Why does acne happen?
Start Looking at acne from a holistic point-of-view
A lot of people who see me for naturopathic acne treatment want to address the cause of their acne. A lot of them say how they’ve recognized that conventional acne treatment only addresses their symptoms, and don’t address the cause of their symptoms. And, because of that, they’ve seen that their acne comes back time and time again when they’ve done conventional methods.
And, it’s my goal to provide something different and more meaningful that addresses their unique underlying causes and triggers of acne for longer-lasting relief.
As a licensed naturoapthic doctor, that means I am an expert in holistic and integrative medicine. So, that means I want to treat symptoms and the causes of those symptoms with integrative options.
There are many ways to explain why acne happens - and it’s all about understanding 2 things:
What is happening on the outside at the skin level
AND what is happening on the inside that is affecting the skin.
And, we’re going to talk about these two elements in this article.
So, you will learn what science has to say about what is happening on the skin level. You will also learn what science says about different underlying causes and triggers from within that affect skin health to manifest as acne.
Scroll through to learn how acne could be addressed from a HOLISTIC point-of-view
DISCLAIMER: This article does not constitute as medical advice; it is not meant to diagnose, prevent, treat, or cure and conditions or disease; and it is meant for educational purposes only. Speak to your doctor before starting anything new.
WHEN LOOKING AT THE SKIN LEVEL, THIS IS WHAT IS HAPPENING
SCIENCE TELLS US THAT ACNE OCCURS ON THE SKIN BECAUSE OF 4 THINGS,
AND THESE 4 THINGS DON’T HAPPEN IN ANY SPECIFIC ORDER:
1) EXCESS OIL PRODUCTION
Oil made by skin cells can play a role in clogged pores, contributing to the formation of a white head or a black head
2) HYPERKERATINIZATION
Hyperkeratinization is when there is overproduction of cellular debris, which contributes to the formation of a white head of a black head
3) BACTERIA
Bacteria can be found in the pore. This bacteria called Proprionibacterium can release enzymes that break down the oil found in the pore.
4) BACTERIA-CAUSED INFLAMMATION
Bacterial enzymes that break down oil can trigger an immune response that leads to inflammation of the pore. This inflammation can cause the pore to be raised, red, and painful.
By understanding what is happening on the skin level, there are some topical skincare options that your doctor might recommend to address each of these elements.
Some commonly prescribed topicals for mild acne that your doctor may recommend include:
Topical benzoyl peroxide
Topical antibiotics
Topical vitamin A derivatives
WHEN WE LOOK DEEPER, HORMONES PLAY A BIG ROLE
Hormones play an important role in acne. When looking at the science, it seems that it plays a primary role in triggering excess oil protein and hyperkeratinization, leading to clogged pores.
Androgen hormones:
According to science, acne-causing hormones are called androgens. Some examples of androgen hormones are testosterone and DHEA. And, there are many reasons why someone could be experiencing imbalances in these hormones, leading to the development of acne.
While there are hormone conditions that play a role in higher levels of acne-causing hormones, such as polycystic ovarian syndrome and classical/non-classical congenital adrenal hyperplasia; there are many elements that trigger the body to overproduce these acne-causing hormones.
When patients come to me for acne, and I suspect some sort of androgen hormone imbalance playing a role in their acne, I want to do testing so that we know what targeted treatment options can be done. Testing for hormones can be completed via blood work and other methods.
Stress hormones:
Have you ever noticed that stress causes breakouts? Well, science can explain why!
The brain is responsible for perceiving stress. There are different types of stress - physical stress and emotional stress.
When the brain recognizes that there is a stressor taking place, it triggers a domino reaction that starts off in the hypothalamus of the brain, then activates the pituitary gland, which then sends signals to the adrenal glands to active it. And, hormones all play roles as messages in between these different organs and different areas of the brain.
During states of stress, the brain releases a hormone called corticotropin releasing hormone (CRH), and science says that this hormone may trigger acne by activating oil production. In addition to that, when the adrenal glands are activated because of a stressor, it sends out DHEA. And, we already mentioned DHEA earlier.
There are several holistic and natural options that can be done to address some of these stress hormones, and there’s interesting science saying that when people with polycystic ovarian syndrome (PCOS) did yoga regularly, it drove down their DHEA levels! Beyond yoga, there are many other things that a naturopathic provider, like myself, may recommend to their patients to address adrenal health, adrenal hormones, and stress response.
Going deeper, gut health is linked to acne
Science tells us that different facets of gut health have been linked to acne. Science tells us that diet can trigger acne in some individuals, and science also tells us that gut bacteria changes have been linked to acne.
Gut bacteria:
Whenever someone experiences constant acne, it makes me curious to know how their gut health is.
Science tells us that gut bacteria may play some sort of role in the whole acne process. There is scientific evidence that shows that people with acne have very different gut bacteria profiles compared to people without acne, and scientists specifically say that people with acne have gut dysbiosis. Dysbiosis means that there is a recognizable imbalance in bacteria populations!
Additionally, scientists have found that irritable bowel syndrome (IBS) is linked to acne. And, IBS is a condition where people can experience gas, bloat, abdominal discomfort, and changes to bowel movements. And interestingly enough, science says that gut bacteria changes are linked to IBS too!
If someone sees me with acne and they have gut symptoms, I want to check if they have gut dysbiosis, which I do via stool testing. If results show that they do have dysbiosis, there are several natural and holistic options that I may recommend to them to bring their gut bacteria into balance to address both gut symptoms and skin symptoms.
Diet:
Diet is a foundational aspect of overall health and wellness. But, have you noticed that certain foods trigger breakouts? You’re not alone!
Science tells us that some foods may actually trigger acne-causing hormone changes! There is scientific evidence saying that excess consumption of simple carbohydrates may trigger the body to overproduce androgen hormones by increasing insulin hormone levels in the body.
Some examples of simple carbohydrates are: white rice, white potatoes, breads, pastries, and sweets.
There is also scientific evidence that says that dairy can also trigger acne-causing hormone imbalance. Scientists have found that whey protein in dairy triggers the body to produce a hormone called insulin-like growth factor-1, which tells the body to overproduce androgen hormones.
While there’s literature saying that these foods trigger breakouts, I have also seen other foods trigger acne in my patients. And, I usually recommend a strategic method to my patients to identify those food triggers.
Nutrient deficiencies & acne
When looking even deeper, nutrients have been linked to acne. Nutrients are necessary for many biochemical functions to cultivate & maintain health, and there are 3 nutrients deficiencies that have been linked to acne.
Zinc:
A 2020 systematic review concluded that “acne patients have decreased serum zinc levels” when compared to people without acne. This 2020 article also indicated that “Patients who were treated with zinc had a significant improvement in mean inflammatory papule count compared to those who were not treated with zinc,” meaning that zinc may be helpful!
While zinc is a mineral commonly known for its effects on immune function and immune resiliency, science doesn’t know how zinc works for acne just yet.
However, a 2021 study compared the effects of zinc and an oral antibiotic in people with acne. In this study, 100 subjects with mild-to-moderate acne were randomly assigned to take either zinc sulfate alone or an oral antibiotics alone, and researchers saw that both zinc sulfate and the antibiotic reduced severity of acne. And, authors of this 2021 study concluded that “zinc [sulfate] is a valid alternative therapeutic approach in the treatment of mild to moderate papulopustular acne.”
Vitamin D:
A 2016 study with 80 particpants showed that vitamin D deficiency is more likely to be seen in people with acne compared to healthy individuals. In this same study, they had people with acne and vitamin D deficiency supplement with vitamin D, and researchers found an “improvement in inflammatory lesions was noted after supplementation with vitamin D in 39 acne patients with [vitamin D] deficiency.”
While science doesn’t know how vitamin D impacts acne, a 2021 study suggests that vitamin D may reduce inflammation in the body in those with acne.
Iron:
A 1985 study showed that “moderate anemia was present in 25% and low serum iron levels in 75% of patients with severe nodulocystic acne.”
And interestingly enough, iron might be a necessary mineral for vitamin D. Science shows that people who are iron deficient have a higher chance of having low vitamin D.
While science has linked these 3 nutrient deficiencies to acne, it doesn’t mean that all people with acne have these nutrient deficiencies! So, I always want my patients to get tested first before supplementing them with therapeutic dosages of zinc, vitamin D, and/or iron.
Supplements & medications that trigger acne
When looking at the science, there are some supplements and medications that could trigger acne. Scroll through to learn about some of these supplements and medications.
Whey protein:
Science shows that whey protein can trigger skin changes! A small study completed in 2012 showed that whey protein supplementation promoted acne formation in human subjects, and that all subjects taking whey protein “had poor response to acne treatment regimens of oral antibiotics, topical retinoids, and benzoyl peroxide,”
Another small study completed in 2017 showed that whey proteins supplementation in healthy teenagers led to “acne located only to the trunk after the consumption of whey protein supplements for faster bodybuilding.”
B-vitamin supplements:
Science says that Vitamins B12 and B6 may trigger acne in some people. There’s evidence saying that oral B12 and oral B6 both triggered acne in case studies, and that breakouts got better when these were discontinued. Additionally, a case study showed that injected B12 triggered acne.
Hormonal birth control & other medications:
There are different types of hormonal birth control, and these medications are commonly prescribed to females with acne to control acne.
Hormonal birth control uses synthetic estrogen and/or progesterone hormones to reduce the body’s own production of acne-causing androgen hormones. However, some of these synthetic hormones may trigger acne!
There’s some interesting science showing that some synthetic progesterones found in hormonal birth control could have androgenic effects! This means that these synthetic progesterones may activate androgen receptors. And by activating androgen receptors, it may trigger acne in some individuals.
Some examples of synthetic progesterones that have androgenic effects are: Levonorgestrel, Norgestrel, Norethinidrone, Norethinidrone acetate
Beyond hormonal birth control, there are other medications that have been shown to trigger breakouts, such as: Carbamazepine, phenytoin, lithium, azathioprine, cyclosporin, and more
So, if someone started to experience breakouts after starting a new medication, it would be worth their while to speak to their prescribing provider if these breakouts are concerning to them.
WHAT IF YOU WANT TO TREAT ACNE NATURALLY?
The answer is simple: Work with a licensed naturopathic provider. As mentioned earlier, licensed naturopathic providers are experts in holistic and integrative medicine.
As integrative medicine experts, we are trained in both natural and conventional options. So, you will be able to capture a vast array of treatment options to help you achieve your skin goals when you work with a licensed naturoapthic doctor.
If you want to see me, I see patients in-person and virtually. The only caveat is that since I am only licensed in the state of California, I can only see patients who are physically in the state of California (especially for telehealth patients).
If you are outside the state a California, a great resource to find a licensed naturoapthic doctor in your state is the Institute for Natural Medicine’s directory: https://naturemed.org/find-an-nd/.
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