When it comes to solutions for Acne, it has been found that the general public has been opting for more natural products so often at the clinic we see patients who are seeking advice specifically for their skin (1). It may be surprising to learn that Acupuncture is an effective treatment. In a recent blog, our resident Acupuncturist Kylie Skillen expertly describes Acne from a Traditional Chinese Medicine (TCM) perspective. Here we discuss the Naturopathic perspective and take a look at the common factors that contribute to Acne, with a focus on hormone imbalances and the Western diet as major drivers.
Acne vulgaris is a common chronic inflammatory disease of the skin found in about 80% of young adults and adolescents. (1) It also affects 64% of adults in their 20s and 43% in their 30s (2) either as persistent post-pubescent acne or adult-onset acne. It can vary in appearance and severity, but generally, acne will appear as initial lesions called comedones (whiteheads and blackheads) and as it progresses, papules, pustules and cysts can form. (3) Sebum, produced in sebaceous glands of the skin, fuels the inflammation in acne and an increase in sebum provides an appropriate setting for the growth of bacteria and indirectly contributes to the inflammatory phase. (3)
As multifactorial disease Acne has many contributing factors including: (2),(4),(5)
- Genetics and family history
- Environmental factors including smoking, occupational exposures, sun exposure
- Occlusive cosmetics containing lanolin, petrolatum and certain vegetable oils
- Hormonal issues, especially androgens and Pregnancy
- Western Diet
Androgenic stimulation of sebaceous glands is always important to consider(2) and is one of the reasons why the Oral Contraceptive Pill (OCP) is effective at treating hormonal acne in females. Post-pill acne is a common complaint, since in the 3-6 month period after stopping the OCP a rebound production of sebum and circulating androgens occurs. Another common presentation is a premenstrual flare-up, which occurs in 70% of female acne patients(5). It is caused by an increase in the ratio of the androgen testosterone in relation to oestrogen. (2) In Naturopathy, it is a major consideration to address androgenic hormone imbalances in both males and females when it comes to treatment strategies for acne, due to its influence on sebum production.
Pregnancy can often worsen acne since, among the physiologic changes of pregnancy, a rise in serum androgen levels results in increased sebaceous gland activity. (4) It is vital that women seek safe prescriptive advice if they are actively trying to conceive, pregnant, or lactating(4) since treatment options like retinoids in women of childbearing age is limited due to being teratogenic (potentially causing congenital disabilities). (5) A guided approach is best in these cases, which may respond well to simple dietary changes and appropriate and safe therapeutic applications.
The Wicked Western Diet
Diet is a powerful tool when it comes to the influence on our skin health and addressing Acne naturally. Acne is found to be absent in populations who don’t consume refined sugars, grains, milk and dairy products. (2) Acne specifically in adults is associated with a Western diet, defined as high consumption of milk, high glycemic load and high-calorie intake. (2) The androgenic hormones present in dairy products can have their effect on androgen-sensitive receptors, thus stimulating an increase in sebum production. (2) Changes to the diet can be a big step towards resolving the inflammation of acne and improving digestive health influences skin health greatly, known as the Gut-Skin axis.
Treatment strategies for addressing Acne Naturally.
Treatment approaches can include counteracting androgens, decreasing sebum production and decreasing inflammation(6) and may include diet change, herbal medicine, nutritional medicine, referral for Acupuncture and topical applications. Ensuring our patients feel supported to overcome any mental health obstacles associated with their acne such as poor self-image, depression and anxiety, which leads to a negative impact on the quality of life,(4) is a top priority. While it may take 3–6 weeks until an improvement can be observed,(1) addressing Acne naturally is possible.