One of the first doctors to lead me down the path of natural medicine once told me that the skin is a reflection of our internal health, and that in many ways an expressive skin can be healthier than a non-expressive one because it is a sign that what is going on internally is being expressed (and therefore excreted) instead of staying internalised, and therefore causing potential long-term damage. Of course, that doesn’t deal with the issues, but since the skin is both an organ of excretion and the first “line of defence” of our organism against external threats, there is much to be said about this phrase as a starting point for approaching skin health. This article deals more specifically with acne in that context.

Acne (vulgaris) is a common dermatological skin disorder, often appearing for the first time in puberty. It presents as obstructions and inflammation in the pilo-sebaceous (hair follicle) glands in the form of comedons, papules, pustules, nodules and/or cysts. It can express as mild, moderate or nodulocystic.

Whether it shows up in adolescence or in adulthood, in women/girls or men/boys, and whether mild or more problematic, acne is, at its root cause, primarily a question of hormone imbalance. More precisely, it is an exteriorised expression of an imbalance related to gonadal androgens (in other words, testosterone and dihydrotestosterone). When this imbalance is present and in addition other pathways of excretion (referred to as emunctories) are also congested, acne can appear. In addition, on the nervous-system level one finds that there is an imbalance towards high parasympathetic function (hypervagotonic terrain).

What are commonly referred to as the causes of acne, such as excessive proliferation of keratin and production of sebum, overgrowth of Propionibacterium acnes bacteria, and inflammation, are actually downstream mechanisms of the hormone and terrain imbalances above rather than the true causes.

Conventional medicine’s approach is usually to give either or a combination of:

  • the contraceptive pill (for girls/women), cortisol injections, selective aldosterone antagonists, etc
  • medium to long term antibiotics or
  • Accutane (retinoids) and
  • Topical treatments (benzoyl peroxide, glycolic acid, salicylic acid, etc)

These tend to be harsh treatments with quite strong side effects and in addition, with the exception of the pill (which can’t be given to boys and has side effects and potential long-term consequences as well) don’t actually address the underlying hormonal causes. It is an area of health where, though it may take a bit longer and require more effort, natural medicine will address the underlying causes (as well as the downstream mechanisms and the symptoms) extremely well without the harsh side effect and consequences to health of conventional medicines. It’s worth giving it a try first with a herbalist trained to address the causes.When treating acne naturally, I always address the following 3 factors:

  • Hormones, primarily LH, gonadal androgens, cortisol, thyroid metabolism (indirectly), and endocrine pancreas function (insulin regulation)
  • The nervous system, particularly  parasympathetic dominance, and including also stress and psycho-emotional factors
  • The emunctories (and therefore also diet) – particularly the liver, exocrine pancreas and colon. I remember hearing comments on many occasions that acne had nothing to do with diet, including from dermatologists. Well, that isn’t quite true. The issue related to emunctory dysfunction above is the reason why diet is an important aspect to improving acne and needs to be addressed. Clearly it isn’t always an easy thing to do with adolescents but taking any number of small steps at a time will make a big difference.

I won’t go into more specific details of the hormonal mechanisms here because they are complex and also manifest differently in different people, but below are some general suggestions for addressing each of the 3 aspects on your own, if you don’t have access to a herbalist or while waiting to see one.Herbs:

  • Nervous system: Roman chamomile, Lavender
  • Emunctories: Artichoke, Milk thistle, Black radish, Burdock root, Dandelion root, Agrimony
  • Adrenals and Gonads: Black currant in gemmotherapy, Rhodiola, Oat straw or seed, Lady’s mantle, Yarrow, Borage
 Topical treatment (symptomatic):
  • Clay masks (always keep the mask wet) made with the following: plain yogurt (no additives or thickeners) rather than water to avoid some of the drying aspects of clay, 1 drop essential oil of German chamomile or Lavender (Angustifolia variety) and 1 drop of tea tree EO, a medicinal infusion (i.e. longer than a normal herbal tea infusion) of Wild pansy or Marigold flowers. Make the mask 3-4 times a week for 5-15 minutes (keeping it wet with a little mist of water or hydrosols/aromatic water). Start at 5 minutes and increase if skin can handle it.
  • Wash face with adapted gentle soap-free products and hydrate with light emollients – I like the Salcura range which is specific for skin issues and can be found at the Natural Dispensary (use my practitioner code Terra10 for 10% off their products).
Diet and Lifestyle:
  • Pancreas and liver sparring diets which means:
    • low/no refined sugars/carbs, low/no high GI-low fibre foods including some fruit (bananas, grapes, mangoes), breads, white/refined grains
    • low/no milk products, particularly non-organic cow products
    • low/no fried foods, trans-fat etc,
    • low/no alcohol, coffee, black teas, fizzy drinks, fruit juices
    • plenty of green/colourful vegetables, pulses, whole grains, berries
    • good healthy fats – olive oil, linseed/hemp seed oil, nuts & seeds, avocados, eggs, etc
    • good quality lean meats/fish
    • some natural yogurts (low amounts), kefir and other fermented foods
    • plenty of water, lemon water, herbal teas
    • clay internally (ask me how to take this and type of clay necessary)
  • Stress reduction:
    • Increase exercise and fun – at least 20-30 minutes of activity where heart rate stays up; dance, socialisation
    • Meditation, walks in nature, breath work, yoga or similar
  • Supplements and trace minerals:
    • Stress: magnesium
    • Hormones and Skin: vitamin A and E, B complex, Omega 3, zinc, copper, selenium

As always, I’m available for specific questions but an individualised consultation is always best.

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