Acne is often associated only with the years of adolescence however, unfortunately it can often continue to appear throughout our adult years too. In fact up to half of all men and women experience acne well into their 30s while some suffer for many years more. The impact of acne is far more reaching than simply blemishes on the skin. Alarmingly, chronic acne sufferers are more likely to experience anxiety, depression, suicidal thoughts, poorer employment outcomes and lower self-esteem than non-acne sufferers. Dealing with acne is not trivial.

What causes acne?

Acne vulgaris is an inflammatory disease of the skin which affects those areas which contain sebaceous glands including the nose, forehead, cheeks, chin, back and trunk. There are many different causes of acne, and as naturopaths, we look at the location of the pimple to determine the root problem and formulate a successful treatment. For example, the jawline is related to hormones and lymphatic system, while pimples on the forehead relate to stress and excess oil production.

Other primary causative factors and risk factors that can contribute to the incidence of acne include:

• High insulin levels, associated with insulin resistance, are implicated in the development of acne. A high glycaemic load diet (a typical Western diet) leads to a persistent elevation of serum insulin. This then causes an imbalance in androgen levels which triggers an increase in epithelial cell proliferation and an increase in sebum production under the skin, both risk factors for acne
• Fluctuating hormones associated with adolescence, menstruation or pregnancy or hormonal imbalances such as PCOS
• Acne patients of both genders have been found to have serum zinc levels on average 28.3% lower than normal. Hair levels were 24.3% lower and nail levels were 26.7% lower than controls.
• Genetic predisposition- particularly affects the severity of presentation
• Certain medications- corticosteroids used topically or in high oral doses, anabolic (androgenic) steroids, oral contraceptives; lithium, isoniazid, phenytoin and phenobarbitone may also cause eruptions. High levels of halogens such as iodine (from kelp, for example) may also lead to or exacerbate acne.
• Poor liver function and difficulty with excretion of toxins and the metabolism of hormones
• Topical cosmetic or hair products containing vegetable or animal fats may further block skin
• Environmental irritants such as industrial cutting oils, tar, wood preservatives, sealing compounds, and other pollutants
• Friction and sweating – for example, from headbands, back packs, bicycle helmets, or tight collars, can initiate or aggravate inflammatory acne lesions.
• Squeezing and picking comedones can worsen acne

Conventional treatment uses antibiotic creams or tablets, the contraceptive pill or for more severe forms of acne, Roaccutane. However, topical treatments are often just addressing the symptoms, not the cause, and medications often come with negative side effects, from mood changes to liver damage and even inflammatory bowel disease. Like most conditions, a holistic approach that investigates the underlying causes is the best way to get long lasting results.

So what can be done for a chronic case of acne?

Opt for a low GI diet

Focus on low GI foods as foods that are high on the glycaemic index increase insulin-like growth factor (IGF-1). IGF-1 increases circulating androgens such as testosterone which, in turn, upregulates epithelial cell proliferation and an increase in sebum production under the skin. Restrict your intake of refined sugar, desserts, pastries, bread, pasta, lollies, chocolate and sweetened drinks.

Check your dairy intake

Similarly, dairy products including cheese, cream, milk, ice cream, yoghurt and milk solids have been found to increase levels of IGF-1 as well and subsequently, androgen levels. As well as affecting sebum production, androgens cause keratinocytes (a type of skin cell) to go into over production resulting in clogging of follicles and comedome formation, otherwise known as acne.

Reduce exposure to toxins and chemicals

Reduce your toxin exposure by switching to natural skin care and make up. A lot of skincare and cosmetic products not only dry out your skin or cause your skin to produce an overabundance of oil, they contain a lot of harsh toxins which can do serious damage to your skin. Your body absorbs these toxins and chemicals through the skin, which in turn puts a load on your liver. Always remember to keep hydrated by aiming for 2-3 litres of water per day to flush out toxins via the urine.

Make sure your lymph is moving

When lymphatic fluid is congested, it can accumulate beneath the skin and the body is forced to excrete metabolic waste products out through the skin leading to acne. Unlike the blood, lymphatic fluid doesn’t have an organ like the heart to pump it. Movement and exercise is essential as muscles compress on lymphatic vessels, pushing the lymph towards the liver. Drinking plenty of water and avoiding congestive foods like dairy and wheat can also be helpful. Dry skin brushing is another way to get your lymph moving.

Increase your zinc levels

Zinc is the number one mineral for acne as acne sufferers have been found to have lower serum zinc levels. There is also a higher risk of deficiency for women especially if you’re on the pill or follow a vegetarian diet. Zinc is important as it reduces androgen production, speeds up skin healing, balances sebum production, dampens inflammation and reduces keratin production to unclog pores. It’s also an important nutrient for stress and immunity. Zinc is found in pumpkin seeds, oysters, beef, salmon, eggs and vegetables like spinach.

Learning to manage your stress

Finally, while having acne can be stressful, the general stresses of life can also contribute to making your acne worse as it increases inflammation. Learning to manage your stress is one of the best things you can do for your health as well as for your skin. Exercising, getting outside, meditating, practicing gratitude and making sure you schedule in some play time are all ways you can help alleviate stress.

Implementing some of these strategies into your life can make a huge difference to your skin. In many cases, hormonal imbalances and digestive issues such as leaky gut are also implicated so it’s worthwhile seeking individualised support. Healing skin takes time but addressing the underlying causes and working from the inside out is the best way in healing acne long-term.