Acne - Beyond the Skin

Acne vulgaris is a common skin condition that many people experience during their lifetime. Acne lesions occur when pores become clogged by excess oil and dead skin cells, while an increased production of skin cells (keratinocytes) forms a barrier, preventing this excess from being released from the pore. This environment within the pore is favourable for bacteria, Propionibacterium acnes, to grow and replicate, leading to inflammation and spreading of acne lesions. Conventional treatment for acne is geared towards reducing the production of keratinocytes, killing the bacteria, and removing excess oil from the face. While this treatment approach makes sense in many ways, it doesn’t always treat the root cause. Some of these treatments can come with negative side effects and may not produce lasting results. It’s important to understand that acne treatments that provide sustained results involve figuring out the root causes for this condition and treating the body from the inside out. There are a number of factors that have been found to contribute to acne. You may have one or a number of these factors contributing to the severity and chronic nature of your acne.

Causes Can Be Related to Diet

Diet has been found to play a major role in acne.^[1] There is scientific support that have linked acne to the “Western diet,” which is comprised of:

• High consumption of dairy products such as milk and cheese.
• Foods that register high on the glycemic index (GI), e.g. refined carbohydrates (mainly white-flour foods such as bagels, white bread, croissants, and baguettes, as well as high-sugar foods).
• Diets high in trans and saturated fats (deep-fried foods, animal fats) and low in essential fatty acids, particularly polyunsaturated fatty acids (fish, plant oils such as olive oil or flax oil).

Try removing these foods from your diet, and see if it makes a difference, especially if you also have digestive-health concerns. You can always use alternatives in order to make this transition easier. Alternatives to milk and dairy: Almond milk and coconut milk are great milk substitutes. Breads: Try a sprouted, whole-grain bread, which is lower on the glycemic index and easier on the digestion, or remove bread altogether and try sticking with whole, lower‑GI grains such as brown rice, white basmati rice, millet, quinoa, amaranth, teff, buckwheat, spelt, or rye. 

Poor Digestive Health Is Linked to Acne

Your intestinal flora (probiotic flora) plays an important role in regulating your immune system. An unhealthy (dysbiotic) probiotic flora causes widespread inflammation, oxidative stress, and poor sugar control, all of which are part of the pathogenesis of acne.^[2] Digestive health conditions that are tied to a dysbiotic flora—such as constipation, food sensitivities, and poor stomach-acid regulation—are also likely to occur alongside acne. So if you experience symptoms such as bloating, gas, heartburn, and/or stomach pain in addition to acne, you may need to shift your attention to balancing your intestinal probiotic flora.^[2] Probiotics can make a world of a difference for some people; however, if you’ve tried this as well as the dietary suggestions and are still experiencing symptoms, your digestive system may need a tune-up or a complete overhaul. Having your digestive health professionally assessed can provide you with accurate treatment approaches to effectively improve your health concerns and clear your acne. 

Which Hormones Contribute to Acne?

Hormones play a major role in acne, which is why one of the most common conventional treatments for acne is the birth-control pill. These are the top hormones that play a role in acne:^[3]

• Androgens (testosterone and DHEA) encourage increased production of oil (sebum) on the skin, leading to increased likelihood of clogged pores. Puberty and premenstrual states are extremely common times when people notice an acne flare, and are coincidently times of high androgen activity.
• Progesterone is a funny hormone when it comes to acne. Excess of progesterone has been linked to acne as the hormone itself, like androgens, can stimulate the production of sebum. However, progesterone can also stop androgen activity by blocking androgen receptors, so low levels can indirectly increase sebum production caused by androgens.
• Estrogen plays a positive role in acne overall—it lowers androgen levels, improves skin barrier function, and increases hydration to the face. However, estrogen excess can lead to a relative deficiency in progesterone, which is a common cause for premenstrual acne.
• Stress and stress hormones such as corticotropin-releasing hormone (CRH) have been well-known to be a trigger and an aggravator of acne. Did you know that skin cells produce the same stress hormones your brain produces in response to stress? Did you know the stress hormones can bind to cells that produce sebum (oil) in the skin and activate this production? These stress hormones also stimulate skin cells to produce inflammatory molecules, which perpetuates the production of acne. Not only does your skin respond directly to increased stress, but the overall effect that stress has on the body can create an environment favourable to acne flare-ups. In response to stress, there is a decrease in blood supply to the skin, an increase in systemic inflammation, and changes in hormonal patterns such as increased androgens. Stress is also known to alter the probiotic flora which, as we know from before, plays an important part in the development of acne.^[4]

As you can see, hormones are a complicated bunch, but each plays a prominent role in the development of acne. Using the birth-control pill to control the acne is a temporary solution to the problem as in many cases, acne will reappear after birth control is discontinued. There are many reasons why skin can be acne-prone. By looking deeper and beyond the skin, you might be able to find other contributing factors to this condition, such as diet and imbalanced hormones. If your diet is riddled with many of the above-mentioned food, try cutting these out and see if it makes a difference. If you have digestive health problems, solving this may actually clear the skin as well. If you suspect hormones are at play, consider seeing a qualified medical professional to gain better understanding of your hormones and the role they may be playing in your acne-prone skin.