Updated: Aug 16, 2022
Perfect skin is possible!
We all want flawless glowing skin. Here is some advice to get to the root cause of your skin blemishes and how to clear it up.
Skin disorders can be very frustrating and lead to decreased self esteem. There is a wide range of skin disorders and it is best to have your specific skin disorder diagnosed by your Physician. The most common of these conditions include Acne, Eczema (atopic dermatitis), Rosacea, Seborrheic Dermatitis. I will address these causes over a couple of blogs, starting with Acne today.
The good news is that there are many things within your control that you can do to improve your skin.
You are not alone, more and more adults are reporting acne. Acne causes can be multi-factorial. If we thoroughly investigate the cause of acne, me might often find that skin issues might be related to food sensitivities, food allergies or hormonal imbalances. Acne includes blackheads, whiteheads, nodules (tender collections of pus deep in the skin that discharge to the surface of the skin) and cysts: deep nodules that fail to discharge contents to surface. Large deep pustules are cysts that contain inflammatory compounds that break down adjacent skin tissue, leading to scar formation.
One of the root causes of cystic acne is often hormones.
Hormonal acne is any acne that occurs due to hormonal fluctuations. It’s common during puberty, because androgens, a group of hormones that include testosterone and other “male hormones,” naturally increase production during this time. But hormonal acne can happen any time there are fluctuations in hormone levels, which is why so many women notice acne increase days before their menstrual cycle. I recommend keeping a journal to document your menstrual cycle as well as acne severity/ appearance of new lesions.
Causes of hormonal acne
The most common cause of hormonal acne is an excess amount of androgens and increased systemic inflammation. Both can lead to an increase in sebum production, and this is where the major problem starts. Sebum is oil produced by your skin via the sebaceous glands, also known as the oil glands. It serves to protect your skin and lock in moisture. However, if its production increases above normal limits and your skin cell turnover rate remains the same, your pores will quickly become clogged. When this happens, the sebum cannot leave the pore, so as a result it becomes inflamed and a pimple forms in its place. Since most of your oil glands are located on the face, chest, back, and shoulders, these areas are most prone to hormonal breakouts.
Androgens are one of the major hormone-related culprits when it comes to acne. They are produced by the ovary and adrenals and have been specifically linked to many forms of acne. Androgen production can increase for a few different reasons:
Women with Poly Cystic Ovarian Syndrome have higher than normal levels of androgens in their system. Therefore acne, when paired with a few other symptoms, such as an irregular menstrual cycle, serves as a strong indicator of the syndrome.
During menopause, hormones are constantly in flux. Women most commonly experience a decrease in estrogen paired with an increase in testosterone. Since estrogen directly combats the effects of testosterone, and levels are low during menopause, there’s nothing to put up a defense against the sudden spike in testosterone. As a result, testosterone levels will continue to increase along with sebum production.
-Your monthly menstrual cycle
When you have your period, your levels of estrogen and progesterone are at their lowest, both of which are shown to reduce sebaceous gland activity. With neither of these hormones around to balance the testosterone lingering in your system, you’ll likely experience more breakouts around this time of the month. Keeping track of your menstrual cycle will help you notice the relationship between your cycle and acne breakout.
Another cause of hormonal acne is inflammation. Systemic inflammation is the chronic activation of our immune system caused by our diet and lifestyle that can play a major role in disrupting internal hormonal balance.
Dietary intake, specifically of inflammatory omega-6 fats such as linoleic acid, may have a direct impact on acne development. For example, diets rich in refined foods such as processed grains, fried foods, breads, and potato chips, boost internal inflammation by providing excess linoleic acid through the diet—one of the main components in sebum. With an overproduction of sebum on the skin, acne is more likely to develop.
Inflammation caused by chronic stress has been linked to the aggravation of acne. The stress response boosts production of certain hormones, such as cortisol and corticotropin-releasing hormone (CRH), which increases inflammation and accelerates the body’s production of sebum. Studies show that skin with acne has higher levels of stress hormones, such as CRH, when compared to normal, acne-free skin. In essence, the more stress you experience, the more likely the resulting inflammation may contribute to hormonal breakouts.
Common environmental interactions with the skin such as air pollutants and cosmetics have been shown to have inflammatory and hormonal effects on the body and the skin. Cosmetics can negatively alter the skin’s microbiota balance especially in the oil glands, thus triggering inflammation and the onset of a breakout. Similarly, air pollutants such as ozone, nitrogen dioxide, and sulfur dioxide can have harmful effects on the skin and increase oxidative stress, which boosts inflammation and alters the normal functions of the skin, leading to an uptick in acne.
1. Hormonal Acne Management options may include:
- Reduce your dairy intake
Most evidence-based studies agree that dairy can be a common trigger for acne. While the exact mechanism is unknown, researchers theorize that dairy’s role in acne is likely due to the artificial hormones dairy cows are treated with or the growth hormones that naturally exist in cow’s milk. These hormones may throw off our own hormonal balance and contribute to acne. Others believe it is the common combination of refined foods and processed sugars with milk products in the Western diet that regularly disrupt insulin levels and cause hormonal breakouts in those that are prone. Despite the lack of consensus on the connection, many people with acne find that reducing or eliminating dairy helps them reduce acne and improve skin quality. If you’re regularly experiencing breakouts, it might be worth experimenting with the removal of dairy to assess its effects on your skin. You can work with a Functional Medicine Nutritionist to help you with an Elimination diet (see more under food sensitivity)
- Get your hormones checked.
Consider getting a hormone test to check your total androgen levels and serum testosterone. Rocky Mountain Analysis (from Lifelabs) offer a Comprehensive Hormone Insights test o evaluate metabolized hormones and gives an insight into hormone stores. This test requires 4 urine samples over two days and costs around $450.
- Topical tea tree oil
Tea tree oil is the best option when it comes to treating hormonal acne naturally. While it does have a slower onset, one study found tea tree oil just as effective as traditional topical agents, such as benzoyl peroxide and you will experience less side effects. I sometimes advise tea tree oil in gel form, as it is easier to apply a drop to each pimple, and for the drop to stay!
- Balance your microbiome (gut bacteria) with a probiotic.
Probiotics can help reduce inflammation further by feeding your microbiome with good bacteria that will support your immune function. Taking a probiotic also helps ensure your microbiome is healthy, a sign of good health. In addition to an oral probiotic, topical probiotics, when bacteria are applied directly to the skin to help restore microbial balance and improve conditions at the site. Foods that contain healthy microorganisms include yogurt, kefir, certain fermented foods like kimchi, kombucha beverages, tempeh, pickled foods and sauerkraut. If you choose capsules, make sure your supplement contains both Lactobacillus Acidophilus and Lactobacillus Bifidobacterium.
2. Food Sensitivity
Even if you don’t have digestive issues, persistent acne can still be an indicator that you’re eating something you’re sensitive to. Food sensitivities are tricky to nail down because different than having a severe food allergy, food sensitivities can arise later in life and likely won’t produce a reaction as obvious as an anaphylactic response.
Instead, food sensitivities can cause delayed hypersensitivity reactions which take more than 12 hours and sometimes up to 48 to 72 hours to develop after exposure—often making food triggers extremely difficult to pinpoint. These reactions might look like a headache, joint pain, fatigue, bloating, diarrhea, or acne. They occur when your immune system mistakenly identifies certain foods as threats to the body and starts attacking them—fueling our body’s inflammation pathways. This cascade sends pro-inflammatory molecules throughout the body which can contribute to any number of the above symptoms.
The most common sensitivities we see that cause acne include dairy, gluten, and eggs—just to name a few. However, there are countless foods that your unique immune system could react to that could contribute to breakouts.
Treatment of dietary causes to acne
To uncover any potential foods that cause acne, we encourage you to do an elimination diet. Elimination diets work by removing common inflammatory foods from the diet for a minimum of 30 days. If acne resolves, restricted foods are then methodically reintroduced back into the diet to help pinpoint which ones may re-trigger breakouts. A functional medicine health coach work closely with you to help guide the process and provide resources along the way.
If you are unable to pinpoint acne-causing foods triggers, we may then recommend a food sensitivity test. This can help to provide a clearer understanding of a wider array of foods that may be responsible for causing immune-related inflammation outside of the typical suspects.
This can also be done at LifeLabs (about $400) for IgG Food Sensitivity Test.
Many people experience an exacerbation of their acne when they feel stressed out or under pressure (work/family/life). There are a couple of reasons for this. One is that when you are constantly experiencing stress, your body begins to break down the barrier in the gut lining, allowing foreign antigens, microorganisms, and toxins from entering into the body’s bloodstream and spur inflammation, the major underlying acne cause. Another reason is that when you are stressed your body releases cortisol in hopes of bringing you back to equilibrium, but high levels of cortisol can increase your likelihood of immune dysfunction, inflammation, and hormone imbalances. Managing stress reduces inflammation in the body, so it can also help manage hormonal breakouts. Repairing your gut with probiotics also play a role here, but most important:
I encourage everyone to employ daily stress management techniques to help keep skin clear. This can look like a meditation, gratitude journaling, deep breathing exercises, or a daily stretching routine or perhaps something as simple as incorporating more walking, reading, painting or dancing into your day. There is no right way to reduce stress. Rather, the goal is to intentionally incorporate specific activities into your routine that help promote a greater sense of calm and give your body—and gut lining—some much needed relief. The more regularly you engage in stress reduction and work to re-frame an anxious mindset, the better off you will be at successfully warding off stress-induced blemishes.
4. Not enough healthy fats
Despite the urge you may have to dry out oily skin in an attempt to treat acne, healthy fats and oils are actually your friend. Specifically, essential fatty acids like omega-3s and omega-6s help produce the skin’s natural oil barrier, keep skin hydrated, and ensure systemic inflammation is kept in check. The proinflammatory effects of excess of omega-6 fats in the diet could be linked with increased acne.
Since this improper ratio is a common acne cause, rebalancing it to favor omega-3 fatty acids will help counteract omega 6’s inflammatory properties and have a therapeutic effect on breakouts. Swap out foods rich in omega-6 fatty acids such as processed foods and industrialized seed oils such as corn, soy, canola, and sunflower oils and opt for more anti-inflammatory omega-3 rich-foods such as walnuts, chia seeds, salmon, sardines, anchovies, pasture-raised eggs, and flax seeds. If you can’t get in enough of the above into your diet, consider talking with your doctor about supplementing with a high quality fish oil to help meet your needs.
5. A diet too high in sugar
Eating too many high glycemic foods can overfeed the “bad” bacteria in your gut, contributing to dysbiosis or an imbalanced ecosystem in your gastrointestinal tract. When this community of microbes is out of balance, the overgrowth of bad bacteria and yeast can contribute to many issues, including acne.
Focus on consuming a varied, whole foods based diet rich in a balance of well-sourced proteins, healthy fats, and complex carbohydrates. Swap out high glycemic carbs from rice, pasta, cereal, and bread with high fibre carbohydrates from your favourite fruits, starchy vegetables, and whole grains which will help to promote a balanced gut microbiome and help treat acne. This is another indication for probiotics literally attack and kill bad bacteria.
6. Check your beauty products
Your current beauty routine might be causing/exacerbating your acne. More than 50% of acne cases are triggered by cosmetic products.
For acne products specifically, topical treatments for breakouts don’t tend to work long-term because the inflammatory root of the acne is likely coming from inside, not outside, of the body. A new product might initially work to quell localized inflammation on the skin’s surface, but over time they tend to stop having the same effect as they strip the skin of its natural oil and leave the area dry, chapped, and even more susceptible to breakouts. In an attempt to protect itself, the skin will then produce more oil which contributes to the never-ending cycle.
Powerful pharmaceutical products, including topical antibiotics and retinoids, may also disrupt the acid-base balance of the skin and destroy the beneficial bacteria that live on your facial microbiome. This bacterial imbalance can cause more acne down the line as the ecosystem and immune system in place on the face is thrown out of equilibrium. This is where topical probiotics play a role to directly kill of skin bacteria.
Simplify your beauty routine
When it comes to skincare and fancy topicals, less is more. Try to limit how many products you’re using to best assess what’s working for you and what’s not. Research the products you use on The Environmental Working Group’s database Skin Deep which helps to compare safety ratings for various personal care products on the market. Sticking to a high quality, natural cleanser, moisturizer, and toner that you use once daily. Less is always better.
7. Drink more Water!
When you drink enough water, the cells in every part of your body get hydrated through the blood (blood is 90% water). The skin (which is the largest organ in the body) rely heavily on water for all its functions. Water helps to maintain your pH balance. Water prevents heat related eruptions. Water helps maintain a healthy gut and aids in proper digestion, flushing away toxins through your gut. Staying hydrated helps increase elasticity in the skin as it stays moisturized for longer. Heightened elasticity in the skin implies delayed sagging of the skin and prevents premature appearance of fine lines and wrinkles. Water hasten healing after sunburn. When your skin looks puffy, it could actually be retaining water to protect you from dehydration. Staying hydrated will reduce swelling and puffiness in your face.
Sweating helps your skin to get rid of toxins. Running, cardiovascular exercise or a sauna can help you sweat out toxins. Remember to hydrate adequately and shower afterwards to wash all the sweat and dirt away.
Supplements that are often prescribed for acne management:
Vitamin A: 3000units/day (talk to your doctor)
Vitamin C: 1000mg /day
Chromium 200-400 mcg/day
Vitamin D3: 2000 IU/day (ideally measure blood levels and adjust dosage accordingly)
Fish oils: 3000mg EPA+ DHA/day
Probiotics: active lactobacillus and bifidobacterial cultures: a minimum of 5billion colony-forming units/day.
As always, this blog is for educational purposes only. For your individual diagnosis and management, consult your doctor.