microbiome, the happier your skin!

• Beauty products:

  • We can also have skin reactions to products that we put directly on the skin surface. A lot of commercially available products may contain harsh chemicals and don't have ingredients that benefit the skin. So take a look at your products, and if you need help, make sure you talk to a skin expert! The skin care world is confusing and it's worthwhile to get professional advice.

How to investigate possible causes of acne:

• See an ND:

  • Naturopathic doctors have the time and resources to investigate the root causes of symptoms such as acne. There is a lot of information that is obtained in an initial visit and often with a detailed history we can have a good idea of where to start. Testing may not even be necessary in some cases.

• Possible Testing options:

  • Food sensitivity testing:

    • This can be done by a simple blood test that looks at IgG antibody responses to several foods. This is often followed by a short-term elimination diet and gut healing to reduce inflammation and restore the integrity of the gut lining.

  • Hormone testing:

    • The most useful test in regards to sex hormones for acne is bioavailable testosterone. This is a blood test as well and shows not only the total level of testosterone, but also SHBG and active testosterone. This gives a more accurate picture of testosterone involvement in acne (if any).

    • Fasting insulin can be checked to assess insulin sensitivity and its possible contribution to acne.

  • Gastrointestinal tract (GIT) investigations:

    • There are a few options for GIT testing when it comes to acne. Testing for small intestinal bacterial overgrowth (SIBO) could be beneficial if there are other symptoms warranting it. Another option is looking for a dysbiosis in a stool sample. This checks for different bacteria, viruses, and parasites that could be causing problems.

Possible acne treatments:

From the Inside:

• Dietary changes

• Optimizing the microbiome & skin biome

• Balancing hormones

• Reducing inflammation & optimizing gut health

• Optimizing liver function

From the Outside:

• Skin care: Vitamin C serums, hyaluronic acid, retinol, benzoyl peroxide, azelic acid are all possible options to help reduce acne formation. But not all of these are universally beneficial for everyone, so check with your skin care specialist and/or healthcare provider first!

  • Switching skin care and making sure there is good quality ingredients and no harsh chemicals in it or things that your skin is sensitive to.

• Photomodulation/cold laser:  Stimulates collagen production and skin healing.

• Exfoliating peels: Helps to clear up acne & minor scarring.

• AC dual: This targets acne-causing bacteria on the skin while also reducing inflammation and stimulating healing.

**To learn more about photomodulation, exfoliating peels or AC dual click below!**

My approach to acne is unique because although the main goal is to treat the root cause, I also support my patients with external, symptomatic treatment in the meantime if necessary. Working from the inside out & the outside in can be very beneficial for those that suffer with acne. A multi-faceted approach is often much more successful for lasting results!

If you have any questions, please reach out to me or book in for an appointment to discover what naturopathic medicine can do for you!

**Disclaimer: This is not medical advice and is intended for educational purposes only.