Happy July! I wanted to shift gears this month and discuss inside-out causes of acne as I see this in my practice often. It's very common yet the cause can be complex and difficult to treat. Acne is the most common skin condition in the United States. The entire surface of the skin is covered with tiny hair follicles and oil glands. These sebaceous glands serve you by lubricating and waterproofing your skin and hair. Oil, also called sebum, travels up the hair shaft to the surface of your skin. Acne requires three ingredients: oil, bacteria, and dead skin cells. When these three elements are present in your pores, they become plugged and infected, leading to the inflamed pimples you see on the surface of your skin.
Non-inflammatory vs. inflammatory acne
An easy way to detect inflammation anywhere in the body is to look for redness, swelling, heat, or pain. When P. acnes bacteria combine with sebum and dead skin cells within hair follicles, the resulting infection leads to inflamed papules, pustules, nodules, and cysts. These are often sore to the touch and sometimes feel like large underground pimples that may or may not reach the skin’s surface. Blackheads and whiteheads, or comedones, are typically painless and non-inflamed acne lesions.
For those who made it through the teen years with little to no acne, the onset of adult acne can come as quite a surprise. The causes of acne vary from person to person. A complete acne protocol involves skincare, diet, and lifestyle change. Mainly affecting women, hormonal changes are often to blame for adult-onset acne. Hormonal acne most frequently appears on the lower portion of the face, such as along the chin and jawline. Other common triggers that cause acne are medical conditions, medications, stress, gut dysbiosis, and acne causing foods or body care products.
PseudoFolliculitis - Folliculitis literally means “inflammation of the hair follicle.” This skin condition is generally caused by a fungal or yeast infection that tends to flare up during humid weather. Exercising and hot weather can make matters worse as sweat hardens inside pores, leading to breakouts on your face, neck, shoulders, and back.
Acne-rosacea - Often misdiagnosed as adult acne, rosacea is known for its signature inflamed facial redness along with sensitive skin that might burn or sting. Rosacea typically begins any time after age thirty as a flushing or redness on the cheeks, nose, chin, or forehead that may come and go. Over time, the redness tends to become more persistent, and visible blood vessels may appear. Left untreated, bumps and blemishes often develop.
Maturation Arrest Acne (closed comedones) - If you can see small pebble-like bumps beneath the surface of your skin, you likely have what’s called maturation arrest acne. Although this type of acne isn’t inflamed or painful, it can give your skin an uneven or dull appearance.
Causes of Acne:
Hormones/Hormone Imbalance: Birth control pills, IUDs, implants, and contraceptive shots are widely used today and often prescribed as a means to control acne. Most forms of birth control can have the potential to cause cystic acne and weight gain in those who are susceptible. Birth control is typically categorized as estrogen or progestin dominant and has varying degrees of androgenic (or testosterone-like) effects. As a general rule of thumb, those with the potential for higher androgenic symptoms should be avoided for people prone to acne. The monthly hormonal changes that affect women cause an increase in testosterone around the time of ovulation, which normally occurs in the middle of the menstrual cycle. An increase in testosterone does signal the sebaceous glands to produce more oil, which can lead to clogged pores. Avoid dairy products the week before your menstrual cycle begins as well as the first week of menstruation. Dairy products interfere with healthy hormone levels and increase inflammation and inflamed pustules.
Gut dysbiosis: There’s a direct line of communication between your gut microbiome and skin. When the bacteria in the gut become disrupted, this is known as dysbiosis. Not only does an imbalanced gut microbiome impact your immune system, but it also gives acne-causing bacteria access to your bloodstream. Food sensitivities and intolerances can lead to gut dysbiosis as well as antibiotics. Other causes of dysbiosis are pesticides, the overconsumption of sugar, alcoholic beverages, poor dental hygiene, and stress.
Medications and Medical conditions: Read over the labels of all over the counter and prescription medications you take to see if acne is a side effect. This is especially common with both oral antibiotics and oral contraceptives. If your acne is particularly stubborn despite a consistent skincare routine, an undiagnosed medical condition could be the culprit. Polycystic Ovarian Syndrome (PCOS) is caused by a hormonal imbalance that causes oily skin and acne as well as irregular periods, excessive hair growth, weight gain, and thinning hair.
Pore-clogging ingredients: Cosmetics, skincare products, lotions, and hair care products can cause flare-ups if they contain ingredients that aren’t acne safe. Even products that are labeled non-comedogenic, oil free, or won’t clog pores may be problematic. Ingredients such as cocoa butter and coconut oil are found in many organic skincare lines. These types of oils may not be pore-clogging, but they cause inflammation in the hair follicle and can cause severely inflamed acne. Other oils such as jojoba, olive, and lanolin are mildly acnegenic and can be a problem if combined with other acne-causing ingredients. Some prescription products, such as the cream form of Retin A, have pore-clogging and acnegenic ingredients. Many over-the-counter acne medications also have the potential to cause breakouts. “Oil-free” does not mean that a product is safe from acne-causing ingredients. Please check all of your skin care products, sunscreen, and foundation to be sure they are acne safe. Many companies say that their products are noncomedogenic. However, this is not a term that is regulated.
Detergents and additives:
Skip the fabric softener. The waxy residue found in fabric softening liquid detergents and dryer sheets turns up on pillowcases, towels, washcloths, and sheets that have direct contact with your skin
Use fragrance free detergents
Don’t use water softeners
Change your pillowcase. Acne-causing bacteria can spread to your face from your pillowcase while you sleep
Wear a clean T-shirt
Wash your workout clothes
Stress and sleep deprivation: cause your adrenal glands to promote oil production that can lead to clogged pores. Cortisol is a steroid hormone that plays a very important role in helping your body respond to stress. When you’re feeling stressed and cortisol released, this can be a trigger for excess oil production in your skin that, once again, could lead to clogged pores and pimples.
Take a 30-minute walk
Get at least 7-8 hours of sleep each night
Practice yoga or stretching exercises
Spend a few minutes slowly breathing in and out
Take a break from your phone and other media
Don’t skimp on the sunscreen: Overexposure to the sun can also damage hair follicles, exacerbate dark spots, cause skin cancer, and lead to premature aging. Avoid touching your face. Clean your phone daily. Holding your phone up to your face quickly spreads bacteria to your skin. Wiping down your phone daily with a damp microfiber cloth will help to prevent this.
Food that you put into your body: can cause inflammation, allergic reactions, sensitivities, excess sebum production, and aggravated acne. At the same time, the right foods can have the opposite effect.
Foods that heal acne
Vegetables - Beets, purple cauliflower, purple sweet potato, purple carrots, broccoli, green & red peppers, tomatoes
Fruits & Berries - Blueberries, dark cherries, pomegranates, acai, black grapes, papaya
Healthy Oils - Avocado oil, olive oil, coconut oil
Leafy Greens - Spinach, kale, watercress
Tea & Spices - Green tea (especially homemade matcha), spearmint tea, ginger, cinnamon, turmeric
Omega-3 Fatty Acids - Deep leafy greens, blueberries, brussels sprouts, wild-caught salmon, sardines, anchovies, herring, white fish, Atlantic mackerel
Supplements - CurcumaSorb, O.N.E. Omega, zinc, & probiotics
Foods that can cause acne
Iodized table salt (use Himalayan Sea salt instead). Iodine, Iodide, B12, biotin, Algae.
Whey and dairy products
Kelp & seaweed
High glycemic goods
Pre/post workout supplements
*A recommendation for acne safe protein powders is Amy Meyers paleo protein powder (all flavors) and Pure paleo protein powder.
Remember that it can take about 90 days for acne to develop beneath your skin to appear as a pimple. It will take time for the infection in your ways to clear. The key is to be consistent.
Keep Moving Forward 😊 Sarah