By Dr. Shawna Darou, ND
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 often 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, without much breaking out lower down on the face.
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), or high DHT levels (dihydrotestosterone). 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. Breakouts related to stress-hormones also tend to be deeper and cystic, but fewer spots overall.
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 function, gut microbiome, inflammatory foods, intestinal tract lining. 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.
6. Diffuse breakouts all over the face
Diffuse breakouts all over the face are a little more difficult to diagnose. They can be caused by food intolerances, milder hormone imbalance, poor nutrition in general, and hormonal transitions such as puberty, pregnancy, coming off hormonal birth control. The key to diagnosing these is a thorough look at other health issues. Are there additional signs of food intolerance (past eczema, recurrent childhood ear infections, chronic digestive upset)? How is nutrition in general – too many processed foods, fried foods, sweets and sugar? Are there any hormone transitions that need to be supported? Are there other signs of poor liver-detox – bloating, fatigue, high alcohol intake or exposure to other environmental chemicals?
I hope that this short article has given you some idea of where to start with your acne. From a naturopathic perspective, there can be many causes and it is always important to address the underlying imbalance. Another point to remember, is that all breakouts tend to worsen around the menstrual cycle, but this does not always mean that they are hormonal.
Putting it all together – How to Treat your Acne:
- Improve overall nutrition: Minimize fried foods, dairy products, coffee, sugar and all white carbohydrates, and do not over-eat nuts. Emphasize lots of vegetables, especially leafy greens, regular protein intake through the day and sufficient dietary fiber. Drink plenty of water.
- Test for food intolerances if you also have digestive disturbances, or if you acne is primarily on the forehead or diffusely all over the face.
- Test for hormone imbalance if the breakouts tend to be deep and cystic, and especially if the are on the lower cheeks and jawline.
- Rebalance digestive flora, especially if there are indicators in the location and type of breakout. Remember that many digestive issues show up on the skin.
- Work on lowering your stress levels, and beginning a regular practice of yoga, breathing exercises, meditation or mindfulness to reduce your stress hormone levels.
- Use gentle, natural cleansers and skin products to prevent additional flare-ups. Be cautious with your makeups, as many will clog the pores and aggravate your skin.
- Make sure that you are getting sufficient rest – your body needs at least 7 hours of sleep per night to rest, recover and repair.
If you need some help to determine the cause of your acne struggles, there are many strategies that can be taken to improve the quality of your skin. The first step is usually some form of testing – foods intolerances and/or hormone testing. Once we have a roadmap, it is simply a matter of putting together a personalized plan to address any imbalances found.
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