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Acne: Healing Skin from Within

As a teenager, I did get the occasional #pimple, sometimes a few at a time, more often across my forehead or down my nose. It seemed I would often get a nice-sized one, that I would feel coming for a full 24-hours before it would show its ugly head and then it would claim serious real estate on my face, tempting me to skip school to avoid further embarrassment.


I always felt for the kids who were covered in acne, and as much as I fully recognize hygiene is important in skin care, I also knew enough of these kids to know that routine washing and all the over-the-counter remedies were not always going to offer a clear complexion.


During my first pregnancy and every pregnancy after that, I would break out on my chest, my upper arms and back, even sometimes on my belly. This would clear up, slowly, after my little ones were born, but it seemed there was always some level of break out on my shoulders. Hormones can great havoc on our face during adolescents, but for many of us, this continues even into our adult age.



Half of women in their twenties, a quarter of women in their thirties, and more than 10% of women in their forties still have clinical acne, so enough to still bother them and cause them to see medical care. Acne can even sneak into our peri-menopause years, but after menopause, acne is typically gone for good.


Acne is the Most Common Dermatology Condition


At least 85% of adolescents and young adults have acne, and many of those have permanent scaring and resulting self-esteem issues, even anxiety and depression. When we are young, and moving into puberty, we naturally secrete more androgen hormones and this increases the oil production in our skin. This oil increases bacteria growth, but interestingly, not all gals increase their androgen production. Some of us, in fact most of us, simply have greater sensitivity to androgens. This may explain the persistent or reoccurring acne that occurs way into a woman's fourth decade.


These #hormones all ramp up prior to our menses, and interestingly the pores that create these oils constrict to some degree so it's harder for these oils to get out, so the sebum builds up. We also naturally have a bit more inflammation prior to our menses, simply because this is a physiologically aspect of getting that uterine lining to shed. We can then have a bit more sensitivity to the hormone that creates the oil or constricts the pores, or even metabolize testosterone in more potent way or even have more inflammation in general - or all three, then you'll find you are more prone to having acne, particularly premenstrually.


Those with polycystic ovarian syndrome produce higher levels of testosterone which is why these girls have more acne, and interestingly, times of high stress can cause our adrenals to respond so that similarly to polycystic ovarian syndrome, we produce excess androgen. Steroids do something similar, increasing acne outbreak. This adrenal activation can cause cystic acne, and along with increased testosterone or the metabolism of testosterone into a more potent expression so we'll see acne on the cheeks, the chin, and under the jaw, where you would grow a beard.


Hyper-insulinemia is another cause of increased acne, which can also occur with those who have polycystic ovarian syndrome. While not necessary to also have PCOS when one is insulin resistant, combine the two and acne can be even more significant. If a gal presents, in any decade and they have acne that is more cystic-like or around where one would grow a beard, then a work-up to identify PCOS should occur, if not already completed.


Conventional Approaches


The informed and discerning healthcare consumer often shies away from conventional medicine, and I get it; there are many problems with Big Pharma. I also just really love Earth Medicine. But there are times conventional medicine can be implemented short-term, for a season of life, and make truly profound changes in one's life, self-esteem, and overall health and happiness.


Hormonal birth control, particularly a low-dose progestin that doesn't easily convert to testosterone, can significantly improve acne. Acne can cause anxiety and depression. It can destroy our confidence, cause us to miss out on life opportunities, to even hide or miss school and work. As a ballroom dancer, many of the dance outfits have open backs, but I had to avoid these for years because it seemed I was always broken out. It also impacted my intimate relationship.


Like many scenarios when I am working with clients, I want to meet them where they are at and triaging the immediate circumstance may mean offering a band-aide to help them through physically and mentally, and then, I will always discuss botanical approaches, along with diet and lifestyle. Oral contraceptives are tough on the gut and they do mask a lot about our bodies that we want to be in tune, but so does #depression. My goal is to help you find your own path towards health and happiness.


This is true too for oral antibiotics and the retinol products. In fact, I've never prescribed a retinol product for acne, nor even found it was necessary. Antibiotics have pretty profound impacts on the gut and even our systemic health. Antibiotic resistance globally is a real concern. Topical would be my first approach if my client were really leaning into this approach. Doxycycline is often the antibiotic prescribed, an oral pill, and it is often prescribed at 100mg a day, but studies show it is pretty effective for acne as low as 25 to 50mg.


Benzoyl peroxide and salicylic acid have been shown to be quite effective, but if you've used them before, you know they are also quite drying. When we dry the skin, we're really just pushing our skin health to the other end of the spectrum, which is also pathologic. We're changing the pH of the skin, which changes the flora.


Dietary Approaches


It amazes me how many specialists tell clients that diet doesn't make that big of a difference. It happens all the time, and I think this is because nutritional education is absolutely nil so they aren't very equipped at including this in a treatment plan. We know though that women who consume a low amount of fruits and vegetables in their diet have more acne, as well as women who have lower levels omega-3 fatty acids. Red meat is associated with more inflammation, and those who eat more have more PCOS and endometriosis.


Those with iron deficiency anemia have higher incidence of pre-menstrual syndrome, so more evidence that our diet does impact disorders with our menses. Ladies who bleed more heavily are more inclined to have iron deficiency, so adding red meat to the diet about once a week can boost iron, as well as eating more plants and fish.


Dairy can be inflammatory so reducing this in your diet may help, and since we know that high insulin can create more acne, it would make sense then to be mindful of your sugar intake, which can be exceedingly high as a teen. Switching to healthier cosmetic products and avoiding drinking from plastic bottles which can be an endocrine-disruptor can potentially also help here as well. Lastly, smoking has been linked to acne in a few studies, possibly due to nicotine's impact on sebum production, but importantly, smoking does age the skin.


Treating Hormonal Acne


We talk a lot about treating the root causes as functional medicine practitioners, so looking for that underlying cause of acne is ultimately our goal, but also, if we think of approaching treatment like add healing modalities as far upstream as we can muster so that our efforts impact all the water downstream, then we'd think of hormones being part of the stream more near the mouth of the ocean. When we simply add hormones to the stream then, we aren't really going to change the overall health of the river, right? We aren't upstream enough. So while maybe temporary fix, if we want a truly healthy stream, we need to walk upstream a bit and focus our efforts here.


We want to eat well, reduce stress with yoga and journaling, and ultimately balance our blood sugar and cortisol. We also want to eliminate excess inflammation, which our practice often does through MRT testing and LEAP therapy. If clients don't opt for MRT for whatever reason, then an Anti-Inflammatory diet initially, working into a Mediterranean diet will typically aide in healing.


We would want to also focus on assuring all the vitamins and minerals needed for optimal skin health are available in abundance, which will include an array of plants, seeds, and berries, as well as, fish and oils. Beta-carotenes are important for skin health, but also aiming for about 8 servings of plants each day. Low levels of vitamin D, vitamin A, selenium, Vitamin E and zinc have been associated with severe acne, and vitamin B6 has been shown to be helpful with premenstrual acne. A multivitamin may be helpful here.


Our Gut Health program can help restore the microbiome, and then adding probiotics specific for acne (Lactobacillus rhamnosus GG) can really support efforts to clear one's complexion. Those who have acne, often also have bloating and constipation, which should be no surprise as each are a reflection of our underlying health. Our gut is central to our hormone balance, our estrobolome, in that there are specific bacteria in the gut that modulates our estrogen. When this is out of balance, so are our hormones. An unhealthy gut will also only exacerbate inflammation and insulin resistance, which you now know are precursors to acne. Healthy gut equals healthy hormones, equals happy skin.


As we work to improve gut health and decrease inflammation, we will want to support natural detoxification and understanding your specific pathways can be helpful through an epigenetic profile. Supporting your liver is also important, as hormones can become congested with the liver becomes a bit sluggish. Bitter leafy greens like kale and dandelions were often eaten prior to meals to get your gastric acids flowing to better break down your foods, so you could pull a fancy salad together with burdock root, artichoke, milk thistle, and Oregon grape or add a few dropperfuls of tincture into some sparkling water and enjoy. When your liver is working optimally, this takes a lot of pressure off your skin, which you may not realize is the body's largest detoxification organ.


Botanical Medicine for Acne Vulgaris


Nervines and adaptogens are great botanicals to add to your plan to support acne healing, in that part of this treatment is addressing stress and overwhelm. Even those seeking a natural healing practitioner struggle to take the advice to sit in nature and meditate, to simply calm themselves and find peace in the everyday, but it truly is healing and I am not sure that even the best botanicals can heal dis-ease when we aren't prioritizing sleep, sufficient time for pleasure, and easy movement. Admittedly, it's just hard to show up for yourself until you have the emotional and mental space to do so.


Truly, sit in nature or stroll a dirt trail; it will heal you. Learn to take deep breaths and meditate, but also utilize relaxing herbs such as lavender, chamomile and lemon balm. Stress-reducing nutrients like B-complex, magnesium, and L-theanine can support healing as well. Adaptogens such as ashwagandha, reishi, and holy basil can help calm the body, reduce inflammation and improve insulin resistance.


This may take a minute to correct, but it took a few to get here, right? Give yourself a few months, but as you start to resolve your inflammation, balance your blood sugar, and reset your hormones into better balance, you'll start to see your skin health improve. The approach as a functional and integrative provider is to heal the whole woman, not just treat the symptoms.


When we craft treatment plans for healing a concern such as acne, we think whole woman, which means gut health, liver health, mental and emotional health, immune and hormone health. It's all integrated and can't be truly healed independently of each other.


Alteratives, also known as blood cleansers, are part of this whole woman approach. We use these in skin treatments to help the body detoxify itself. Gentle choleretics and laxatives are sometimes used as well, to stimulate bile flow and persuade bowel frequency. When we optimize the health of the body within, the long term result is improved skin health. Antimicrobials and anti-inflammatories can be added, both as topical and systemic therapies, as yet another approach for addressing acne, nudging the body back into optimal balance.


Further detail into specific herbs is available in our Earth Medicine program or those in our pediatric practice can access more direction on using botanical remedies for acne within our Littles Wellness program. Addressing this issue when it first presents, in adolescents, may help detour fertility issues or any other women's health pathology into the decades ahead, if we take a holistic approach and bring oneself into balance.

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