It’s time to dip into the mailbag again. A reader sent me a fantastic question that I believe many people struggle with.
Hi! I just discover your site and it seems to have lot of valuable information on acne. I’m 34 years old, had acne since a teenager but it got worse since the last 2 years (face and body). My problem is that there’s so much information on the subject (here on this site but also all over the internet), I have no clue where to start.
I hear you man! In fact I’m in the process of writing my book at the moment and was just thinking that I have to write a how to get started chapter. The book covers so much information and makes so many specific recommendations that without a good guidance people can get overwhelmed.
The problem with acne is that it’s caused by two ‘fundamental things’ (for lack of a better word): hormones and inflammation. Inflammation especially can come from many, many sources. And that means there are an almost infinite number of causes and cures to acne. Not all of those are relevant to you, but we have no good way to say which are and which aren’t It’s like the old advertising truism that half of my advertising is wasted, but I don’t know which half. And different people have different causes. For example, one person may get breakouts from stress, another from gut issues and a third person from eating gluten. That’s why I have to cover a lot of ground.
Good places to get started
I have no data to back this up, but based on what I’ve heard from acne patients, the most common causes are (in no particular order):
- Stress and negative emotions
- Gut issues
- Diet, either
- Blood sugar issues stemming from insulin resistance
- Specific dietary triggers, like gluten, dairy or eating something you are sensitive to
- External irritants or improper skin care regimen
Unfortunately I haven’t covered all of these topics on my blog, so I can’t always point you to lot of additional information, but let me at least cover the basics on this post.
Stress
I believe that to some degree stress is a factor for every acne patient. We just live in such stressful and hectic lives. When you get stressed the brain releases neurotransmitters. One of these, known as substance P (SP), has a direct effect on the skin. It can cause inflammation and increase sebum production. One study on psoriasis showed that injecting SP on the skin triggered psoriasis flares – even on people who are not prone to getting psoriasis. Substance P, and stress in general, also has a very negative effect on gut health.
Gut
I’ve covered gut issues pretty well on this blog. I have a hunch that most people are unaware they even have gut problems. That’s because they don’t necessarily cause symptoms we take note of. At least in my case I dismissed them as normal rumblings of the stomach. It was only until I started paying attention that I noticed there’s some problem with my gut. I also noticed that when I get gut problems flare up of my scalp acne soon follow.
Please see this post for more: Is Your Acne Caused By Gut Issues? 3 Simple Ways To Know.
If you have gut issues, it might also be a good idea to ask your doctor to test you for Candida infection in the gut. A couple of studies have shown that people with chronic skin problems have higher rates of Candida infections in the gut than people with clear skin.
Diet
I’ve also written about diet a lot here. I think that in the natural health circles the effect of diet on acne is overrated. Yes, it’s a factor, but people make unwarranted claims on how much dietary changes can affect acne.
Unfortunately the whole diet thing is a huge can of worms. There are a few easy things you can do, like try eliminating gluten and dairy from your diet. But pinning down dietary sensitivities and other triggers is a stuff of nightmares. For food sensitivities I want to say that never, ever get diagnosed by naturopaths, chiropractors or other alt-med practitioners. The problem is that they often use unreliable tests, such as vega tests or muscle testing. Those tests look impressive on people who don’t know any better, but when they always fail in blinded tests. Studies have shown they are no better than guessing. The practitioners who use these are fooling both themselves and their unfortunate patients.
See the diet section for more info on diets.
External irritants and improper skin care
I wrote a lot about these into my book, but unfortunately haven’t covered these well on the blog. But the crux of the matter is that acne is triggered by inflammation (in the skin). And the skin doesn’t care where that inflammation comes from. It can come from external irritants, harsh skin care products or internal factors, but the end result remains the same.
Luckily there’s a simple way to get some idea of whether your skin care regiment helps or hurts. Just keep an eye on your skin for any signs of irritation shortly after applying your skin care products. It’s normal for your skin to feel slightly tight or dry following benzoyl peroxide, but any signs of burning, redness, itchiness or more persistent dryness of the skin are all bad signs.
There’s also a flipside to this. Acne-prone skin needs better care than normal skin. That’s because it produces more sebum and has a stronger reaction to P. Acnes bacteria than normal skin. So if your skin feels dry, tight or is easily irritated then you probably need to take a better care of it. I’ll give some specific tips later.
How to get some quick wins
Let’s talk about how to get some quick wins. Given the nature of acne, these things should be effective for many people.
- Daily 15 minute relaxation or meditation session. Little bit of relaxation can do wonders to stress levels. And it doesn’t have to be more than 15 minutes. You can find plenty of free relaxation or meditation audios online for free. Just pick one that you like listening and do it every day.
- Eat fermented foods. I believe that fermented foods are better way to get probiotics than supplements. They are also simple to make at home. I don’t have instructions on my site, but you can find them online. Yogurt, kefir or sauerkraut are good ones to get started with.
- Eat less carbohydrates and more fat and protein. No need to go low carb. Just eat less carbs than you normally would and substitute them with fat and protein. This can really help with blood sugar issues and hormonal acne.
- Omega 3 fats. Balancing omega 3 and 6 fats can do wonders for inflammation. In practice this means eating less processed foods (and especially bakery products) and more omega 3 rich foods. Omega 3 enriched eggs are a surprisingly good source.
- Drink 5 cups of green tea per day. Green tea polyphenols are potent antioxidants. Studies have shown that regularly drinking green tea can help with hormonal issues and reduce inflammation.
- Use antioxidant moisturizer or cream. People with acne often shun moisturizers since their skin is already oily. But oily skin is not the same as moisturized skin. Moist skin means there’s water in the cells of the top layer of the skin. More importantly you can use them to apply antioxidants to your skin. Studies have compared antioxidant creams to benzoyl peroxide and topical antibiotics. The results show that antioxidant creams can be as effective as those established treatments in treating acne. Look for something with vitamin B3, C or E. Green tea creams can also be effective.
Of course there’s lot more to acne than what I can cover here, but this should set you on the right track. And I’d be surprised if none of the above helps your skin.
Thanks a lot Seppo, really. It gives us a way to start understanding that complex problem that is acne. I’ll dig into that for the next few days and write you back with questions, comments etc. I really hope your blog will help me in my quest of defeating acne, a quest that was not really succesful to this date…
Thx again.
Happy to help Jason!
First question 😉
I’ve read on the blog that yogurt raise the IGF-1 levels quite high but it can also brings probiotics. If I go with a greek yogurt that is high on protein but really low on carbs (in fact so low that it doesn’t taste tht good), is it good alternative?
Jason, I’m not quite sure that yogurt will increase IGF-1 level. I know it will increase insulin level, but I think increase in IGF-1 is much more damaging to the skin.
From what I’ve been able to gather IGF-1 level is related to protein intake. Large studies also suggest it’s tied to calcium and some other nutrients, but it’s hard to know what to make of those results. Take this study as an example:
https://www.nature.com/ejcn/journal/v61/n1/full/1602494a.html
It showed a link between milk and IGF-1, but much less so for yogurt. People who ate more yogurt had somewhat higher IGF-1 levels, but the increase was much smaller than for milk. Even fruits increased IGF-1 more.
Similar results from this study:
https://www.ncbi.nlm.nih.gov/pubmed/20553076
This study showed no difference in IGF-1 levels between women who supplemented with yogurt and women who supplemented with carbs:
https://www.ncbi.nlm.nih.gov/pubmed/21719898
Anyway, I wouldn’t read too much into those studies. It’s hard to make sense of IGF-1 nutrient relationships.
As to carbs in yogurt, they are not the problem as far as IGF-1 is concerned. It’s more about the protein in milk, and possibly also about bovine IGF-1.
Hi Seppo,
You talk about being careful about what you are using on your skin. I had been using all natural products on my skin for a while (Anne Marie Gianini), without any improvement. My skin was constantly itchy and pretty dry (even though I was using oil on my face twice a day). I have recently switched over to Exposed (its been about a week). My skin feels the same so far, pretty itchy and its definitely dry. My question is, is it normal to have itchy skin when you have acne? Its so itchy sometimes that it wakes me up at night. I find sleeping with a humidifier tends to help a bit. I know it is likely too early to know if Exposed is still causing this problem or if my skin is still adjusting to this new regimen, im just sick of the itch!
From what you wrote, it seems you had this problem before you started using Exposed. If that’s correct, then it’s unlikely that Exposed caused it. It does sound like you have an irritant reaction to something. That something could be something in the skin care products you’ve been using or it could be something in the air or environment, perhaps even laundry detergent residue.
No, it’s not normal to have itchy skin when you have acne. Itching indicates an irritant/allergic reaction. The damage this causes could contribute to acne though.
I should add that natural products aren’t necessarily any safer or better for the skin than products with synthetic chemicals. Sometimes they are, but sometimes synthetic chemicals are much better for the skin.
Here’s what I would do in your case:
1. Stop using all skin care products, including cleansers, you currently use. You can replace cleanser with honey.
2. Find a moisturizer formulated for sensitive/eczema-prone skin, Cetaphil products are usually a good option. And please don’t buy this from Anna Marie Gianni or from anyone else selling ‘all natural’ solutions. In this case it’s better to go with a company that has sound experience in formulating cosmetics for sensitive skin.
3. Give it a few weeks to see if anything changes.
If that doesn’t work, please see a dermatologist who can do patch tests to figure out what your skin is reacting to.
I wouldn’t try to treat your acne until you have the itching under control. It’s possible that once we have that sorted your acne also goes away.
Wow. Thank you so much for this information. I had been advised by someone from the natural field that the itching was likely the cause of dry skin and to keep moisturizing. The itching is not from Exposed, it started long before, and even before the Anne Marie Gianni products.
For the honey – would you recommend Maneuka honey or will some from the grocery story work? Have you ever heard of an intolerance to FODMAPS causing this type of reaction?
Again, thank you.
Happy to help 🙂
Yes, itching is likely related to skin dryness. The ‘thing’ that causes itching also damages the skin barrier function and allows too much moisture to escape from the skin. It’s not that the itching per se is the cause of dry skin, rather both are caused by the same thing.
Manuka honey is more about hype than any real difference to normal honey. It could be somewhat more antibacterial, but I’m not sure whether that makes any difference in daily use.
The reason I asked you to use honey as cleanser is that the surfactants in washes and cleansers are one of the more common skin irritants. They are a necessary evil because they help to make the skin clean, but at the same time they can be too aggressive and irritate the skin.
It is possible that FODMAPs, or other dietary irritants, cause skin problems. Whether they can cause itching, I can’t really say, but I wouldn’t rule it out.
Hi Seppo,
So its been a few weeks and my skin is still itching. I stopped all cleansers, clean my face with honey and use cetaphil as a moisturizer. I went to see the dermatologist and she kind of dismissed that I may be reacting to something as she said there is no sign of a reaction anywhere else on my body except for my acne. She thinks it might be the inflammation that is causing the itching since my skin is pretty flared up right now. She reluctantly said she would do a skin patch test if I really wanted to (at $320), but does not suspect that something coming into contact with my skin is causing the acne. She knows that I don’t really want to go on Acutane, and was concerned about the the flare up so she suggested blue light therapy and a glycolic peal. Not sure what I should do at this point…Still deciding on patch test and blue light as both are rather expensive and I dont know if either will yield results…
Ok, so then we can rule out topical products as the cause of the itching. To me itching indicates some form of hypersensitivity reaction, but I have to say that I’m not really an expert when it comes to skin issues other than acne. It’s possible I’m wrong about it. I can say that when people email me about their acne, they rarely say anything about itching.
I also have a text book on cosmetic science and technology. I just checked it and it also notes that itching is usually associated with some form of irritant reaction. That said, it’s also possible that stress or some medication cause itching. Unfortunately this is really all I can say about this. Dry skin can also feel itchy. In your case I might consult another dermatologist to see what they say.
As to blue light and glycolic peels, they can be effective against acne. But if you have some allergic/irritant reaction then they probably won’t help.
Found this study out of Poland. Not sure of the significance but it could shed some light on itching:
https://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-0355&html=1
Interesting, thanks for sharing this. In brief, this study shows quite a few of the surveyed acne patients had some degree of itching. In most cases this was mild and relatively infrequent.
Here are a few points you should keep in mind about this study:
– This does not prove that acne causes itching, or the other way around. It simply shows that a portion of acne patients also had some degree of itching.
– Unfortunately there was no control group (people without acne), so we don’t know if the reported itching was abnormal. It’s possible that people without acne would report similar degree of itching. Perhaps because they are a part of a study and are actively paying attention to itching.
– Itching was not linked to acne severity, i.e. severe acne didn’t itch more than mild acne. This would suggest acne doesn’t cause itching.
– Itching is likely linked to problems with the skin barrier, and it’s well established that people with acne have skin barrier problems.
Thanks for sharing the paper. Unfortunately it doesn’t really give us much new information 🙁