Let’s Talk Acne

Acne is the result of clogged oil glands in the surface layer of skin, with or without inflammation and infection. The oil glands secrete a waxy oil called sebum and can become plugged, leading to whiteheads, blackheads, and eventually red, inflamed and infected pustules or boils. The boils can be severe enough to damage underlying collagen layers leading to scarring.

The simplest form of acne is caused when the oil glands are plugged by the normal outer layer of dead skin, called keratin. Certain hormones increase oil production while inflammation or infections are often driving forces for acne.

The skin, the body’s largest organ, acts as a supplemental filter to the kidneys for removing wastes from the blood. When the other organs are congested the skin tries to push out toxins through the skin. The skin throws off toxic waste in the form of perspiration. 

When the body is not functioning well, there can be increased production of oil, increased inflammation and infection and reduced turnover of skin cells, leading to skin problems such as eczema, dull skin, wrinkles and acne.

For many people acne is a sign of underlying inflammation or problems with the immune system as a whole. Everything from diet, stress, poor sleep, infections and allergies might play a role in acne.

Diets high in sugar and simple carbohydrates lead to increased production of insulin. Insulin can result in an increase in the production of oily sebum in the sebaceous glands of the skin. This lipid-rich environment allows for the growth of the bacterium Propionibacterium acnes. P. acnes is a normal colonist of human skin, but its’ overgrowth is thought to be involved in the development of acne lesions.

Conditions such as delayed food allergies or “leaky gut” can cause acne due to the resulting inflammation and increased cortisol hormone production. Intestinal permeability and the influx of toxins from the gut into the bloodstream can cause systemic inflammation, which can also increase local inflammation in the skin. Small intestinal permeability is closely associated with food hypersensitivities, and eliminating inflammatory foods may help to resolve permeability. Common offenders are foods containing gluten or dairy products. 

While rarely the sole driver of acne, nutrient deficiencies can also contribute to the pathogenesis of acne. The following are the most common nutrient deficiencies in acne.

Zinc: Zinc tends to reduce free fatty acids in the sebum, and inhibits the lipases in several bacteria, including P. acnes.  Zinc is also important for gut barrier function and may reduce the influx of inflammatory molecules into the bloodstream.

Vitamin A: Vitamin A works along with zinc to modulate the skin response to microbes, inhibit sebum production, reduce androgen formation

Omega 3 Fats: omega-3 fatty acids are anti-inflammatory and may help reduce IGF-1 levels and prevent the hyperkeratinization of sebaceous follicles that is characteristic of acne

Selenium: An antioxidant, increased levels have been shown to result in clinical improvement of acne symptoms.

The skin microbiome also plays an important role in skin health. The skin microbiome, sometimes called the skin flora, is the term for the trillions of bugs that live on our skin. Essentially, this ecosystem controls a lot about our skin, from how well products are absorbed to the overall health of our skin. It communicates with our immune system, protects us against infection, reduces inflammation and allergies and protects us from environmental stressors. 

An imbalance in the skin microbiome may result in acne. New research shows that anything damaging to your gut microbiome also influences what’s happening to the skin. It’s called the gut-skin axis, and scientists are just beginning to understand the connection. 

Acne is also often a tell-tale sign of an underlying hormone imbalance. Similar to cortisol (the stress hormone), the androgens or “male hormones” such as DHEA, Testosterone, and its byproduct DHT, all increase oil production in the skin and stimulate hair growth. When the androgens are in excess relative to the “female hormones” such as estrogen and progesterone then the skin can become oily, hairy, or both.

Women commonly have pre-menstrual breakouts due to hormone imbalances. During and after menopause many women experience a flare up of acne not seen since their teens or at all due to the falling levels of estrogen and progesterone. Other hormonal conditions such as low thyroid and polycystic ovarian syndrome can affect the skin. 

What are some practical ways to heal acne:

  1. Eat healthy and stay hydrated

Eating high quality produce containing good fats, proteins, complex carbohydrates, colourful vegetables and clean water can help reduce the toxin load on our body. The skin is part of our detoxification pathway. By ensuring that our bodies are hydrated and clean, it helps us maintain healthy skin.

  1. Reduce simple carbohydrates and sugar

Avoid any processed and refined carbohydrates, grains, and simple sugars such as bread, pasta, desserts and sweets. A diet high in simple carbohydrates and sugar may lead to insulin spikes and an unhealthy gut microbiome. 

  1. Identify food intolerances and heal the gut

Consider stool testing or food intolerance testing to identify what might be contributing to intestinal permeability. Dairy and gluten have been associated with exacerbating a range of skin issues and trialing a period of elimination may also be helpful. 

Support a healthy gut microbiome by eating plenty of prebiotics such as fermentable fiber and foods and supplementing with high quality probiotics.

  1. Treat any underlying hormone imbalances 

If your acne is related to your period cycle, or experience weight loss or weight gain, an increase or decrease hair growth, low energy, constipation or diarrhea, cold or heat intolerance, you may have underlying hormone imbalances and may consider doing hormonal testing. Apart from acne, hormonal imbalances are associated with many other conditions such as heart conditions, infertility, osteoporosis and metabolic diseases. 

  1. Treat any nutritional deficiencies

Eat a nutrient-dense diet, and specifically focus on increasing consumption of zinc, omega-3 fats, vitamin A, and selenium. 

Foods that are high in zinc include organ meats, red meats and seafood.

Foods that are high in omega-3 fats are cold-water fatty fish like sardines, mackarel, salmon and anchovies

Foods that are high in vitamin A include liver and cold water fatty fish. 

Foods that are high in selenium include Brazil nuts, organ meats, seafood, muscle meats, and fish

  1. Sweat

If you’re eating well, the sweat you produce is likely a fortifying prebiotic for the skin microbiome. Sweating also increases the blood flow to your skin, nourishing your skin with vital nutrients and oxygen. 

Exercising and infra-red saunas are both good options to get your sweat on!

  1. Manage stress levels

Just as elsewhere in the body, stress likely negatively influences what’s happening with your skin. Try yoga, meditation, mindfulness, or another stress management technique to help prevent stress-induced flares. Some patients with severe HPA dysregulation may benefit from testing and targeted supplementation with adaptogens to restore HPA balance.

  1. Use gentle, nontoxic beauty products

Harsh chemicals and soaps can destroy the skin microbiome. Try topical probiotics, and products that do not alter the skin pH.  You can try using kefir or yogurt on skin or applying a probiotic powder mixed with coconut oil or shea butter to the skin for healthy skin. 

References 

Grice EA, Segre JA. The skin microbiome [published correction appears in Nat Rev Microbiol. 2011 Aug;9(8):626]. Nat Rev Microbiol. 2011;9(4):244–253. doi:10.1038/nrmicro2537

Kong HH, Segre JA. Skin microbiome: looking back to move forward. J Invest Dermatol. 2012;132(3 Pt 2):933–939. doi:10.1038/jid.2011.417

Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459. Published 2018 Jul 10. doi:10.3389/fmicb.2018.01459

Melnik, B. C. & Schmitz, G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp. Dermatol. 18, 833–841 (2009).

Agak, G. W. et al. Propionibacterium acnes Induces an IL-17 Response in Acne Vulgaris that Is Regulated by Vitamin A and Vitamin D. Journal of Investigative Dermatology 134, 366–373 (2014).

Khayef, G., Young, J., Burns-Whitmore, B. & Spalding, T. Effects of fish oil supplementation on inflammatory acne. Lipids in Health and Disease 11, 165 (2012).

Michaëlson, G. Decreased concentration of selenium in whole blood and plasma in acne vulgaris. Acta Dermato-Venereologica 70, (1990).

Lawrence, D., Shaw, M. & Katz, M. Elevated free testosterone concentration in men and women with acne vulgaris. Clinical and Experimental Dermatology 11, 263–273 (1986).

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