After you hang out at acne forums and blogs for a while you’ll realize that most acne patients fall into two categories. There are those who see acne mostly as a topical problem and try to get rid of it with creams and lotions. And then there are those who believe acne is a sign that there’s something wrong inside of them, and once they fix what’s wrong then they can get clear, often these are the so-called holistic or natural folk.

In a way both groups are correct, but neither gives you the complete picture. What the holistic folk usually fail to understand is that there are things about acne that nobody can fix. Similarly the topical (or external) care folk needs to understand that hormones and other internal factors affect acne, and that those can’t be fixed with creams and lotions.

Before we go on, let’s quickly define what we mean with internal and external care.

• External care: Anything that you do directly on your skin. This includes creams, lotions, steaming, exfoliating, lasers, etc.
• Internal care: Things you do to indirectly treat acne. Things like diet, stress management, sleep, supplements, ‘cleansing’ and so on.

Pretty self-evident, right.

The importance of topical care

Here are some reasons why you external/topical care is important:

• Topical treatments are the fastest way to deliver active ingredients to your skin, i.e. the site where they are needed. It’s true that ingested vitamins and nutrients eventually make their way into the skin, but it’s much faster and more effective to apply those nutrients directly to the skin.
• Acne-prone skin is hyper-sensitive to androgen hormones. Proper topical remedies can reduce that sensitivity – something you can’t achieve with diet and lifestyle modifications.
• Similarly hyperkeratinization demands external management. Things like salicylic acid can break the extra-hard bonds between cells and thus help to keep the pores open.
• Topical remedies are the best way to apply anti-inflammatory remedies to the skin. And this is absolutely crucial since the immune system tends to overreact to P. Acnes bacteria in acne prone individuals.

As acne patients we got little bit unlucky in the genetic lottery, and because of those genes acne-prone skin is extra-sensitive to many things. This is something that the holistic folk either doesn’t understand or chooses to ignore. Those genetic factors won’t go away – no matter how much you cleanse and detox.

To summarize: we need local remedies since local factors in the skin do affect acne.

The importance of internal care

On the other hand, it’s equally foolish to think you can cure acne just by applying creams and lotions.

• Acne patients have much higher prevalence of gut issues. They increase systemic inflammation in the body and indirectly contribute to acne. You can’t address these with creams and lotions.
• Hormones require both internal and external management. With proper diet and lifestyle changes you can balance many of the acne-causing hormones.
• Studies show that acne patients have higher levels of inflammatory markers and lower levels of anti-inflammatory vitamins and nutrients. This needs internal treatment.

The above examples show the importance of internal care, because acne is also affected by systemic (relating to the body as a whole) factors, and they can only be treated with internal care.

Need for integrated approach

Good acne treatment program should include both internal and external care, because doing just one rarely gives you good results. Depending on the individual you may need to emphasize one over the other, but for best results you should attack acne at both fronts.

Hormones are the perfect example of this. Topical treatments can reduce your skin’s sensitivity to hormones, and internal care can balance out those hormones.

This isn’t really a revolutionary idea. Just something I think many people have either forgotten or overlooked.