Why You Keep Breaking Out: A Holistic Deep Dive Into Acne & Skin Health
Whether it’s the occasional pimple or a lifelong journey with cystic acne, nearly every man, woman, and teenager has been plagued by the inconvenience (and even physical pain!) of acne at some point in their lives. Many of us have tried countless products, expensive facials, or fad diets to clear our skin, with varying degrees of success. Pharmaceutical treatments such as antibiotics and accutane may work for some, but not without serious side effects, and the acne usually returns after the treatment is complete. No thanks! So why do some of us, even if we lead “healthy” lifestyles and follow a vigorous skincare routine, still suffer with acne? Join us as we delve beyond the surface of the skin, and learn why acne is more than skin deep.
What Causes Acne? Meet the Culprits:
Inflammation
At its core, acne is a condition of systemic inflammation. Dermatologists have historically blamed bacteria, or “excess sebum production”, as being the main cause of acne. While bacteria is certainly part of the equation, new research shows that inflammation, which triggers abnormally rapid shedding of skin cells (hyperkeratinization), is often the main offender [3]. This explains why we can wash our face with antibacterial cleansers all day long, and still suffer from acne. Systemic inflammation may be caused by many things, including:
Pro-inflammatory diet (refined sugars, processed carbohydrates, excess omega-6 fatty acids, alcohol, etc.)
Diabetes / blood sugar dysfunction
Excess weight or obesity
Chronic stress
Exposure to toxins and pollution
Genetic predispositions
Hormonal Imbalances
Have you ever wondered why you’re more likely to have breakouts around certain points in your menstrual cycle? Or why so many of us experience acne with a vengeance after coming off hormonal birth control? As it turns out, elevations of hormones (Estrogen, Progesterone, and especially Testosterone) that occur prior to menstruation, and surge rapidly following cessation of birth control, lead to excess sebum (oil) production, and often contribute to acne. If you find that you are breaking out beyond the occasional pimple or two around the time of your cycle, or if your blemishes are concentrated around your chin and jawline, this is a red flag that your hormones are out of whack.
Food Sensitivities / Poor Gut Health
Gas, bloating, constipation, diarrhea, indigestion. These are all common symptoms of food sensitivities and poor gut health. However, less commonly discussed symptoms are skin conditions such as acne and eczema. If you are sensitive to certain foods and continue to eat them, or if you overwhelm your digestive system with pro-inflammatory foods and drinks, you may damage the lining of your digestive tract - a condition known as “leaky gut”. This allows toxins and undigested food particles to “leak” into our bloodstream, resulting in systemic inflammation, and consequently, acne. If you are experiencing digestive symptoms in addition to your acne, food sensitivities or poor gut health may be a leading cause of your acne.
Damaged Skin Barrier / Topical Sensitivities
The outermost layer of our skin, aka the skin barrier, has two roles: keep the good stuff in (moisture, nutrients) and the bad stuff out (toxins, allergens). In fact, you can think of a damaged skin barrier as the “leaky gut” of the dermal layer. Because a damaged skin barrier is highly susceptible to external invaders, and has trouble retaining moisture, it is prone to acne, as well as other skin conditions including dermatitis and eczema. Using ingredients that your skin is particularly sensitive to may also alter your skin barrier. Signs of a damaged skin barrier include:
Acne, rosacea, dermatitis, or eczema
Dry, dull skin
Hyperpigmentation
Redness and sensitivity
Overuse of harsh skincare products, such as retinoids, benzoyl peroxide, acids, and abrasive exfoliants is the leading cause of damaged skin barriers. However, other contributors may include:
Nutrient deficiencies (omega-3s fatty acids, amino acids, Zinc, Vitamin A)
Makeup / beauty products with chemicals or fragrances
Environmental toxins / pollution
Smoking
Overuse of drying cleansers
Changes in weather
Pharmaceuticals & Supplements (yes - even natural supplements!)
Both pharmaceutical drugs and natural supplements may contribute to acne in a variety of ways. For example, we have already touched upon how hormonal birth control or cessation of hormonal birth control may lead to fluctuations of hormone levels and therefore cause breakouts. Steroids (especially anabolic steroids such as Testosterone), lithium, and anti-epileptic drugs have all been shown to contribute to acne [6]. Additionally, antibiotic usage may lead to acne by altering the microbiome [4].
In addition to medications, high doses of certain supplements including biotin (B7), B12, B6, and iodine have all been shown to cause or worsen acne in certain individuals [6]. If you are taking any of the above medications or supplements, they may be contributing to acne.
So How Do I Figure Out What's Causing MY Acne…
The first step to figuring out your unique acne triggers is to work with a holistic practitioner who specializes in root-cause medicine. Collaborating with a holistic practitioner will give you access to various types of testing to unravel the complex web of factors which may be contributing to your acne. These factors may include inflammation, hormonal imbalances, poor gut health, a damaged skin barrier, pharmaceuticals & supplements, endocrine disruptors, genetic predispositions, lifestyle choices and more. This approach empowers you with a scientific toolbox to achieve clear, glowing skin, while steering away from generic solutions or gimmicky products. Some of the best functional lab kits to identify your specific acne causes include:
GI-MAP (comprehensive gut health test)
DUTCH Test (complete hormone panel)
Vibrant America Food Sensitivity Test
Blood panel including HbA1c, hs-CRP, Vitamin D
Once you have found a trusted practitioner to order the necessary labs, you will work together to identify causes & triggers and put into place a tailored treatment program involving specific dietary, lifestyle, supplement, and product changes.
How Do I Prevent & Deal With Breakouts Naturally?
Identify the Root Cause of Your Acne.
The most foolproof method to achieving clear skin is to work with a holistic practitioner who can create a personalized plan for you based on your unique lab results, genetics, and lifestyle. However, if this is cost-prohibitive, we have some additional tips to help lower overall inflammation and rebalance your skin barrier, which should make a noticeable improvement in your complexion.
Optimize Your Skincare Routine (+ Eliminate Endocrine Disrupting Chemicals).
Did you know that your expensive skincare products may contain chemicals known as endocrine-disruptors that can be causing a whole host of health issues and further damaging your skin? The endocrine system refers to the hormonal messengers that coordinate our bodily functions including reproduction / sexual function, sleep, growth and development, mood, and metabolism. Endocrine-disrupting chemicals (EDCs) include “forever-chemicals” known as PFAs, phthalates, parabens, BPA, synthetic fragrances, and sulfates that not only affect our endocrine system, but have been shown to be carcinogenic, immunogenic, and linked to neurological conditions. In addition to being good for overall health, swapping to non-toxic skincare can help reduce and prevent acne by improving endocrine function and lowering overall inflammation. Some of our favorite non-toxic skincare brands include:
Consider Traditional Chinese Medicine (TCM) for Acne.
Traditional Chinese Medicine (TCM) is a form of Eastern Medicine that has been used successfully for thousands of years and can give us many insights on how to restore balance to the body. TCM believes that the face is the map to your internal health status. In fact, each area of the face is connected to a specific organ system that may be out of balance. For example, you may notice hormonal acne around your chin or jawline as this section of the face is linked to the reproductive system. Additionally, you may notice acne on the forehead after eating dairy or any food that you are particularly sensitive to, as this section of the face is linked to the small intestine, which is responsible for absorption and assimilation of our food's nutrients into our systemic circulation. The TCM map can be a great tool to help you and your practitioner know where to get started in terms of testing and building your personalized treatment plan.
Take the Holistic Approach to Addressing Acne.
While we all love a good non-toxic skincare routine, this is only one piece of the puzzle in terms of treating the root causes of acne. Dietary and lifestyle adjustments are crucial for many people to finally achieve radiant, acne-free skin and prevent future breakouts from occurring. Our top holistic tips for managing acne include:
Regular, appropriate exercise. A regular exercise routine can reduce acne by lowering overall inflammation and cortisol levels, improving blood-sugar control, and aiding detoxification. However, keep in mind that excessive sweating may promote acne.
Keeping an acne-friendly diet. Keeping inflammation low and blood sugar levels in-check is critical to combat acne. The best way to do so is to follow an anti-inflammatory diet, rich in organic veggies and fruits, high-quality protein sources (grass-fed meats, pasture-raised eggs, beans & legumes), and skin-specific nutrients. Skin-specific nutrients include:
Omega-3 Fatty Acids (found in fatty fish, flax seeds, hemp seeds, chia seeds)
Zinc (found in oysters, red meat, pumpkin seeds, dark chocolate)
Protein / Amino Acids (especially the amino acids glycine, proline, glutamine, lysine)
Vitamin A (found in liver, eggs, carrots, sweet potato, fatty fish)
Vitamin C (found in strawberries, oranges, broccoli, bell peppers, tomatoes)
An anti-inflammatory diet also requires avoiding the most inflammatory foods, including refined sugars, processed carbohydrates, refined oils (vegetable oil, canola oil, sunflower oil, etc.), fried or heavily-processed foods, and alcohol.
Optimizing sleep & reducing stress. Managing stress levels and getting 7-9 hours of restful sleep is critical to keeping inflammation low and giving the body the resources it needs to recover & repair skin.
Sunlight / sunscreen. While appropriate sun exposure is beneficial for overall health and Vitamin D levels, frequent sunburns can damage the skin and lead to collagen breakdown. When choosing sunscreen, look for non-toxic mineral-based sunscreens, we love Native Unscented.
Try Acupuncture to Help Alleviate & Prevent Acne.
A key component of Traditional Chinese Medicine is the ancient practice of acupuncture. Acupuncture works by using tiny stainless steel needles to stimulate energy points in the body, recalibrating and unblocking stagnant energy channels. Acupuncture may be beneficial for acne as it increases blood flow, reduces systemic inflammation, calms the nervous system (aka: lowers cortisol levels) and restores balance to the endocrine system. To book a session with one of our licensed acupuncturists, click here.
Additional Resources
Instagram:
@dr.shannoncurtis
Books:
-Younger Skin Starts In The Gut by Nigma Talib
-The Clear Skin Protocol: Treat the Root Causes of Acne by Renelle Stayton
References
Chen, H. Y., Lin, Y. H., & Chen, Y. C. (2016). Identifying Chinese herbal medicine network for treating acne: Implications from a nationwide database. Journal of ethnopharmacology, 179, 1–8. https://doi.org/10.1016/j.jep.2015.12.032
Elsaie M. L. (2016). Hormonal treatment of acne vulgaris: an update. Clinical, cosmetic and investigational dermatology, 9, 241–248. https://doi.org/10.2147/CCID.S114830
The Role of Inflammation in Acne Vulgaris - Practical Dermatology. (n.d.). Practical Dermatology. https://practicaldermatology.com/articles/2013-aug/the-role-of-inflammation-in-acne-vulgaris
Mahmud, M. R., Akter, S., Tamanna, S. K., Mazumder, L., Esti, I. Z., Banerjee, S., Akter, S., Hasan, M. R., Acharjee, M., Hossain, M. S., & Pirttilä, A. M. (2022). Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut microbes, 14(1), 2096995. https://doi.org/10.1080/19490976.2022.2096995
Parke, M. A., Perez-Sanchez, A., Zamil, D. H., & Katta, R. (2021). Diet and Skin Barrier: The Role of Dietary Interventions on Skin Barrier Function. Dermatology practical & conceptual, 11(1), e2021132. https://doi.org/10.5826/dpc.1101a132
Pontello R Jr, Kondo RN. Drug-induced acne and rose pearl: similarities. An Bras Dermatol. 2013 Nov-Dec;88(6):1039-40. doi: 10.1590/abd1806-4841.20132586. PMID: 24474128; PMCID: PMC3900370.
Thiboutot, D., & Del Rosso, J. Q. (2013). Acne Vulgaris and the Epidermal Barrier: Is Acne Vulgaris Associated with Inherent Epidermal Abnormalities that Cause Impairment of Barrier Functions? Do Any Topical Acne Therapies Alter the Structural and/or Functional Integrity of the Epidermal Barrier?. The Journal of clinical and aesthetic dermatology, 6(2), 18–24.