Acne, or more specifically acne vulgaris, is the most common skin disorder affecting adolescents and young adults. In fact, as many as 35 to 90 percent of adolescence self-report having acne, and over a quarter of those aged 30-50. Many people affected by acne can recognize the significant mental and emotional toll it may have on your life. Feelings of embarrassment and anxiety can impact your social life as well as your self-esteem. Additionally, the scarring that may form as a result of acne lesions can be difficult to treat, worsening the fear and anxiety around the condition. This is why I have devoted a lot of time researching the best ways to treat acne, both naturally and conventionally, to best serve my patients and help them regain their self-esteem.
What causes acne?
Acne is primarily an inflammatory disorder of the hair follicle and surrounding sebaceous glands. There are many factors that contribute to acne formation including the bacteria on the skin (most commonly P. acnes), amount of sebum production, follicular health as well as inflammation.
Interestingly, all of these causal factors are affected to some degree (varying by each individual) by genetics as well as dietary patterns and hormones.
While genetics can make some individuals more susceptible to acne it is not the only factor at play. Dietary choices and hormonal imbalances have a large influence on your overall skin health. The good news here is that there are many things we can do outside of genetics including proper nutrition, hormone balance, and lowering inflammation all of which help reduce the severity and rate of growth of acne lesions.
Targeted Treatment for Rapid Results
My first goal in treating acne is to get rapid improvement in the number, size, and appearance of lesions, quickly clearing up the skin and reducing the future risk of scarring. Because of the significant self-esteem impacts, fast and effective topical therapies always come first. Adequate skincare requires a good cleansing and exfoliating agent, antimicrobial toners, as well as active ingredients to help skin cell turnover. Cleansers such as benzoyl peroxide and azelaic acid help reduce P. acnes on the skin, while salicylic acid and topical retinoids help with inflammation, excess sebum production, and healthy skin turnover. Depending on your skin type, a blend of these topical therapies help reduce oil-clogging pores without over-drying or irritating the skin's natural balance.
Although topical therapies are the best place to start, for lasting improvements it is best to focus on the root cause.
We have to ask the question of "Why you are getting acne to begin with?". This is where the diet and hormone-related treatments come in.
Treating the Root cause for Lasting results
Dietary Factors
The role of diet in the formation of acne has long been dismissed as a legitimate factor or treatment strategy. A growing body of research, however, has supported the idea that certain foods in the diet such as dairy milk and high amounts of sugar has been associated with higher rates of acne and increased acne severity. Furthermore, the role insulin resistance may play in the development of acne has led some to describe the condition as "the diabetes of the skin". Higher levels of sugar and thus insulin creates additional sex hormone imbalances including increased androgens. Ultimately, the result is increased sebum secretion and acne severity. So as you can see, there really is no separation of hormone health, from skin health or nutrition - they each interplay with each other and can either be the cause of - or the cure for your acne concerns.
Medications and Supplements
As many medications and supplements there are for treating acne, there are many times more that can actually cause or worsen acne. Unless your physician has conducted a full medication and supplement review, you could likely be missing the underlying cause of your acne and potentially be undergoing unnecessary treatment. Some common medications associated with acne include glucocorticoids, certain B vitamins, iodine, androgens, and certain hormone-based birth controls (Safety note: never discontinue a drug before first speaking to your doctor). Talking to your health care provider about the side effects of the medication you are taking can help you better understand your treatment options.
Hormonal Factors
Androgens (aka the male-associated sex hormones) contribute to acne formation by stimulating the production of sebum and secretory gland secretions. One common example of acne as a result of excess androgens in women is PCOS (polycystic ovarian syndrome). Women with PCOS commonly experience acne, irregular cycles, and weight gain. The underlying insulin resistance and excess androgen production ultimately stimulate excess sebum and P. acnes growth resulting in persistent acne. Additionally, most women notice changes in their skin with respect to their menstrual cycle. These skin changes may be due to fluctuating levels and estrogen and progesterone affecting the skin's sensitivity to androgens. It's important to understand if your acne is primarily hormonal by conducting a comprehensive medical history as well as reviewing supportive laboratory testing to facilitate the appropriate hormonal balancing treatment.
If you have ever had acne you understand how important it is that physicians take your concerns seriously and work with you to find effective solutions. You do not have to solve your skincare concerns alone. Let's talk about your skincare and other treatment considerations to help you get clearer skin and the confidence you deserve.
- Dr. Randi Brown, ND