Acne
Acne is a common, distressing condition characterised by blocked pores, spots and blackheads due to excessive production of sebum/oil from hair follicles and hyperkeratinzation leading to a build-up of surface cells. There are many factors that sustain acne including hormonal imbalances, dietary deficiencies, poor liver and digestive function and therefore there are also many ways in which herbs, diet and lifestyle can be used to improve the condition.
Underlying factors:
- Androgens – Testosterone and more active metabolite dihydroxytestosterone (DHT): Stimulate sebum-producing cells, increasing rate of cell division, size and keratin production. There may be increased sensitivity to androgens produced in the hair follicle (a genetic trait).
In women, the effects of testosterone increase around ovulation and at onset of menstruation, therefore symptoms may be exaccerbated around that time. Unlike most other hormones, there is no negative feedback on androgen production in women to reduce elevated levels. - Progesterone: In women, an increase in androgens may be linked to an inadequate secretion of progesterone after ovulation, prompting an increase in luteinising hormone (LH) secretion which raises ovarian androgen production.
- Digestive and eliminative functions: Poor elimination of waste products of metabolism, inflammation and toxins or absorbtion of toxins through the gut due to poor digestive function or dysbiosis (gut bacteria imbalances) can lead to inflammation, poor skin health and compromised skin integrity.
The liver plays an important role in elimination and maintaining the equilibrium of circulating ovarian, glucocorticoid, androgenic and thyroid hormones. - Insulin and glucose:
- Insulin and ILGF increase with blood glucose and cause increased androgen production; insulin also decreases sex hormone binding globulin which binds testosterone in the blood>
- Glucose in the skin is increased due to need for increased energy because of cutaneous hypertrophy
- Insulin supports inflammation and tissue growth and is associated with chronic inflammatory conditions generally – e.g. cancer, atherosclerosis.
- Insulin also increases inflammatory arachidonic acid via delta5-desaturase
- Low cortisol (possibly due to chronic stress and adrenal depletion):
- Lack of cortisol exacerbates the condition (cortisol is antiinflammatory)
- Cortisol also combats acne by its anti-mitotic action on the germinal cells, opposing the action of the androgens.
- Depressed cortisol causes increased secretion of ACTH therefore stimulating other adrenal hormones e.g. androgens.
- Stress affects acne negatively – for example it reduces insulin sensitivity and increases androgen production from the adrenals via increased ACTH. Chronic stress also increases androgens via prolactin and leutenising hormone.
- Growth hormone and prolactin have anabolic activity and, in synergy with androgens, encourage the multiplication and growth of cells generally and of sebaceous cysts in particular, and set the scene for super-infection.
- Thyroid: Hyperfunction of the thyroid axis also stimulates cellular multiplication and the growth and proliferation of cysts.
Diet:
Diet generally should be low in sugars and easily absorbed carbohydrates (low glycemic load) to reduce blood sugar and insulin production.
Eat lots of: Raw food, fruit, veg, water, yoghurt (for good gut bacteria), garlic (boosts immune system), fibre (aids with reducing toxins), oily fish, watercress and brassicas promote liver metabolism (specifically phase II).
Avoid: Dairy (promotes insulin and IGF1), alcohol, caffeine, chocolate, eggs, fried food, bad fats, spicy foods, wheat, sugar (reduces immune system function and glucose tolerance in skin), processed foods (unhealthy fats, sugar, few enzymes therefore unhealthy and damage skin and collagen)
Lifestyle:
- Reduce stress
- Include sunshine, exercise, healthy sleep
- Appropriate weight loss reduces inflammation
Micronutrients:
- Vitamin A and K deficiency associated with acne
- Vitamins B C D E may be helpful
- Zinc (shellfish, soy, grains, sunflower seeds, nuts) – healing, normalises oestrogen and reduces androgen excess
- Vitamin B6 and Zn may be helpful for pre-menstrual acne
- Selenium aids skin health and elasticity and is antioxidant
- Pre/probiotics, enzymes and betaine hydrochloride for good gut health
- Chromium picolinate may aid glucose balance (and cinnamon, fenugreek)
- Essential fatty acids (EFAs) are beneficial for skin health, maintenance of stratum corneum permeability barrier, maturation and differentiation of stratum corneum, healing, reduction of inflammation via multiple mechanisms, inhibition of 5Alpha reductase (5AR) which converts testosterone to DHT) and lecithin (aids absorption)
(Flaxseed clinical trial – reduced skin sensitivity and improved condition)
Omega3 – oily fish, linseeds, walnuts; GLA (omega 6) – hemp oil, linseed, walnuts
(NB Mg, B6, Se, Vit C needed to convert short chain omega3 to long chain in vegetarian diet) - Magnesium deficiency increases inflammation
Required actions:
- Hormone regulating (testosterone, DHT, LH, PL, GH, thyroid) and raise sex hormone binding globulin (SHBG) which binds testosterone in blood (e.g. phytooestrogens (e.g. flax), fibre and reduce insulin levels) and inhibit 5AR (Zn, B6, green tea, EFAs, flax lignans)
- Support elimination / ‘cleanse’ blood including good digestive and liver health
- Support adrenals and stress response /cortisol production
- Regulate glucose and insulin
- Healing / skin integrity
- Immune system support and antibacterial action
- Circulatory support
- Antioxidant and anti-inflammatory
Topical treatment:
- Antibacterial topically (Lavender / tea tree EO diluted 5-25%)
- Apple cider vinegar:water 1:10 topically
- Omega 6 oil (e.g. sunflower oil)– linoleic acid deficiency associated with acne (causes hyperkeratinisation and comedones)
Herbs:
Hormone modulators
- Chaste tree berry (Vitex agnus castus) – Clinical trial showed improvement. Anti-androgenic and anti-prolactinaemic via dopaminergic effect on pituitary.
- Liquorice (Glycyrrhiza glabra) – anti-inflammatory, supports cortisol production, aids liver function, decreases DHT from testosterone via 5AR and inhibits aromatase
- White paeony (Paeonia lateriflora) – reduces DHT from testosterone and modulates aromatase
- Saw palmetto (Serenoa repens) and nettle root (Urtica dioica) inhibit 5AR
Anti-inflammatories / anti-bacterials
- Turmeric (Curcuma longa)
- Echinacea spp. – supports immune function, aids lymphatic drainage/elimination
- Barberry (Berberis aquifolium) – berberine anti-P. acnes and sebaceous lipogenesis in studies
- Gotu kola (Centella asiatica) – supports tissue health, wound healer, stimulates fibroblasts to synthesise collagen, aids stress response
- Commiphora mukul reduced lesions in trial
Liver herbs
- Milk thistle (Silybum marianum),
- Turmeric,
- Schisandra chinensis
Nervine herbs
- St John’s wort (Hypericum perforatum),
- Skullcap (Scutellaria lateriflora),
- Vervain (Verbena officinalis),
- Rosemary (Rosmarinus officinalis) (all also beneficial for liver and anti-inflammatory)
Digestive herbs and herbs to aid elimination
- ‘Bitters’ to aid digestion and gut flora health (e.g. gentian (Gentiana lutea), barberry, Verbena, Dandelion (Taraxacum officinalis)
- Burdock (Arctium lappa) – aids elimination of toxins / metabolites from tissues
Caution: The information here is offered for its educational value only and should not be used to diagnose, treat, or prevent disease; please contact your health care practitioner.
