Acne
Root-Cause Care for Acne
Adult acne is common and frustrating, and it usually has internal drivers.
The Basics
What acne actually is
Acne starts in the hair follicle, the tiny pocket in the skin where each hair grows. Four things tend to happen at once: the skin makes too much oil, skin cells build up faster than they shed, the follicle gets clogged, and bacteria or yeast overgrow inside it. The result is inflammation you can see and often feel.
Most people have the common form, acne vulgaris. Some develop more severe forms with deep, painful nodules, and a rare few have acne that comes with fever or joint pain, which needs prompt medical attention. There is also fungal acne, caused by Malassezia yeast. It shows up as small, uniform, often itchy bumps, mostly on the chest and back, and it usually does not respond to standard acne treatment.
Why acne keeps coming back
If you have acne, you have probably tried retinoids, benzoyl peroxide, salicylic acid, antibiotics, or birth control pills. Those treatments can work, and for some people they are exactly the right tool. What they don't treat is why your skin is making so much oil and inflammation in the first place, which is why breakouts so often return when treatment stops. Long courses of antibiotics can also disrupt the gut microbiome, which can feed the very inflammation we are trying to calm.
A word about isotretinoin
Isotretinoin, once sold as Accutane, can be very effective for severe acne. It also requires careful monitoring, including lab work and strict pregnancy prevention, because it causes birth defects. Whether or not you use it, looking at what is driving your acne from the inside still matters.
What I Look For
What is often driving it
Acne rarely has a single cause. These are the patterns I look for most often, some at the surface of the skin and some deeper inside the body.
On the Skin
Excess oil and clogged pores
Oil glands respond to signals from inside the body, including hormones and insulin. When those signals are overactive, the glands make more oil, skin cells stick together, and pores get clogged.
Bacteria and yeast
A bacterium called C. acnes lives in everyone's follicles, but in a clogged, oily pore it overgrows and triggers inflammation. In fungal acne, Malassezia yeast breaks down the skin's oils into irritating compounds that inflame the follicle.
What touches your skin
Pressure and friction from masks, helmets, and chin straps can trigger breakouts where they sit. Heavy cosmetics and some hair and skin products can also clog pores.
From the Inside
Food, blood sugar, and growth signals
Diet is well documented to influence acne. Sugar and high-glycemic foods spike insulin, which raises a growth hormone called IGF-1. Together they increase oil production and androgen activity, and androgens raise IGF-1 further, which keeps the cycle going. Dairy, wheat, sugar, and concentrated proteins like whey all switch on the same growth signal inside skin cells, called mTORC1 (Melnik, 2012), while fiber, vegetables, and plant compounds called polyphenols help calm it.
Gut infections and imbalance
An overgrowth of Candida, or an infection like H. pylori in the stomach, can keep the immune system activated, and that inflammation can show up in the skin. H. pylori has been linked to several skin conditions, including acne (Kutlubay, 2014), and in one small study it was significantly more common in people with severe acne than in people without acne (Khodaeiani, 2014). Parasites also sometimes travel along with H. pylori, so I test for the whole picture.
Hormones and other triggers
High androgens such as testosterone or an imbalance between estrogen and progesterone can drive breakouts. Sometimes the problem is happening only at the level of the follicle, so normal hormone tests don't rule it out, and sometimes acne isn't hormonal at all. Some medications, including certain birth control pills and steroids, high-dose biotin or B12 supplements, and chronic stress can also trigger flares.
Sources:
Kutlubay Z, Zara T, Engin B, et al. Helicobacter pylori infection and skin disorders. Hong Kong Med J. 2014;20(4):317-24. PubMed 25045884
Khodaeiani E, Halimi M, Hagigi A. Severe Acne Vulgaris is Associated with Helicobacter pylori Infection: First Report in the Literature. J Med Sci. 2014;14:92-96. doi:10.3923/jms.2014.92.96
Melnik B. Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet. Dermatoendocrinol. 2012;4(1):20-32. PubMed 22870349
C: Cut inflammatory foods. Removing dairy, wheat, and sugar, lowering the glycemic load of your meals, and adding more vegetables and fiber.
L: Lower toxic burden. Simpler, non-clogging skin and hair products, and a review of supplements and cosmetics that may be adding to breakouts.
E: Eliminate gut pathogens. Testing for and treating H. pylori, Candida, and other gut infections, along with targeted treatment for fungal acne when it is part of the picture.
A: Absorb key nutrients. Targeted nutrients that help regulate oil production and inflammation, used under supervision because some are risky at high doses.
R: Rebuild and Restore. Repairing the gut lining, especially after rounds of antibiotics, and calming the stress response, since chronic stress suppresses progesterone and worsens hormonal imbalance.
What to expect
Acne takes time to change, because the skin needs several months to work through new cycles of oil, cells, and healing. Acne is also deeply emotional, and many people worry about it coming back the moment things improve. That is why we step down treatments gradually, so you can see your skin hold its ground before anything is removed.
Ready to find out what is driving your acne?
A free consultation is the best way to see whether this approach is the right fit for you.