The Road to Acne Free Skin

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      Our skin provides us with a wonderful reflection of what’s occurring below its surface. Contrary to popular belief, acne is not a result of improper facial hygiene. It typically presents itself as the unfortunate indicator that there's an internal problem. And while most reach for the latest and greatest topical products that promise results, many forget to ask the important question of "why is this happening in the first place?"

The root to acne formation is centered on the oil gland, known as the sebaceous gland. Hormonal changes, inflammatory foods, disrupted skin pH, etc. can lead to changes in the quality and amount of sebum produced, creating low level inflammation. This inflammation can plug the follicle, creating little papule-like lesions called closed comedones. Bacteria see these comedones as honeymoon destinations, and the more overgrown with bacteria these blocked follicles become, the larger and more cystic the resulting "pimple". If the cyst ruptures below the dermis, the lesions last a lot longer and are more likely to trigger scarring.

So how do we manage it? Since lesions are most commonly the result of oxidative damage and hormonal imbalances, the trick is to work from the inside out. 

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HORMONES
First and foremost, we must investigate hormones. Higher levels of dihydrotestosterone attribute to increased sebaceous gland activity and acne formation. This is common in conditions like PCOS and congenital adrenal hyperplasia, with associated symptoms of irregular or infrequent menses, middle age onset of acne, male patterned hair growth around the chin/nipples/stomach/hands, and insulin resistance. However, not all of these symptoms have to be present for hormones to be disrupted, making it difficult to uncover the underlying problem. Hormone testing can be a useful tool in these cases
Speak to your ND about completing a thorough hormonal assessment

Furthermore, evaluate your birth control pill. Certain birth control pills have higher androgen activity than others, resulting in a higher likelihood to worsen acne. While birth control is never my suggested treatment of choice for acne, if you choose to use it, ensure it's an appropriate combination.

THE LIVER
While balancing hormones in the body is important, elimination of these hormones is just as critical. Your liver acts as a filter, eliminating degraded hormones and preventing hormonal congestion that results in acne. Alcohol, birth control, environmental toxins, etc all burden our liver on a daily basis, leading to sluggish detoxification and toxins being shifted to our major detox organ, the skin. 
Try: lemon water in the morning, dandelion root tea, 2-3 L of water daily (depending on body weight), alcohol free for 6 wks

DIET
A high intake of refined carbohydrates, sugars, and preservatives results in blood sugar spiking, and subsequent boosts in insulin levels. High levels of insulin in the bloodstream triggers sebum production and an increase in pore clogging cells. Dairy also tends to be a problematic food, as it's rich in IGF-1, which also promotes insulin release. An imbalanced, high carb diet may be attributing to you producing all the wrong hormones as an older adolescent or adult.
Try: a low GI diet, removing dairy for 6-8 wks, having your insulin resistance measured

DIGESTION
Just as the liver detoxifies hormones, the colon actually excretes them. If bowel movements are not regular, degraded hormones sit in the gut waiting to be reactivated and resorbed by "bad" bacteria. Furthermore, consuming foods you may be sensitive to  (ie food intolerances) results in higher levels of overall inflammation in the diet every time you eat them. 
Try: lactobacillus acidophilus probiotics, increasing intake of naturally fermented foods like komboucha or sauerkraut 
Consider: Food Sensitivity Testing
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NUTRIENTS
Certain minerals and vitamins have been shown to be effective treatments for acne prone skin. Zinc containing foods, like pumpkin seeds, lamb, chicken, kefir etc, are encouraged for those with acne, as a recent study published in BioMed Research International identified a correlation between low zinc levels and the severity of acne.
Furthermore, B6, B5 and Vitamin A all have balancing effects on skin pH and sebum production.
Always remember, vitamins and nutrients at the therapeutic dosages required to treat certain conditions can have severe risks and side effects. Never self prescribe; always speak to a licensed professional.
 
TOPICALS
Last but not least, what you put on your skin is important.
If you’ve been using strong washes or cream moisturizers, STOP now. Harsh chemicals in washes that come over the counter or prescription grade strip the natural pH of the skin, leading to higher amounts of oil production to recent the balance. Furthermore, creams are glycerin based, which the skin does not properly absorb. Instead, it sits on the surface of the skin, trapping debris and oil within the pores, and preventing the skin from breathing. That sounds like a recipe for acne to me.
Try: gentle foaming cleansers without sulfates and benzoyl’s, and serum moisturizers that are glycerin free (light carrier oils are important).
 
 As always, feel free to contact me should you have any questions regarding testing and/or treatments.

1. Leyden JJ. Therapy for acne vulgaris. N Engl J Med 1997; 336(16):1156-62.
2. Pantothenic Acid, Vitamin B5 for Acne by Jeffrey Dach MD. http://www.drdach.com/Acne_B5.html
3. Rostami Mogaddam M, Safavi Ardabili N, Maleki N, Soflaee M. Correlation between the severity and type of acne lesions with serum zinc levels in patients with acne vulgaris. Biomed Res Int. 2014;2014:474108