Updated: Nov 6, 2018
I like to educate my patients about the physiology of their acne. I try to be as
simple as possible and draw them a diagram of their sebaceous glands and all
the things that act on it to produce acneic lesions like pustules, comedones or
cysts. Then we can formulate a plan of ATTACK that addresses all of these
factors – like inhibiting sebaceous glands, controlling the hormones acting on
them, managing the skin bacterial load and enhancing the skin immunity.
The most important thing for them to understand is that hormonal acne is a
complex interplay and everyone is a little different. It’s not necessarily just
your PCOS or just the cheese in your diet or the stress or polluition… it’s a
unique gamut of factors that create the perfect recipe for acne.
The main culprit in acne is the sebaceous gland. This little guy is highly
susceptible to the balance of hormones in our body. It will respond to
hormonal disarray by overproducing sebum. Ultimately the sebum blocks the
gland making it a sitting duck to be colonised by bacteria on the skin and form
an inflamed or cystic or pus-filled spot.
Hormonal disarray is increasingly common – there are many postulations
about why. You may have heard a few, for example the abundance of women
on the contraceptive pill, hormones in our food, high stress causing the body
to overproduce oestrogen in relation to progesterone. There may be more
than one reasons your hormones are not happy. The most common reasons I
see in non-PCOS patients would be stress and lifestyle factors. The main
lifestyle factor that we can easily address would be glycaemic load in the diet.
A big shot of sugar or alcohol (which acts like sugar) causes an insulin spike
which is ultimately a stress response. This has a complex interaction with your
sex hormones. It is easily managed by veering toward a low glyaemic index diet
and reminding yourself that binge drinking is going to negatively affect your
The ideal way to intervene with hormonal disarray would have to be lifestyle
management– but this can be a long and challenging road for some. Other
options include androgen blocking medications like Aldactone or some forms
of the contraceptive pill. Apart from managing hormones, we can manage the
skin by inhibiting sebaceous glands using vitamin A or gentle acids. We can also
treat infection and inflammation using low dose antibiotics or my favourite –
high quality zinc supplementation.
Everyone’s different when it comes to the causes and the management of
hormonal acne. It is often a journey of finding exactly what works for the
patient. My biggest piece of advice would be to seek medical support early.
You can integrate your wishes for naturopathic or herbal management with a
medical protocol if you like. When hormonal acne is causing scarring, pigment
alteration or social awkwardness, I caution you to turn toward a multi-modal
treatment using both conventional medicine and the alternative medicine of
your choosing. The power is in the two working together to ensure you are not
left with permanent scarring. There are great solutions to offer from both
herbal and scientific realms of medicine.