Hormonal Acne 101: Causes and foundational steps to healing
I can’t even COUNT the number of people who have been asking for a post on hormonal acne. AND I KNOW WHY. Girl, I understand. I’ve had acne since I was 16.
Though the psychological toll and insecurities that come from having anything less than perfect skin as a woman deserve it’s own post ENTIRELY, for now, I will say this: It is just as much Mental as it is Physical. I’m sure your experience speaks to that, but guess what, so does science.
An article from DermNet describes some of these psychosocial components perfectly :
“Skin conditions can reduce the quality of life, defined by the World Health Organization as a state of complete physical, mental, and social well-being. This can often be attributed to feeling pressured to look normal or comply with social standards.
Many people with a skin condition:
experience decreased sense of body image
have lower self-esteem
avoid situations whereskin is exposed
feel anxious about people judging them
withdraw from social interactions it
have sexual and relationship issues
feel shame and disgust about their appearance.
higher likelihood of mental disturbances and suicidal thoughts
Experiences like this can have a profound impact and make the individual feel ashamed"
You could eat all the sardines and sauerkraut and avocados in the world, but if you aren’t acknowledging and working through the psychological components of acne, then it is for naught.
The social anxiety, the stress, the depression, THESE THINGS ARE REAL. I don’t need to link to studies to prove it (even though I do…because science). And as I speak about the bodily processes that contribute to acne, we need to take this all in context: ABOVE ALL, your self-care and acceptance practice for yourself (skin included) is the most important. Okay? Okay. Let's move on.
I’m what I like to call a Delicate Flower. Some seasons of my life have brought clearer skin than others, mostly depending on my stress level (and subsequent inflammation and gut health). Life happens, and it’s unrealistic to expect to have porcelain skin if you have a genetic predisposition to acne, especially when your diet consists of processed foods, you’re nutritionally depleted, and you are a walking stress ball. Spots will happen, but knowing the source and contributions of CHRONIC breakouts and acne can be helpful in identifying bigger issues going on in the body. *note that I said CHRONIC breakouts. Getting breakouts here or there cyclically isn't necessarily an indication of a health issue. And EITHER WAY, skin acceptance rules all!
So, acne is characterized in the medical literature is an INFLAMMATORY CONDITION. Meaning it is caused by inflammation of some sort….. To which I say yeah no shit Sherlock. Zits are red and angry, OBVIOUSLY, it’s some inflamed ish. But that isn’t the full answer. Saying acne is caused by inflammation and that the answer is eating an anti-inflammatory diet is only ONE piece of the WHOLE puzzle. If someone’s main source of inflammation was caused by antibiotic filled dairy, and they went on an anti-inflammatory diet than yeah they might see their face clear up. But what about the patient whose main source of inflammation is actually stress? What if it’s the psychological component or negative body image that is causing their cortisol to be chronically inflamed? Or even consider the fact that most of us have MULTIPLE causes of inflammation. Then cutting out dairy isn't going to solve all their skin problems!
Have you felt frustrated or at fault because eating “clean” didn't fix all your skin woes? You’re not alone. Diet is just ONE piece of the puzzle. (A big one, for sure, but only one). And often it takes a more tailored approach that requires us to get REAL about our emotional and physical stressors so we can best eradicate them and their inflammation along with it. Even doing so, though, it is important to realize that the end result isn't necessarily always 'perfect' skin. Breaking out here and there is a part of life! Some individuals are genetically prone to be more skin sensitive and androgen sensitive than others, and I don't believe perfection in ANY area is a reasonable goal. So keep that in mind!
We need to know WHERE the biggest sources of inflammation are in your body if we are going to REALLY get to the root cause of your breakouts.
I'd like to quickly caveat with this: Acne is not actually the problem, it technically has no health concern attached to it in isolation. It is simply a way your body COMMUNICATES about something in the body. So, with that in mind, let’s dig into the 3 foundational systems that contribute to acne and how we can best support them for optimal skin health.
You might be thinking: Three? Only? But jess there are like a MILLION things that can cause acne. Dairy, coffee, sugar, even fabric for some people!
Yes. But those are what I call the BRANCHES of skin health. Your branches are secondary to your ROOTS. Let’s focus on the root cause and not things like “remove coffee and get clear skin”. Sure, that definitely helps a lot of people, but WHY it does that has to do with the state of your roots. Let me explain.
Here are my 3 ROOTS of skin health—aka the 3 systems in the body that are critical for maintaining clear skin.
You’ve HAD to have heard by now that your gut health has a direct impact on skin….No? WELL WELCOME TO 2018. It seems like everywhere I look people are swearing up and down that the gut is the root of any and all skin conditions.
Though I’m not a fan of a singular approach, the truth is your gut health REALLY is imperative to the health of your skin. Even more so if you are battling a gut-specific infection and are dealing with acne because of it. Then healing your gut really would be the singular step to clearing your skin! It all depends on YOUR SOURCE/SOURCES of inflammation.
For most of us, though, our gut is DEFINITELY playing a role in our acne. A 2008 study of 13,000 acne sufferers found they were MUCH more likely to suffer from symptoms like gas, bloating, and constipation than their clear skin counterparts.
This all has to do with bacteria. The colony of bacteria in your gut should be 2 things: VARIED and BALANCED. Meaning you’ve got more GOOD bacteria than bad, and said good bacteria have multiple varied strains. The same study above found that 54% of acne patients have SIGNIFICANT alterations/imbalances in the gut flora.
Why is this bacteria balance so important for skin? Basically, having a robust Microbiome strengthens the lining of our gut, making proteins and toxins less likely to slip through like in the case of LEAKY GUT. Leaky gut happens when the lining of our gut has been compromised and now foreign proteins, toxins, and food particles can leak into our blood stream. The body sees them as foreign invaders (because food isn’t supposed to be leaking out of your intestines…duh) and mounts INFLAMMATORY responses to them. One way this shows up is on our FACE. As I mentioned earlier, acne is an inflammatory condition for everyone, but where that inflammation is coming from can differ for many. The root cause HERE is leaky gut and bacterial imbalances/infections in our Microbiome like SIBO, candida, or even parasites (both leaky gut and imbalances often co-occur together!)
I wrote an entire post all about my foundations for gut healing HEREwhere I describe my 5 pillars for gut healing: 1. Remove Gut irritating foods 2. Include Healing Foods SPECIFIC to the gut 3. Support stomach acid 4. TEST 5. Stress less. These all apply specifically to healing skin! To read more about these steps in detail, GO HERE.
If you have regular breakouts or even severe acne, and you struggle with ANY digestive distress then I HIGHLY recommend making gut healing a priority for you. For more than just your skin health, it is the pinnacle of your immune system and a major contributor to mental health as well. GUT IS LIFE guys. Love it well.
Here are some more gut--skin specific causes/solutions that aren’t mentioned in my gut post (go therefor the basics first):
1.antibiotics: Many Functional Medicine practitioners have said just one round of antibiotics can disrupt your bacteria balance for up to 3 YEARS. This is fairly unfortunate considering antibiotics are still one of the most popular drugs prescribed for acne. Ironically, they end up doing more harm than good in the long run for the health of your gut and consequently, YOUR SKIN. So if you are or have been a chronic antibiotic user and you have acne, chances are you’ve got some gut rehab to do in the form of testing for infections and repopulating that good bacteria colony. This is true for a lot of us in our 20's and 30's who were raised as children in the years of antibiotic prescriptions for EVERYTHING.
2.prebiotics and resistant starch: both are crucial for feeding the good bacteria you are repopulating. Prebiotics include Jerusalem artichokes, raw garlic, onion, green bananas, raw asparagus, raw leeks, raw jicama while RESISTANT starch is found in most cooked then COOLED starches like white or sweet potatoes, white rice, gluten-free oatmeal, plantains, and even green bananas!!
3.Skin Specific Probiotics: studieshave shown that patients with acne were particularly low in the strains Lactobacillus and that supplementing with a fermented milk drink high in this strain led to a reduction in acne over the course of the trial. Check the probiotic you use to make sure it has ample of this strain family, bonus points if its Lactobacillus Casei or Plantarum, which have been shown to be highly effective in lowering inflammatory cytokine markers.
4. TEST: I know I talk about this in my gut post, but if you have recurring acne and gut distress symptoms after doing the basics of a gut healing diet, I HIGHLY suggest finding a functional medicine practitioner who will test for overgrowths and parasites and can get you on a natural antifungal or bacterial to correct the imbalance that is happening. It's costly, so do all the dietandlifestylechanges first, but WORTH IT. Acne, in particular, has been linked to a specific imbalance with the bad bacteria Corynebacterium, which you would only know you had if you tested for it.
5. PATIENCE: let’s say you do all the right things mentioned above and in my gut post, and you get tested and are taking NATURAL antibacterials like garlic and oil of oregano and taking loads of skin specific good probiotics, You STILL have to give it at least 4-6 months to see some healing. That is a LONG time for any of us with acne who want a solution this second! I get it, and we’ve all been there. Patience is a virtue, my friend, especially in root cause medicine.
I know it's hard....but I believe in you.
* a note on constipation: it is very common for patients struggling with chronic constipation to experience acne. Besides being indicative of less than ideal gut health, it also means you aren’t excreting your used hormones as efficiently as you should, allowing them ample time to be reabsorbed by the bloodstream and disrupt hormone balances, therefore leading to acne and other imbalance symptoms. Poop well and poop often for optimal skin health!
This organ is the SECOND place I highly suggest all acne patients look.
This is for 2 reasons: TOXINS and INSULIN
We are bombarded with so many toxins daily, through the food we eat, products we use, and the air we breathe. A liver can’t help but be overwhelmed in today’s modern world, which can cause it to get a little sluggish. A sluggish liver may not be able to adequately and sufficiently detox all the toxins entering the body, so excess toxins are either stored in our fat or eliminated through one of our 7 elimination systems: liver, lymph, lungs, SKIN, kidneys, blood, and colon. CRAZY RIGHT? More than just our liver detoxes, which can make the point of this number misleading, HOWEVER, the foundations of helping the liver out for acne still stand.
Did you see I mentioned skin as one of our elimination pathways? This means toxins can technically be excreted through our sweat AND sebaceous glands (our oil production). *oil isn’t the problem here, we produce oil daily and it's good and protective of our face and body, but excess or toxic sebum is definitely a contributor to acne.*
What does this mean? Well, the outstanding theory states that a burdened liver will route detoxification to other pathways like the skin, therefore causing us to secrete them through sweat and pores which can lead to sebum build up and, you guessed it, acne.
Another reason why toxin build-up in the liver contributes to acne is simply that it contributes to imbalances in our hormone levels. I have spoken at nauseam of the importance of your liver in making sure excess hormone levels are filtered OUT and not BACK in the blood. Your gut has an equal role in this (the liver dumps the old hormones in the gut to be excreted, but if you aren’t pooping AT LEAST once per day, then they sit there and get absorbed back in the bloodstream which is a NO NO for hormone levels and acne!). The gut and liver are the dynamic duo for hormone balance, and if BOTH aren’t in working order, then we have a problem. And your breakouts could very well just be letting you know that.
Want to know how to ACTUALLY detox and support your liver health? I wrote an ENTIRE post dedicated to proper detox HERE that I highly recommend you give a read.
For skin specifically, here are some extra tips that go above and beyond that post:
Get nutrient specific: Eating fat-soluble vitamins like A, D and K, support your liver with leafy greens and herbal bitters. Drink dandelion tea and warm lemon water, etc. (see all my food detox recs in my detox post above!)
coffee and alcohol: 2 common irritants for acne sufferers, and many find that when they cut both out for a time being it helps with breakouts. The best way to see if it is a trigger for YOU is to remove them all COMPLETELY for 6 weeks, then add one back in a couple days in a row and see how your skin responds. For some, it’s just a dose thing (like coffee every day breaks them out, but coffee once a week is fine) and for others, it’s just a big no (like me….because I’m sensitive AF).
castor oil packs and coffee enemas are two great tools for increasing circulation and detox capabilities of the liver and can be a great addition to any skin healing protocol. Coffee enemas, in particular, are the MOST effective way to increase glutathione, our master antioxidant produced in the body. There hasn’t been a study isolating the use of coffee enemas in acne patients for skin health alone, but countless studies have shown it to be amazing for detox and lowering inflammation, AND lots of anecdotal evidence has shown it to really help many skin issues. It’s up to you though. Some people feel weird sticking stuff up their butt..... I wonder why.... *shrug *. If you’re one of those, you can still naturally increase glutathione by getting all three of these CRITICAL detox minerals: Zinc, Selenium, and Magnesium. I eat a few brazil nuts a day for my selenium and supplement with zincand magnesiumwhich I highly recommend you do as well!
Sweating: I mention this in my detox post, but it is ESPECIALLY helpful for skin health. MAKE SURE to cleanse properly directly after or it kind of misses the point.
Invest in cleaner products: water filters, air filtering plants, nontoxic skincare, etc. This ALL lightens the toxic load and can make a massive difference for those struggling with acne. Even if you don’t have acne, it’s worth investing in nontoxic products for the health of your entire body. ESPECIALLY SKINCARE AND MAKEUP.
Drink a SHIT TON of water. I feel like this goes without saying….but I’m just going to say it. It’s an oldie but a goodie.
Insulin is the hormone secreted by your pancreas in response to sugar in our blood. This happens in response to eating carbs, and eating more processed carbs like a donut is going to result in MORE sugar in the blood (and subsequently more insulin secreted) than something like a sweet potato. We all know this though, I'm sure you're WELL aware of that familiar sugar high feeling.
How does this relate to liver health? It has to do with something called Non-Alcoholic Fatty Liver Disease. NAFLD is exactly what it sounds like, fat deposits build up in the liver and prevent it from functioning well. NAFLD affects around 30% of Americans of ALL age groups. We are even seeing children with it due to diets high in processed foods and high sugar sodas. And it’s estimated that 1 in every 3 people in the UK have the early stages of NAFLD (I know we’re not in the UK….BUT LIKE THIS IS SERIOUS).
The problem here? NAFLD is notoriously hard to diagnose because it won't show up as high liver enzymes like it's alcoholic counterpart. It can only truly be spotted by a liver biopsy. Elevated Insulin causes acne because it stimulates our sebaceous glands to pump out more sebum and SENSITIZES our sebaceous glands to androgens like DHT (which is what most acne products on the market try to block in the skin).
Glycogen stores aren’t just found in our muscles, but also our liver. So when we are seeking to lower insulin levels and improve our blood sugar, we cannot just think exercising and cutting out processed food is enough. (It is HUGE, don’t get me wrong, but it’s not enough). The state of your liver and whether you are in the early stages of NAFLD can contribute to your likelihood of developing Type 2 diabetes, and a recent study even showed that 80% of type 2 diabetic patients have NAFLD.
Now, what does this have to do with acne? Well, NAFLD directly causes acne by the mechanism stated above, and in order to fix it, we need to decrease the amount of fat in our liver BY reducing insulin levels. I tell you how below
Prioritize nutrient density, I tell you how in my nutrition post HERE
Make sure to get at least 20 grams of protein at breakfast, and eat breakfast within an hour of waking up
Eat protein and healthy fat at every meal (for a list of my favorites, click here)
Sleep well and keep stress under control
Do not skip meals or “push through” hunger
Preferentially choose nutrient-dense complex carbs (I wrote out a whole list HERE) over bread, pastries, and sweets
Eat fiber-rich green veggies
Whether you think you have NAFLD or not, all these stay true for women with PCOS, high sugar diets, a past of processed food, or are pre-diabetic. Most of us have no idea we have high blood sugar, but if you are experiencing regular acne on your jawline and around your mouth, blood sugar definitely could be at play.
Also, remember that unstable blood sugar is not just caused by diet but also sleep and stress levels too! Which leads me to my last root...
THIS IS MY FAVORITE ONE. It is my favorite because I find it is the MOST underestimated component of skin health in the entire world. We SAY we know that stress causes acne, but I don’t think we understand JUST HOW MUCH.
Did you know it is INCREDIBLY common for women with adult-onset acne to have it all triggered by an emotional stressful season of life or a traumatic event? That they could have had clear skin for years and all of a sudden, with no change in diet or lifestyle, go through something like a family death or hard financial times and BOOM, wake up in the mirror with spots covering their face?
I personally had picture perfect skin until I was 16 and had thought I escaped the normal “puberty skin” until one weekend I went away to dance camp where I was VERY stressed about competing and performing and getting on the national team. I stayed awake all night going over routines in my head and was an anxious mess for 3 days straight, on top of physical exerting myself 10 hours per day. I came home a few days later with more than 20 spots on my previously pristine face. It happened so fast my family thought it was an allergic reaction….Years of acne later and guess what. IT WASN’T.
Dermatologists were shocked, I kept telling them I was REALLY stressed when it happened and they would just skip over that piece of info like it didn’t matter. All the while pumping me with antibiotics and creams and, eventually, Accutane.
Was I an anomaly? NOPE. Here is why stress is the most COMMON cause of breakouts, and what we can do about it.
Stress is the biggest whammy when it comes to breakouts for the following reasons:
It is the NUMBER ONE driver of inflammation in the body, and since Acne is an inflammatory condition it’s not hard to realize that stress could easily trigger an onset of breakouts, whether short-term or chronically
The production of stress hormones take away from our production of Progesterone in a process called “pregnenolone steal”, and acne is one of the most common symptoms of low progesterone
Stress causes our blood sugar to get out of whack ALL BY ITSELF (meaning, even if you were eating kale all day but you were super stressed, your blood sugar would be all over the place). And we know insulin directly is implicated in acne (mentioned above). So, yeah. This is a big one.
High levels of stress hormones can kill off the good bacteria in our gut and trigger overgrowths like SIBO and Candida, which we talked about earlier in the post for being a NO NO for clear skin
Stress and anxiety interfere with sleep, something that is CRITICAL for the health of not just our skin but all our bodily functions
Stress can very often lead our adrenals to be fatigued and overwhelmed, which can lead to sugar and salt cravings that can be not so nice for acne prone skin
Honestly, the list goes on. Stress is the biggest enemy of clear skin.
Out of all three roots, this is the one to take most note of. I promise. Don't be that person that goes out and buys an enema kit and a water filtration system but still engages with toxic people and lets emotions fester without processing. That will bring no fruit in your quest to skin healing.
Did you hear me?
IF YOU HEAL YOUR LIVER AND GUT IT WILL NOT DO ANYTHING FOR YOUR SKIN LONG TERM IF YOU ARE NOT WORKING THROUGH THE SOURCES OF EMOTIONAL AND PHYSICAL STRESS IN YOUR LIFE.
Take a moment. Read that again. This is important.
Stress literally can trigger all the inflammatory processes in the body involved in breakouts ALONE, with no help from processed food or toxins. Stress is the ULTIMATE toxin, the ULTIMATE gut bug, etc. Recognize the emotional and physical stressors in your life and work through them. Here are some common ones:
-the stress of negative self-talk and low self-esteem
-loss of loved one
-life transitions like a new job, moving, etc
-being a new mom--physical AND emotional stress right there
-family or relationship problems
-being unsure or insecure about life decisions, where you’re at right now (very common for young adults)
-the stress of SKIN INSECURITY (yes..the day in and day out stress of being insecure about your skin actually contribute to breakouts. Do NOT underestimate the power of your thoughts in this process)
I wrote an entire post on stress and listed several stress hacks that can physically and emotionally help you cope with stress, read it HERE.
For skin specifically, my greatest piece of advice is to work on your SKIN MINDSET.
I was reading THIS STUDY on the link between social anxiety and severity of acne and a line in the conclusion stuck out to me: “The current findings suggest that how one perceives their skin to be evaluated by others has implications for self-perceptions and may act as a barrier to sport/exercise/social participation”.
Did you see that?
It’s about how we PERCEIVE our skin is being perceived by others. IT’S ALL ABOUT PERCEPTION. And I find that a really freeing thought. We are not in prison from our breakouts. We are not forced to recluse or forced to feel as down as we do. Granted, there is the intersectionality of mental health and gut health and its consequences on skin health. BUT, we still vastly underestimate how much mindset has to do without our ability to live a life free of the insecurity acne plagues so many with.
I’m even sure a lot of you reading this very post were hoping to find answers that would clear your skin and set you free from the prison acne has made for you. But I’m here to tell you that THERE IS NO PRISON. The trauma, the sadness, the social anxiety are REAL. Trust me, girl, I get that. I’ve been there. But there is NOTHING holding you back from allowing yourself to be free from the psychological holds of acne EXCEPT for our own belief in your worth and beauty.
The belief that breaking out is shameful, that having perfect skin makes us superior, and all other bullshit like that.
My name is Jess, I SPECIALIZE in hormones and healing and I still definitely get breakouts. Life happens. Stress happens. We don’t live in a bubble. And it's not a sign that I am broken or majorly unhealthy, it's a sign that I'm human. And if you only get ONE THING from this post, please please please please let it be this: Learn to love and accept your skin WHERE IT IS NOW. Know that there is nothing “wrong” with your face. Having acne does not make you defective, it makes you human. Be okay with who you are HERE, and that will make the healing process all the more effective and nourishing.
All in all, there are countless things you can experiment with when trying to clear your skin: remove dairy and gluten, eat ALL the gut loving foods, love your liver, etc. However, the most important step in healing (both for physical and emotional health) will be skin acceptance.
Show up in life, go to the party, don't hide your face, look people in the eye. AIN'T NO SHAME IN YOUR SKIN GAME GIRL.
What's your experience been with breakouts? What have been ways you've healed your skin on the outside and inside? Comment below!