For acne-sufferers, a fresh crop of pimples can be downright debilitating. Whether they are papules, pustules, comedones, or cysts, these unsightly eruptions on the skin have the ability to wreak as much havoc on one's mental health as they do on the surface of the skin. It's not uncommon for acne-sufferers to avoid social interactions when breakouts appear as a result of unseen trauma to the psyche that occurs on the inside. Desperate to find long-term solutions, some patients are looking to naturopathic skin care to treat acne internally.
Western medicine provides ample treatment options. There are oral medications (like birth control and Spironolactone — great options for acne patients with PCOS — or the controversial drug, Accutane); topical medications (i.e., prescription-strength retinol); and in-office skin treatments that range from chemical peels to Photodynamic Therapy. But, there are also shortcomings to dermatology's most popular approaches to treating the symptoms of acne. Results are often short-term and require continued use for sustained success, which is especially problematic if women are pregnant and nursing, or plan to become pregnant. Getting off prescription medications is also a challenge, as acne is known to flare up with a vengeance.
Patients of Stacey Shillington, N.D., founder of Naturopathic Beauty, are finding long-term success from treating their acne by turning to naturopathic medicine. "In naturopathy, acne is viewed as a symptom rather than a diagnosis," Shillington explains. "The appearance of acne indicates that there is something going on at a deeper level in the body that needs to be addressed."
Naturopathic Skin Care for Acne: What is it?
Naturopathic medicine differs from Western medicine in its inflammation-centric treatment approach. "Naturopathic doctors are trained to uncover the root cause of any condition, including inflammation," Shillington explains. "Instead of finding a band-aid, or temporary solution for inflammation, we want to discover what is causing it in the first place and to treat it, solving the problem for good." Naturopathic skin care essentially mitigates and treats the acne-causing factors from within, whereas dermatology manages the symptoms of acne from an outside-in vantage point.
Naturopaths assess the holistic functioning of the body's interrelated systems, incorporating diet, lifestyle techniques (including sleep quality and stress-management), as well as supplements, herbs, and medicinal interventions into their treatment plans. At its core, naturopathy restores balance to the body as a means of achieving optimal health, with healing the gut as an unmistakable starting point for doing so.
If you're wondering what inflammation has to do with acne, well, it has a lot to do with acne. At the core, skin eruptions — whether eczema, psoriasis, rosacea, or acne — are due to inflammation, showing up on the body's largest organ, the skin. Managing chronic inflammation comes back to the gut. The gut-skin axis is relevant because the skin and the gut are the two places in the body where a microbiome of beneficial bacteria exists. If you've noticed the rise in oral and even topical probiotic and prebiotic supplements, this is all in the interest of healing and optimizing this microbiome. Gut microbiota are directly linked to everything from one's neurochemistry to their immune function, and the health of the gut is reflected on the skin.
Naturopathic Skin Care for Acne: Inflammation is the Common Thread
"Inflammation is the common thread," Shillington says, reflecting on underlying commonalities she observed between dermatological patients. "Acne is a complex medical condition that is rooted in inflammation. When the root causes of inflammation are addressed, acne will disappear because it is an outward expression of [inner] inflammation." The causes outlined below are all inextricably linked, reflecting the philosophy's holistic nature of health.
Because healing the gut is a crucial part of naturopathic treatment plans, naturopathy treats food as medicine. "Certain foods can aggravate existing inflammation in the body [that exacerbates acne] — especially sugar, dairy, and gluten. For those suffering from psoriasis or eczema, eggs may also be problematic," Shillington says.
Research confirms that dietary components (i.e., glycemic index, dairy content, dietary fats, and probiotics) all play a role in the expression and treatment of acne. To weigh in on the central role of the diet in managing systemic inflammation, nutritionist and dietician Maya Feller, MS, RD, CDN explains that "From a systemic perspective, inflammation occurs when the body is out of balance [and] is at the root of many chronic illnesses. Furthermore, nutrition patterns and ways that people engage in eating can increase inflammation." She notes that processed foods with an abundance of refined carbohydrates, added sugars, added salts, and added fats are what can disrupt the body's homeostasis; this is why she emphasizes that her clients incorporate whole, minimally processed foods into their diets.
One negative outcome of a poor diet that is high in processed foods is high blood sugar. Excessive sugar consumption can lead to insulin dysregulation and can disrupt the gut's microbiome — which is closely connected to the skin's microbiome — and imbalances in which leave the skin vulnerable to breakouts. Cow dairy can increase levels of insulin-like growth factor 1 (IGF-1) and androgenic hormones that result in breakouts. Meanwhile, gluten has been linked to 'leaky gut syndrome,' which can result in bodily inflammation and is explained in more detail below. "Everybody's [optimal diet] is a little bit different, but most people that are prone to inflammation cannot tolerate gluten," Shillington says.
To discover what food sensitivities are contributing to your inflammation, Shillington leads you through an elimination diet in which frequently problematic foods are removed and then gradually reincorporated one by one to see which aggravate the skin.
Insulin Regulation & Blood Sugar
The next common thread that Shillington noticed were difficulties among patients with insulin regulation and blood sugar stability. To help understand the role of insulin, which is secreted by the pancreas whenever carbohydrates are consumed, Feller likens its role to that of a mail carrier delivering packages (i.e., blood sugar) to the cells of the body. "Problems with insulin regulation mean that either the body is not creating enough insulin, or too much exists and there is elevated insulin in the bloodstream," she explains. "[With] elevated insulin, the body begins desensitizing itself to it. At this point, food and carbs are ingested, but the insulin does not respond to it."
Now that you understand why ingesting foods that result in high blood sugar can lead to high levels of insulin and even insulin resistance, Shillington makes the insulin-acne connection clear. She explains that something called IGF-1, or insulin-like growth factor, is increased when insulin levels are too high, which has a documented correlation to severe acne in men and women, directly influencing androgen production. Androgens, a class of pro-inflammatory hormones that include testosterone, increase oil production and lead to worsened acne. Adding to the skin connection, many hormonal acne-sufferers possess a sensitivity to androgens; hence, the body produces androgens to mitigate blood sugar spikes, leading to exacerbated breakouts in acne-prone individuals. (Note that this is why anti-androgenic Spironolactone is prescribed for acne.)
Thus, high blood sugar and insulin lead to the production of androgens like testosterone, which, in turn, result in acne. Driving home the importance of diet, Feller emphasizes the role of fiber in stabilizing blood sugar.
Shillington calls acne-sufferers "notoriously poor detoxifiers." This burden falls upon the organs which detoxify; namely, the liver and lymphatic systems. These systems help rid the body of toxins like heavy metals as well as excess hormones. Sluggish lymph, an accumulation of toxins, or even hormonal imbalance can all result in breakouts that show up on the skin. Popular treatments that aid with detoxification range from exercise and lymphatic drainage massage, to taking liver-supportive supplements like Glutathione or N-Acetyl Cysteine. Diindolylmethane (DIM) is another popular supplement alternative to Spironolactone that is derived from cruciferous vegetables and helps with the metabolizatin of excess hormones, serving an indirectly anti-androgenic effect via over-the-counter means.
Poor Gut Health
"The skin and the gut are so closely connected that gut imbalance shows up on the skin," Shillington says. Our body's microbiome of beneficial bacteria exists in two places — our guts and our skin. "When there is a dysbiosis — or imbalance in the pathogenic and beneficial microbes in the microbiome — certain foods can exacerbate this imbalance, especially sugar." In fact, the so-called gut-brain-skin axis has been linked to the immunobiology of acne by researchers, hence the rise of microbiome-based acne treatments.
In some instances, acne-sufferers might be afflicted by Leaky Gut Syndrome, a condition gluten is notorious for exacerbating. Chronic inflammation to the intestines can damage their epithelial cell lining (i.e., enterocytes), compromising their integrity and leading to intestinal permeability. When this damage occurs, food particles, proteins, and more can leak into the body and cause inflammation.
To nourish the gut, Feller again emphasizes the role of fiber, which can be found in food sources like berries and beans. It stabilizes blood sugar, and also serves as a source of prebiotics that promote the diversity of probiotics (i.e., beneficial bacteria) found in the gut. "When we consume foods that are higher in fiber and have fewer additives, we see more diversity in the bacteria in the gut [whereas] foods that are higher in the added sugars, salts, and fats actually reduce the diversity," Feller explains.
Poor Stress Management
Stress management is a lifestyle-based intervention that can have an impact on your body's expression of acne. "When we experience stress, there are three different biochemical pathways in the body that can contribute to acne formation," Shillington says. "Stress increases cortisol, substance P, and prolactin levels. All these pathways lead directly to increased androgens and acne in susceptible individuals."
When chronically stressed, our bodies are unable to properly balance our blood sugar levels — setting the process above in motion. "Until you calm down your body, it's as if you have to regulate blood sugar manually," Shillington explains. And yes — this absolutely gives you a medical excuse to indulge in stress-reducing self-care practices like meditation, acupuncture, breathwork, yoga, exercise, proper sleep, and more.
Naturopathic Skin Care for Acne: Should You Try It?
"It's hard enough to live in a world being bombarded with unattainable standards of perfection and images on social media, let alone having to face this when dealing with an inflamed face," Shillington says. "People often come to me because they have tried everything and still haven't found success."
It is typically years of failed attempts — and let's face it, suffering — that forces patients to consider a more integrative approach to medicine. Shillington herself eventually turned to Naturopathic medicine after going off of birth control in her twenties and experiencing severe adult acne. "My personality transformed," Shillington recalls of the hormonally-induced cystic acne that fell primarily along her jawline, but could pop up anywhere on her face. "I went from being an outgoing and successful media executive, to stopping socializing, quitting my job, and avoiding seeing my friends." It was a naturopath who re-framed this affliction in terms of being a bodily imbalance that needed addressing, inspiring Shillington's decision to go back to school for her N.D.
While Western medical experts acknowledge many of the very sources of acne Shillington has identified, this approach might seem controversial to some. This is why it is helpful to remember that this is not an "either/or" type of situation. The key is to look at the wisdom of experts as interlocking and synergistically functioning. In my experience, naturopathy is a wonderful complement to treatments from integrative M.D.'s and dermatologists, and has been a part of my life for over a decade.
Remember that for anyone dealing with chronic inflammation and persistent acne, the inner-outer approach to treating it is an innovation that brings hope. "Now looking back, I know that acne was a gift because it led me down a path where I learned about the body and how to heal it. It also taught me unconditional self-love — even when my skin looked like crap. People need to know that there are other ways to heal their skin."