Before we get started, here's our favorite acne ritual to help nourish your skin or get more information about acne with our printable natural skin solution. You can also check out our acne collection!
HOW DO DERMATOLOGISTS TREAT ACNE?
If you google acne solutions or treatment, most of what you find is focused on products and medications to treat the condition. For years, dermatologists have sought to conquer acne with antibiotics and drying agents. The theory behind this treatment plan is that by killing bacteria and reducing oil on the skin, acneiform eruptions will be diminished. Dermatologists often approach acne like cleaning up an oil spill: get rid of the oil on the surface, and things will be all better, right? My concern with this approach is that it only addresses one aspect of acne: the symptom itself. I'd rather see more dermatologists dig a little deeper into the root cause, instead of just mopping up the mess.
In considering any condition or ailment, a whole health assessment is indicated. In most cases, even for those of us who live a pretty “clean” life, there is room for improvement. In this article, I will touch on a few areas where most of us could bring some extra awareness, and then I'll suggest a different approach to topical treatment of the symptoms.
DOES DIET CAUSE ACNE?
This is, without question, the most important area to examine, and the most likely place to find a few habits in need of attention. At its core, acne is an inflammatory condition. Microbes play a role, to be sure: bacteria cause trouble by triggering a cascade of inflammatory chemicals and cellular activity in the skin. The result of this inflammatory frenzy is increased blood flow (causing redness), and an influx of helper white blood cells called phagocytes. These white blood cells attempt to wall off and contain the offending bacteria, leading to a pus collection, either under the skin or at the surface. (That, friends, is what we refer to as a zit.)
Wait, weren't we talking about diet? Yes, we were, and here’s the message: don’t eat inflammatory foods. You CAN’T expect to eat junky food and not deal with the consequences - it’s not fair to your poor little body. So, we'll cover some of the worst dietary offenders below.
DOES EATING SUGAR CAUSE ACNE?
Sugar is one of the biggest, baddest wolves of inflammation. There’s sugar in almost everything. Things like glucose, fructose, sucrose, lactose (all the “oses” are sugar) are in most foods, so you won’t waste away if you cut out a few. Try to get your sugar from real, unprocessed foods like fruit, complete with the fiber that is meant to accompany it. If you crave more than that, eat a square of dark chocolate in the afternoon—loaded with antioxidants and eaten in moderation, the benefit outweighs the cost. My favorite sweet-tooth trick? Place a drop of fennel essential oil on your tongue or in your tea; it satisfies a sugar craving instantly (but not if you hate licorice).
DOES EATING DAIRY CAUSE ACNE?
Chinese medicine has long considered dairy to be the most congesting, inflammatory food group, increasing mucus production and hindering digestion. Try switching to almond milk, and stick with goat and sheep cheese if you need a cheese fix—they are easier to digest. Some cultured dairy, like kefir, may be beneficial if you don’t take any other probiotic supplementation.
DOES EATING WHEAT OR GLUTEN CAUSE ACNE?
Too many genetic modifications in the wheat crop have started a bit of a gluten intolerance epidemic. People with true celiac sprue are rare, and truly can’t have ANY gluten (not even the gluten in soy sauce or some skin care products). Most of us, though, are just “gluten intolerant”, meaning that gluten causes bloating, gas, and tummy aches, as well as general inflammation in the body. Most of us know that it’s best to avoid white/wheat flour, wheat pasta, and bread: "The whiter the bread, the sooner you're dead" is the upbeat reminder phrase people like to use. But, even whole grains can cause inflammation in some folks, especially when it comes to genetically modified grains. Luckily, there are some really good gluten-free products now (not cardboard-y like they used to be), as well as naturally gluten-free, protein-rich grains like quinoa and millet.
DOES EATING OMEGA-6 FATTY ACIDS CAUSE ACNE?
These belong to a category of essential fatty acids, which are, as the name implies, essential to our diets because we can’t make them ourselves. Some omega-6 acids are good, but too many become inflammatory. Present in soybean oil, corn oil, and safflower oil, omega-6 fatty acids are present in huge quantities in the modern Western diet. Historically, we have eaten comparable amounts of omega-3 fatty acids to balance the omega-6s. With the invention of fast food and the focus on eating cheaply, however, there is a critical imbalance in our diets. The good news? You can correct the imbalance by adding things like walnuts, wild rice, edamame, flax, and sustainably-caught fish like salmon to your diet, as well as decreasing processed and fried foods. (While we're here, let's be clear about one thing: one of the most direct paths to acne, heart disease, diabetes, intestinal problems, depression, allergies, and fibromyalgia is eating fast food. If you are interested in contributing to your own health, fast food is a conscious choice to do exactly the opposite.)
DOES EATING MEAT CAUSE ACNE?
Full disclosure: I’m a vegetarian and have been for 20+ years because I love animals and hate the idea of hurting them. Also, I believe we are evolving toward a more plant-based diet as a species, hence our incredibly long digestive tracts and lack of sharp canine teeth. But, those are not the reasons why meat makes this list. Most meat has been treated with hormones that confuse and irritate your body’s internal environment. Many, especially those from large meat production facilities, have excess saturated fat due to the animals’ diets and forced immobility, and too high of an omega-6 to omega-3 ratio (less true for pasture-raised animals). Even high-quality red meat contains a molecule called Neu5Gc, which does not occur in humans, and which is seen by our immune systems as a foreign agent, causing... wait for it... inflammation! So, opt for non-GMO soy protein, beans, protein-rich grains, or healthier fish instead of the cheeseburger.
DOES CONSUMING ADDITIVES CAUSE ACNE?
Artificial colors, flavors, and things like aspartame and MSG are inflammatory in the diet as well, and have been linked increasingly to diseases of inflammation like arthritis, fibromyalgia, and other autoimmune conditions. So we won't be surprised when the study comes out saying they cause acne, too!
DOES DRINKING ALCOHOL CAUSE ACNE?
I like wine—a lot. It’s like a complex, drinkable perfume to me. But we need to drink it in moderation. While red wine has antioxidant effects due to high concentrations of resveratrol (yes, that is spelled correctly – we all say that word wrong!), as well as a mild blood-thinning effect, other alcohols have fewer documented health benefits. And no form of alcohol is beneficial in excess, when it becomes irritating to the liver, pancreas, and other gastrointestinal organs. So, 1 drink a day for women and 2 a day for men should be the upper limit. And abstinence is a great option, as well.
Phew. That’s enough about diet. The point is that even if you're a clean eater, you probably have room to improve!
DOES STRESS CAUSE ACNE?
We all have it - every, single one of us. Even the wealthy women of Aspen and the most practiced Buddhists in Tibet have to manage stress. When we are stressed, our bodies produce more hormones, namely cortisol and testosterone. Both of these hormones cause an increase sebum production, which can cause breakouts while the skin adjusts to the change. In addition, we tend to care for ourselves less attentively when we are stressed, sleeping less, taking less time for our mental and physical health routines. The result? Acne, dark circles under the eyes, irritability, decreased hydration - any of this sound familiar?
How do you manage your stress? My favorite instant technique is to use deep, slow breathing to slow my system down, and remind myself that whatever is stressful will not always be stressful. Broader management could include yoga, exercise, aromatherapy, time with family, and long baths on weekends. All of those are hard to fit into a jam-packed schedule, yet critical to my health and happiness. There will always be pressure and worry and not enough time and an endless to-do list. But perfect running weather and my girls’ precious childhood years will slip right through my fingers if I don’t pay attention. Step back, breathe, and find your own way to keep stress in check.
CAN EXERCISE HELP MY ACNE?
First of all, exercise is a great way to manage stress. The chemicals released when you exercise are called endorphins – a word made from two other words: endogenous, meaning “from within”; and morphine, a pain-relieving medication. You literally make your own pain and stress-relief chemicals by working out!
Aside from that amazing fact, sweating is generally good for your skin. Through sweating, we balance our electrolytes, and increase blood flow to the skin temporarily, warming it and allowing clogged pores to release. That said, if you exercise in heavy makeup, your pores may become more plugged. So, exercising with clean skin, followed by a gentle rinse with water should leave your skin fresh and revived.
CAN BETTER HYGIENE HEAL MY ACNE?
I don’t mean to imply that you are not a clean person, but if any of us examined our hands, washcloths, towels, headbands, and pillowcases for bacteria with one of those blue lights they use on Dexter or CSI, we would want to die - seriously. So, without becoming completely obsessive about it, here are some steps you can take to decrease the amount of bacteria that ends up on your face and contributes to acne.
- Wash your hands frequently, using proper technique.
- Don’t touch your face unless you are performing your skin care routine. This is a bad habit for so many people – just try to become more aware of it.
- Use clean towels and washcloths. This does not mean washing after every use. But it does mean having a dedicated washcloth for drying your clean face only, and washing it regularly.
- Clean your phone and ipad and keyboard with a natural, antibacterial wipe (like CleanWell). We are all on our devices all the time, and they are gross.
- Wash your face thoroughly before bed every, single night. Your skin needs to be clean while you sleep, especially if you use makeup during the day. And, your pillowcase will stay cleaner this way (but wash your linens once a week).
WHAT SKIN CARE SHOULD I USE FOR ACNE?
Okay, the time has come to discuss a treatment strategy, and it may be different than what you've heard from your dermatologist. We are moving away from the drying, skin-stripping acne solutions involving harsh foaming cleansers and traditional, topical medications. Ultimately, pulling too much oil from the skin will cause it to up-regulate sebum production, resulting in MORE acne, rather than less. Once a pimple appears, drying it mercilessly leaves redness, flakes, and scars – who wants that? What’s worse than getting ready for a holiday party and trying to cover a zit with makeup, only to find that the makeup gets stuck and caked in the dry, flaky skin, making the zit more obvious than when you started?
So, the new idea is to clean the skin without stripping it. Here are a few tips:
- Oil cleansing is having a moment, and while it's a wonderful way to deep clean the skin, it should be limited to once or twice a week. It cleans so deeply that it will pull too much oil from the skin if done more often, and cause increased sebum production and breakouts.
- Use a gentle face wash or hand made soap for your regular cleansing. Usually, the fewer chemicals and ingredients, the less likely it is to aggravate your skin. This does not mean that all natural products will work for everyone! Look for mild astringents (dead sea mud), detoxifying ingredients (charcoal and clay), and healing botanicals (aloe, green tea, helichrysum) to help your skin achieve balance.
- Regular exfoliation (1-2 times per week) will keep the epidermis healthy and help prevent blackheads from forming. Over-exfoliation, though, can leave the skin irritated and compromised - more susceptible to bacterial invasion and acne flares.
- Regular masks with raw manuka honey can settle inflammation and have added antibacterial activity – about twice a week is adequate.
- Don’t be afraid to use an oil serum! Used on damp skin just after washing, the right blend of oils can help the skin regulate its own sebum production more effectively. If you break out from an oil serum, it is probably not the right blend for you. (Remember that almost everyone breaks out when switching skin care products, so give it at least a week.)
- In treating blemishes, look for products that are actively antibacterial but not as harsh on the skin as benzoyl peroxide, salicylic acid, and sulfur. Many essential oils have substantial antibacterial and anti-inflammatory activity, and can be very effective in reducing the appearance and duration of breakouts.
- You already know this, but NO PICKING!!! Honestly, ask yourself how often it makes things better, and how often you regret it. Let's leave extractions to the professionals.
WHEN SHOULD I SEE A DOCTOR FOR ACNE?
If you are doing all of these things, and still having regular breakouts, then it’s time to consider other options with your healthcare provider. Here are some topics to discuss:
- Systemic medications - Aside from their bacteria-killing action, many antibiotics are anti-inflammatory, and can help break the cycle that is keeping your skin inflamed. There is absolutely a place for antibiotics in acne treatment, but it should come after you have taken all of the above, less invasive measures to promote your skin’s health.
- LED light and/or laser therapy - These technologies are on the rise and improving, and can help penetrate deeper layers of the skin, where cystic acne tends to form.
- Natural hormone supplements - Consider a hormonal cause of your condition, especially if you are an adult with new-onset acne. Hormones out of balance can trigger breakouts, even after those awful teenage years. You wouldn’t believe how many women in their 40s suddenly find themselves dealing with acne. (Zits AND wrinkles – so unfair!) But, you can support your body’s hormone balance with a variety of natural supplements, like evening primrose oil or black cohosh.
Most importantly, make sure your doctor takes a whole-health approach to caring for your skin. If the plan doesn’t address your diet and habits, then something is missing, and you should look for a more comprehensive provider.
WHAT PRODUCTS DO WE RECOMMEND FOR ACNE?
With love and healthy skin from us to you,