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Organization: Root Health, Nutrition & Wellness
Author: Zia Work, RDN
Publish Date: 11/4/24
Skin is the largest organ of the body, and it can tell us a whole lot about our health. Acne, rashes, hives, and dry patches are nuisances that most of us have experienced, but have you ever wondered what these external symptoms can tell us about what is going on inside our bodies?
Skin is closely connected to organs and systems all throughout the body, such as hormones, metabolic heath, and gut health. When there is dysregulation or dysbiosis, our skin has this amazing way of letting us know that something needs to be addressed. In this blog, we will be discussing factors that contribute to the development of acne, and some approaches to treatment.
There are a variety of factors that impact the development and severity of acne, such as hormones, nutrient status, and stress. Regardless of the root cause, most acne forms through 4 main ways:
Overproduction of keratin, or dead skin cells which can result in a clogged hair follicle, leading to inflammation.
Overproduction of sebum, causing pore congestion. Sebum and oils are natural and protective for the skin barrier, but too much can be problematic.
Bacteria or dysbiosis of fungus/bacteria on the skin. Everyone has a collection of these microscopic bacteria living on the skin, but just like in our digestive tract there is a delicate balance that needs to be maintained for optimal functioning.
Inflammation of the pores can be a result of diet, genetics, and bacteria.
Many individuals experience acne during their teen years, particularly during puberty. This is because hormones can impact sebum production, leading to increased likelihood of congested pores resulting in acne and inflammation. When we discuss hormones, testosterone and estrogen likely come to mind. Testosterone is classified as an androgen, or male sex hormone, and androgens are known to stimulate sebum production through a process known as the androgen-sebum pathway. Women also have testosterone (which is the precursor to estrogen), but in lower concentrations due to estrogen being the primary female sex hormone. Estrogen has the opposite effect of testosterone, helping to regulate the production of sebum and minimizing the sebum-enhancing effects of testosterone. Another hormone that is typically found in higher amounts in females when compared to males is progesterone. Progesterone blocks androgen receptors resulting in lowered testosterone production.
How can this help me?
Now that we have the science behind acne in terms of hormones down, let’s discuss how this impacts approaches to treatment. For females, birth control is a commonly used method in skin management, and its effectiveness can help to pinpoint the underlying cause of acne. For example, if birth control improves skin, then it is likely that elevated testosterone contributed to acne, as the pill can lower androgens.
Another approach is to use spironolactone, which is a potassium-sparing diuretic. Sprionolactone encourages the body to increase elimination of water and sodium from the body without affecting potassium levels. While the mechanism is not clearly understood, it appears that this medication affects androgen receptors in the sebaceous glands, lowering sebum production. If acne clears up while using spironolactone, then it is likely elevated androgens or mineral imbalances were contributing to symptoms.
For some, antibiotics may have had a positive impact on clearing up acne and blemishes. Antibiotics targeted for acne use help to reduce the number of bacteria on the skin and in the follicles. Minocycline and doxycycline are common antibiotics used to treat acne and inflammation. If use of these medications has helped to manage skin, consider looking closer at the skin microbiome and contributors to inflammation. Factors such as diet, particularly gluten and dairy, along with stress and lack of sleep can all contribute to increased inflammation, exacerbating acne.
Where can I start?
There are a few areas to focus on when looking to help manage acne. If you have tried any of the above treatments, your results can act as a guide to indicate which direction might be most helpful to pursue. We have learned that acne can stem from hormonal imbalances, dysbiosis (disruption to the microbiome), mineral imbalances, and a stressed nervous system. To best address these areas, interventions might be:
Finding ways to balance hormones through dietary interventions, stress management, and supplement use. Seed cycling can be helpful in balancing estrogen and progesterone, two hormones that can have reduction effects on sebum production and testosterone.
Use of probiotics along with dietary changes to help repopulate the gut and improve microbiome balance
Incorporating electrolytes such as potassium, magnesium, calcium, phosphorus and sodium. Magnesium can help to regulate sebum production and potassium can help to lubricate skin which is important in reducing the risk of breakouts. Electrolytes can also aid in pH balance, as elevated pH can encourage bacterial overgrowth and inflammation.
Finding ways to manage stress or anxiety to calm the nervous system. Activities like breathing exercises, practicing mindfulness, and movement can help.
If you are struggling with managing acne or other skin conditions, reach out to a healthcare provider for guidance.
Resources:
Johnson, R., MS, RDN, LD. (2024). Intersection of Nutrition and Skin [Slide show]. Academy of Nutrition and Dietetics. https://academy.mycrowdwisdom.com/diweb/catalog/launch/package/4/eid/14540366
Prakash, C., Bhargava, P., Tiwari, S., Majumdar, B., & Bhargava, R. K. (2017). Skin Surface pH in Acne Vulgaris: Insights from an Observational Study and Review of the Literature. The Journal of clinical and aesthetic dermatology, 10(7), 33–39.
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