Updated: Jun 19
I think we can all agree that acne can be so frustrating! As someone who has struggled with acne for most of their life, I can speak to its impact on self-esteem and confidence firsthand. Those who see me to work on acne have often tried everything and may have found some relief but no true resolution. This story is all too common and is a sign that the root of the problem still needs to be uncovered and addressed holistically.
The when and where behind your acne story can shine light on potential roots. When someone comes to see me with acne management as a main goal, I screen for:
Systemic & skin level inflammation
Hormone imbalances are the most common trigger for acne that I see in clinic. Most people are familiar with androgens & reproductive hormones (ie. testosterone, estrogen, progesterone) as a main acne culprit and typically they are! But our stress hormones Cortisol & DHEA and our blood sugar regulating hormone insulin can also play a role at the skin level. It’s important to look at the whole picture when deciding the best course of treatment as multiple factors may be at play. For example, when blood sugar levels are high due to insulin resistance this can activate signals in the body to make more estrogen and testosterone which only aggravates acne further. In this case, supporting blood sugar regulation & insulin sensitivity will have the best effect.
On the topic of regulating blood sugars, eating a diet high in processed sugar is going to make acne worse. If sugars are minimized and acne persists, then you may also be living with an unknown food intolerance. Common sensitivities I see that worsen acne are those to proteins found in dairy, wheat, eggs, or soy. Either a targeted elimination diet or food sensitivity testing can be useful tools better understand potential dietary triggers.
When looking to nutritional status, there is ample literature showing that those living with acne are more likely to have low zinc and/or Vitamin D levels. Where it’s hard to know if these deficiencies are the cause of acne, evidence shows that supplementation with either can relieve active lesions and support the new skin layer that forms after a lesion resolves.
Systemic or widespread inflammation often shows to me as either puffiness under the skin or persistent GI upset. Proper bowel function is key to managing acne, and this is where the gut microbiome has a role to play. When the digestive tract is burdened, the body utilizes the skin as its next major detoxification organ. Stool sample testing can give insight into the balance of beneficial microbes or flora, potential problematic parasites, and markers of intestinal inflammation.
There is a lot that can be investigated to determine what is contributing to your acne, and this is a great starting place:
Blood Work (ie. CMP, Fasting glucose, HbA1c, CRP, Vitamin D, Zinc, etc.)
Hormone Testing (ie. Estrogen, Progesterone, Testosterone, DHT, DHEA, Cortisol, Insulin, etc.)
IgG Food Sensitivity Testing
Stool Testing (ie. dysbiosis, Candida, etc.)
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Lim SK, Ha JM, Lee YH, et al. Comparison of vitamin d levels in patients with and without acne: a case-control study combined with a randomized controlled trial. PLoS One. 2016;11(8):e0161162.
Rasti SD, Dewinta NR, Kamal RH, Adissadah AF, Madanny AE, Dewanti L. Correlation between serum 25-hydroxy vitamin d levels and the severity of acne vulgaris: a systematic review. Indian J Dermatol. 2022;67(1):31-36.
Yee BE, Richards P, Sui JY, Marsch AF. Serum zinc levels and efficacy of zinc treatment in acne vulgaris: A systematic review and meta-analysis. Dermatol Ther. 2020;33(6):e14252.
Conforti C, Agozzino M, Emendato G, et al. Acne and diet: a review. Int J Dermatol. 2022;61(8):930-934.