Many women and adults develop acne in their teenage years and sometimes it continues into later life. It is important to address so that it does not diminish self-esteem. Acne is not caused by ‘dirty” skin, poor hygiene or oily hair on the face. It is a symptom of an underlying hormonal imbalance of increased androgens (male hormones) together with enlargening of the pores in the skin, bacterial infection in the skin and consequent inflammation. However, some people have hormonal imbalances but do not develop acne, while someone with acne will often have normal androgen levels in their blood tests. It is thought that these people have increased sensitivity to androgens or that the androgens are converted into stronger, more potent hormones in the hair follicle producing a localized effect only which does not show in the blood. These localized increased androgens cause increased sebum production and acne. This is related particularly to acne occurring around the jawline, chest and back as opposed to the T zone of the forehead and cheeks which relates more to internal body toxicity.

 

Diagnosis

• Hormone blood tests: to check if there are other underlying hormonal issues: Testosterone, Free Testosterone and FAI are normally high, Oestrogen and Progesterone levels may be low; Lutenizing hormone LH, Follicle stimulating hormone FSH, SHBG, Prolactin

• Glucose Tolerance Test (GTT) with Insulin to test if insulin resistance, blood sugar problems or polycystic ovaries PCOS are suspected. It is important to determine if the acne is a symptom of an underlying hormonal imbalance like PCOS or a localised condition to the face only.

• Increased androgen production, usually related back to polycystic ovaries PCOS, if detected in blood tests
• Localised elevated androgens: normal blood androgen levels but increased sensitivity to androgens or conversion into more potent androgens in hair follicles of the skin.
• Bacterial infection in local skin area
• Poor liver and bowel clearance of toxins & hormones; constipation will exacerbate; often related to long term use of drugs, medications, the Pill
• Systemic or bowel dysbiosis/low grade infection of candida or bacteria producing inflammatory chemicals and infective agents, often related to long term antibiotic use, food allergies/intolerances
• Poor diet of high sugars which lower immune system and which feed bacterial and candida infections; junk food, processed foods, oily foods, chocolate, alcohol, cigarettes, drugs
• Stress stimulates adrenaline secretion by the adrenal glands that in turn stimulate insulin secretion to provide an immediate energy source for the body cells for "fight/flight". Under chronic stress, excess cortisol is released from the adrenals which disrupts the hormones. These stressors may be current life stressors, emotional and psychological stress or repressed pain from the past.
• Familial link: inherited trait
• Low body weight: oestrogens are converted in fatty tissue so not enough circulating oestrogens
• Stimulants: caffeine, cigarettes, drugs all stimulate the adrenal glands into fight/flight response which stimulates androgen production
• Blood sugar problems or insulin resistance: insulin is a hormone secreted from the pancreas to control blood sugar levels by allowing the body’s cells to take up and use sugar (glucose) for energy. If there are elevated levels of insulin in the blood, the cells no longer respond to the insulin so they require bigger amounts of insulin to remove the same amount of sugar from the blood. Excessive dietary sugars and
high glycaemic carbohydrates, Candida infections, mineral deficiencies, stress or excess body fat, particularly abdominal weight, all contribute to excessive insulin secretion by the pancreas. It is a precursor to diabetes. Any bacterial infection in the skin will feed off the excessive sugars and it will disrupt the hormones.
• Use of steroid drugs eg. body building causes excessive androgen levels

 

• Antibiotics: usually tetracycline or occasionally erythromycin if pregnancy is suspected. However, antibiotics must be used for at least 6-8 months which upsets digestive flora, weakens the body’s immune system and compromises the liver’s clearance capability. They should be taken half an hour before food to increase efficacy.
• Isotretinoin (Roaccutane): can only be prescribed by a specialist dermatologist; has many serious side effects and women must be on the Pill or another suitable contraceptive due to foetal abnormalities. Highly toxic to the liver so liver function tests must be carried out periodically. Common side effects: cracked lips, facial dermatitis, severely irritated conjunctiva and eyelids, nose bleeds from dry and inflamed nasal passages, eczema, photosensitivity, muscle and joint pains, bony outgrowths throughout the skeleton, abnormal cholesterol and blood lipids, associated with inflamatory bowel disease.

• The oral contraceptive pill (OCP) is often suggested for women as a standard treatment for acne. Usually OCPs with cyproterone acetate are given (Diane-35 ED, Brenda-35 ED) which adversely affect blood cholesterol levels, increase cardiovascular risk and increase risk of blood clots.
• Androgen receptor blockers: Androcur & Aldactone effectively block male hormone effects in the body but cause weight gain in high doses; possibly increase insulin resistance; can cause depression in some women; cause a build up of potassium in the blood which must be checked by blood test 3 – 4 weeks after starting treatment or after increasing the dose; cannot be taken during pregnancy.
• Topical applications: retinoic acid for non-inflamed lesions (causes photosensitivity so must wear sunscreen), antibiotic lotions eg. clindamycin for inflamed lesions, benzoyl peroxide, glycolic acid to peel dead skin, oestrogen based creams for local effect – may clog pores if infection, inflammation of the skin (contact dermatitis) occurs.

Naturopathic Treatments for Acne:
Self-Healing