Acne is one of the most common conditions I see in the clinic, with varying degrees of severity. It is one of the hardest things to live with as an adult, and it often causes my patients to make some fairly radical decisions with medications and hormonal treatments.
As with most conditions, my approach as a naturopathic doctor is to first determine the cause. The location of your breakouts is the first step for diagnosis. Certain areas of the face are are known for digestive disturbances, hormone imbalance, stress and liver function. Here is a summary:
The first thing I think of with a primarily forehead breakout, especially if the breakout is itchy, small bumps that look more like a rash, is food intolerances. The forehead is often where I see significant dairy intolerance or other foods which can include egg, gluten, certain nuts and others. Think food intolerance and digestion if your breakouts are primarily on the forehead.
2. Lower cheeks and jawline
The lower cheeks and jawline are an area notoriously related to high androgen levels, meaning high testosterone and other testosterone-like hormones. This can be caused by polycystic ovarian syndrome, high stress levels causing increased DHEA, non-classic CAH (congenital adrenal hyperplasia). One thing to note about this type of breakout, is that it worsens with both stress, and poor diet (especially too many carbs and sugars), and these breakouts tend to be deep and cystic. Think hormone imbalance if your breakouts are primarily on the lower cheeks and jawline.
The chin is where I see the majority of stress-related breakouts, related to rises in cortisol and DHEA. This is where you will find a few spots if you have had a particularly stressful week or month. Bear in mind that stress can amplify any other imbalance, so you may also have other locations.
4. Breakouts around the nasal fold
This is a different type of breakout with a more red and flakey appearance, and may cause redness and cracks around the nasal folds. These breakouts are caused by digestive issues, usually an imbalance in digestive flora caused by too much bad bacteria or other pathogenic organisms. It is treated by addressing the digestive tract. Most people with these breakouts also have digestive symptoms, ranging from bloating, diarrhea or irritable bowel syndrome.
5. Around the mouth (perioral dermatitis)
Breakouts around the mouth can vary from a rashy / eczema appearance to more classic pimples. This type of breakout is called perioral dermatitis and it can have many potential causes, ranging from food intolerance, to toothpaste reactions, to digestive tract imbalances. A starting point for perioral dermatitis is to test for food intolerances, switch to an all-natural toothpaste brand, and rebalance digestive flora.