For many years now the primary treatment for acne has been over the counter creams and cleansers such as benzoyl peroxide/salicylic acid, Vitamin A derivatives such as Tretinoin (Retin-A), antibacterial soaps, and of course oral antibiotics. These treatments are still being used today. But now there is new evidence in the literature on the pathophysiology of acne development. This has lead to newer natural acne treatments. We have known that acne patients and healthy controls have different compositions of skin and gut microbiota. Now we see how acne treatment can disrupt the microbiome, especially with the use of oral antibiotics. This can lead to gut dysbiosis which can lead to chronic inflammation, obesity, cancer, cardiovascular disease, neuropsychiatric conditions such as dementia, depression and anxiety. This gut dysbiosis plays an important role in inflammatory skin conditions such as acne.
One way to look at this gut imbalance is to do a stool analysis. I look for nutritional deficiencies and get labwork that includes nutrient levels, inflammatory markers, blood sugars and food allergy tests. Some patients may have adequate amounts of zinc and omega 3 fatty acids, but many do not. Studies have found significantly lower serum zinc levels in patients with severe acne than in controls. Acne has an inflammatory component, and lower serum zinc concentrations may reflect a response to inflammation rather than a true zinc deficiency. Pantothenic acid (B5), L-carnitine and oral probiotics have also been helpful. For women, Vitamin B6 (Pyridoxine) at 50 mg/day starting 1 week prior to menses and continuing throughout menstruation showed a 72% decease of premenstrual acne flairs.
There are also topical probiotics that can be used to treat acne that use AOB (ammonia-oxidizing bacteria) as the key ingredient which is a type of bacteria already found on the skin. Our natural skin bacteria gets damaged and depleted over time due to harsh soaps and cleansers which many people use to treat acne. This live bacteria (topical probiotic) replenishes what the skin is missing with minimal side effects Mother Dirt. This is a very natural acne treatment.
For female hormonal acne and especially women who have polycystic ovarian syndrome (PCOS), I recommended D-chiro-inositol which is an isoform of inositol that reduces hyperandrogenism better than myo-inositol. D-chiro-inositol helps regulate cycles while reducing symptoms of acne and hirsutism.
Diet is extremely important when it comes to acne. I discuss when and what people eat and drink and then review their stool test results to allow a more complete understanding of what factors shape the microbiome. Common deficiencies I see in the gut is low fiber, low bacterial (probiotics), low stomach acids and low pancreatic enzymes. Acne has been associated with a diet high in refined sugar and fatty foods including processed foods and alcohol. Exacerbations of acne can result from allergic food reactions or from the effects of biologically active substances in certain foods, such as hormones in cow’s milk or amines and other chemicals in chocolate. Eating whole foods is best, in which there are no labels or ingredient lists on products such as fruits, vegetables, lean proteins, and healthy fats such as avocado, olive oils, fish and nuts/seeds. The gut is an important ecosystem that can cause non-GI symptoms such as acne, eczema, fatigue and nutrient deficiencies.
Last but certainly not least is thyroid. The thyroid gland is the “control tower” of your endocrine system. It secretes hormones into the circulatory system that regulates and controls metabolism. The endocrine system is responsible for growth, repair, metabolism (the rate at which food is burned for energy), energy and reproduction. If that system is out of balance, it can significantly effect your health. When thyroid hormone is deficient (known as hypothyroidism) the body cannot convert cholesterol to other steroids such as Pregnenolone, Progesterone and DHEA. Of all of these…Progesterone is the most important when it comes to acne.
Women have thyroid receptors on their ovaries. So if there is an underachieve thyroid, women will not ovulate as effectively and as a result will not produce adequate amounts of progesterone. This may be why many women suffer from premenstrual acne among other symptoms such as anxiety, irritability, breast tenderness or headaches. Yes, all a result of low progesterone and possibly due to a hypothyroid condition. Low thyroid function increases inflammation because it regulates skin function and how much oxygen the skin absorbs. Thyroid levels can be checked with a simple blood test. Talk to your practitioner to get tested.
Acne can be treated in a ‘wholistic” and integrative way vs mainstream pharmaceutical methods. Treatment can also give you additional benefits that you can see and feel besides clear skin.
References: InYoung, K. Recent updates in pathophysiology and treatments in adult acne. Dermatology, Primary Care, May 25, 2022. Elsevier Inc.
Gaby, A. Acne Vulgaris. Nutritional Medicine, Second edition, 2017. Fritz Perlberg Publishing, Concord NH. pp 707-210.
Villett, M. Is low thyroid causing your “hormonal” acne? The Skincare Edit. 2019.
Amer M. Bahgat MR, Tosson Z, et al. Serum zinc in acne vulgaris. IntJ Dermatol 1982; 21: 481-484.
Snider B, Dieteman DF. Pyridoxine therapy for premenstrual acne flair. Arch Dermatol 1974; 110:130-131.