ACNE: The Main Drivers & Foundations For Clear Skin
Having experienced acne myself, I know how utterly devastating it can be to your confidence, mood and self-esteem. Not to mention how expensive and disheartening the many tried (and failed) fancy skincare products you read about online, conventional medicine medications such as Roaccutane, Doxycycline & the oral contraceptive pill can become - and let’s not even start with the side effects of these conventional treatments!
Treating acne naturally really is a journey, and I ideally love to work with clients for at least 6 months, as it can take time for the work we are doing on your insides to begin to expose themselves on your skin’s surface. In saying that though, I do frequently see major improvements in far less time in my clinical practice!
With skin, we are aiming for progress, not perfection. Our goal is to minimize breakout frequency and severity, speed up healing time so that pimples come and go quickly, and work on identifying and removing your unique acne ‘triggers’ or ‘drivers’ and increasing tolerance to these triggers, and resolving these drivers.
The most important thing we will identify together is what ‘type’ of acne you have, or what is most strongly driving it. For example:
Hormonal acne tends to: be aggravated premenstrually due to oestrogen:progesterone ratio issues (however testosterone dominant acne may be persistent month-long), aggravated mid-cycle at ovulation, acne that clears up on the pill, acne that appears post-pill, acne that most commonly presents on the chin, jawline, back & chest where there are high numbers of androgen receptors, accompanied by other signs of hormonal imbalance such as excessive hair growth/loss, PMS, irregular, heavy or painful periods. Many women with this kind of acne may have been diagnosed with PCOS which is, at its core, a syndrome of androgen excess, and often, insulin resistance. Insulin resistance or dysregulated blood sugar is a HUGE driver of acne (and can be caused by factors such as diet and stress), and is often a driving force behind hormonal imbalances as well as breakouts- the two can go hand in hand.
Gut or Stress-Related Acne tends to: have no connection with the menstrual cycle, may still be persistent on the OCP (the pill), there may be some gut symptoms such as bloating, constipation, food sensitivities or tummy discomfort, immune system dysfunction (the gut and immune systems and intrinsically linked), may present on the forehead, around the mouth, cheeks and chin, and/or there are signs of an elevated stress response such as sleep issues, anxiety, fatigue and muscle cramps. Stress hormones can actually bind to sebaceous glands and increase sebum production, and can also increase blood glucose levels which in turn leads to/aggravates insulin resistance. Fungal acne is extremely gut-related & is linked with: intense sugar cravings, sinus infections, a white coating on the tongue, acne that appears in clusters of small bumps with no heads, dandruff or a dry flaky scalp, frequent antibiotic use/acne that gets worse post-antibiotic use, itchy acne, and recurring thrush/UTIs or other fungal infections such as tinea.
Regardless of your acne type or unique drivers, the most important three factors to address which essentially are responsible for the formation of a pimple include:
1. Time for an oil change! Regardless of what’s driving increased sebum production from the sebaceous glands (which are attached to the hair follicles present in the dermis of the skin), we need to make sure that the quality or viscosity of the oil is more watery in nature, rather than cottage cheese-like. In an ideal world, we want water-like oil to flow from the sebaceous gland up through the space created in the hair follicle, onto the surface of the skin to give our skin flexibility, softness, and glow. It is the ‘gluggy’ consistency of sebum that comes up through the epidermis through the hair follicle and causes a blockage. Blockages cause an anaerobic (no oxygen) environment underneath the skin which is ideal for C. acnes bacteria to proliferate in, leading to immune system activation because the body thinks there is an infection, which triggers inflammation and redness, swelling and soreness. Sometimes this inflammation goes away quickly, but most of the time, the next step of the inflammatory process occurs which is the infiltration of immune/white blood cells to engulf and destroy the bacteria resulting in PUS, or a whitehead. This doesn’t happen with water-like sebum. How we change this oil quality is through ESSENTIAL FATTY ACIDS (EFAs). Skin cells are also covered in a cellular membrane; if this membrane is more omega-6 rich (rather than omega-3), it means that the skin cell can’t absorb as much water, which affects skin barrier function and leads to skin dehydration. We can get the essential fatty acids (EFAs) EPA & DHA through the diet from cold-water, oily fish like salmon, sardines, mackerel, Cod liver oil and herring, and ALA is an EFA from plant sources such as flaxseed, chia seeds and walnuts. We need to supplement fish oils long-term when we see an inflammatory skin condition as it is very difficult to change your omega 3:6 ratio but the diet alone. Tip: take your fish oil tablets with a meal with a fat source for proper absorption rather than an empty stomach). We get enough omega- 6 through the diet naturally from nuts and seeds, dairy, meat and poultry so rarely would we need to supplement.
2. Skincare! The skin has its own natural exfoliation process (also known as desquamation) which stops when the stratum corneum (the topmost layer of skin cells aka corneocytes) is out of balance and dehydrated, or when you are applying products that seal the skin and allow no oxygen through. This leads to a build of skin cells on the surface of the skin that can’t shed naturally (“retention keratosis”), blocking the opening of the hair follicle, not allowing oxygen inside, and creating that anaerobic environment that the C. acnes bacteria love to proliferate in. We need to look at the cleansers/moisturizers/serums you are using as well as the makeup you are applying and ensure that they are non- comedogenic. A skilled corneotherapist can help fit your skin to the correct skincare and makeup it needs. To avoid retention keratosis we also need to ensure adequate levels of iron, Vitamin A for skin cell turnover, zinc, B vitamins, and we will need to assess thyroid function as slow thyroid function could be slowing down the skin cell turnover process.
3) Skin pH. The skin needs to be a slightly acidic 4.5-6.5 pH. In healthy skin, C. acnes bacteria, which is present in the skin in both acne and non-acne patients, changes the acidity of the watery-type oil coming up through to the top layer of the epidermis to the correct level in order to keep the other C. acnes bacteria in check. So, functioning correctly, C. acnes is a good guy! However, ‘gluggy’ oil is an incorrect pH for healthy skin. Skin that is correctly acidic maintains skin immune function via warding off bacteria and pathogens. The pH of the skin can be altered by topical applications (I entrust this to the skin therapists), oestrogen status which affects skin hydration, and the gut-skin microbiome connection.
By Phoebe Ackland (BHSc Naturopath)