Conventional medicine has many different options for acne treatment. Unfortunately, although often effective for a short time, they do not always help with the underlying imbalances. They also often require long-term use, which is especially problematic if women are pregnant and nursing, or plan to become pregnant. Getting off prescription medications is also a challenge, as acne is known to flare up with a vengeance. An example of a conventional approach to treating acne is a prescription of antibiotics and/or oral contraceptive pills. In many cases this helps patients, but there are often long term side effects. My approach is to take a closer look at the imbalances in the body which may include hormones, nutrition, liver function, inflammation, environmental exposure and lifestyle factors.
Antibiotics can cause antibiotic-associated diarrhoea, nausea, vomiting, thrush and used long-term can have devastating effects on your good gut bacteria, which can take some time to restore. Some suggest that the reason antibiotics might assist in the treatment of acne is because it is addressing an underlying infection or bacterial imbalance. My approach is often to identify and treat the bacteria naturally.
The oral contraceptive pill can also be effective at supressing sebum in relation to hormonal acne but it does not address the underlying hormonal imbalance which will likely still be there when you decide to come off the pill. It also can have a negative impact on gut bacteria which can cause thrush (candida overgrowth) and bacterial imbalance. The pill also depletes a range of nutrients that are vital for hormone balance.
Roacutanne also know as (Accutane or Isotretinion), is often the treatment prescribed when the antibiotics and OCP are not working. It uses a high dose Vitamin A derivative, that was said to shrink the oil, or sebaceous glands, in the skin. This would help reduce the amount of oil produced by the skin, which was thought to be the main trigger of severe acne. Although it can be effective at clearing the skin it unfortunately comes with a long list of side effects. It often leads to extremely dry skin but, patients on accutane are at an increased risk of spontaneous miscarriages and severe fetal birth defects including craniofacial and heart defects. This side effect specifically, led to requiring all women (even young teenagers), to be put on birth control as well as sign a contract that if they were get pregnant that they would have an abortion. Patients on Roaccutane are also often required to complete monthly liver enzyme testing and serum pregnancy testing due to the severity of its side effects. Vitamin A whilst similar to Roaccutane is not the same, Roaccutane is a medical drug and as such is a synthetic retinoic acid rather than being the same Vitamin A that you consume in foods. Unfortunately, vitamin A cannot be used in the same way as Roaccutane. It is not as strong and doesn’t work in the exact same way. It is however very essential and beneficial in skin health and is needed to support optimal skin integrity and may still be beneficial in skin health. It should also not be used at high doses during pregnancy.
There are numerous diet-related factors that can contribute to acne. The important thing to remember is that we are all a little different and there is no one size fits all but some of the nutrition based approaches I may look at are diets that contain:
- Dairy: eliminating dairy is often my first approach because over the years I have found it to have almost an instant positive affect on most clients. Cow’s milk contains A1 casein which is inflammatory and also increases IGF-1.
- High glycemic index (GI) foods like refined sugars or carbohydrates. These foods increase insulin and insulin growth factor 1 (IGF-1) which is a growth hormone that increases the production of hormones like testosterone. I am not a supporter of reducing fruit intake as I believe the antioxidants and nutrients are essential but we do look at refined sugars and I often look for candida to see if there is a reason you may be craving this kind of sugar.
- Fibre found in vegetables, fruits, nuts and seeds supports cleansing the colon and growth of good bacteria in the gut.
- Low protein diets: protein is important for stabilisation of blood sugar levels. It is also important for skin healing and integrity.
- Inflammatory foods such as gluten, processed foods, sugar, trans fats and additives as inflammatory mediators are thought to play a role in the development of acne lesions.
Reducing overall inflammation includes focusing on the areas that may be causing inflammation for you individually; this may include restoring gut health, reducing stress, reducing food or lifestyle triggers, improving detoxification, increasing beneficial inflammatory reducing herbs or supplements.
Supporting Lymphatic & Detoxification Pathways
As your skin is an organ of elimination, you need to make sure that your lymphatic system is moving in order to rid your body of toxic build up. The body has 5 main organs of elimination; the liver, kidneys, lungs, intestines and skin. Your bowel and lungs are also organs of elimination, so it’s important to ensure these organs are functioning well too. A minimum 30 minutes of physical exercise each day can help to increase blood flow to the skin, aiding the removal of toxins through sweat and improving your skin. It also can help increase endorphins and reduce stress. Using lymphatic herbs to improve skin clearance, dry skin brushing, increasing hydration, exercising regularly and avoiding environmental chemicals as much as possible can all be beneficial.
Balancing of the Gut Micro-Biome
Eating a diet high in processed foods and refined sugars, long term use of antibiotics, stress, candida, leaky gut, can cause poor gut function and negatively impact your skin. The gastrointestinal microbiome forms what is called the Gut-Skin axis, which is a relationship between the good and bad bacteria in your gut and skin conditions. If you have frequent digestive issues like constipation, diarrhoea, bloating, parasites or have frequently been on antibiotics then it is likely your digestive function and microbiome are compromised and need a little help just getting back on track. Regular bowel motions are one of the most important ways the body clears excess hormones and wastes. If you experience constipation then this may be one of the first areas we focus on.
Often the cause of hormonal breakouts is simply an imbalance of hormones. This is particularly prevalent for women during certain stages of their menstrual cycle, when hormones are fluctuating wildly. You may notice that breakouts start anywhere between two to seven days before your period. This is due to a drop-in oestrogen levels and a rise in progesterone levels, which in turn causes an increased production of facial oils. If you have worsening symptoms around menstruation and severe PMS this is where I may prescribe chaste tree to rebalance depending on your Luteinizing hormone (LH) levels. We also see acne in teenage boys. The hormone often linked to acne for both men and women is testosterone.
A healthy skincare routine is important when managing acne. We may look at potential triggers with your current skincare regime if they are harsh and possibly irritating. Starting with using natural/organic skincare products and makeup as much as possible. Reducing make up can also be beneficial. Changing pillow slips regularly can also help.