While most people experience a smattering of acne at some point during puberty, that teenage acne generally clears up over time. But for some people, acne stubbornly sticks around, or even appears out of the blue many years later, causing a great deal of frustration and anxiety.
To find out how to get rid of acne, you need to understand why it’s happening. So let’s get down to business!
- 1 What Causes Acne?
- 2 Sebum
- 3 Linoleic Acid
- 4 Squalene
- 5 Lack of Antioxidants
- 6 Quick Recap
- 7 Acne Hormones 1 – Androgens
- 8 Acne Hormones 2 – Insulin & IGF-1
- 9 Acne Hormones 3 – Estrogen
- 10 Acne Bacteria
- 11 Switch to a Low Carb – Low Dairy Diet
- 12 Boost Your Antioxidants
- 13 Vitamin A & Beta-Carotene
- 14 Vitamin C
- 15 Vitamin E
- 16 Exfoliate to Release Those Dead Skin Cells
- 17 Look Into Anti Androgens
- 18 Essential Oils Can Help
- 19 Final Thoughts
What Causes Acne?
Acne isn’t a simple condition. Unlike a pimple which is the result of a temporarily blocked pore, acne is the result of a number of factors which all combine to create the perfect storm in your skin.
To understand what causes acne, and to figure out how to best to resolve the problem, we need to unpack quite a bit of information and we’ll start off by learning a little bit about sebum.
Your skin has two types of pores. One type produces oil (sebum) and the other produces sweat, and it’s the oil producing pores (also called hair follicles) that give rise to acne.
Each hair follicle has a sebaceous gland which is responsible for producing sebum. Sebum lubricates skin and forms a waterproof barrier which prevents moisture loss. This barrier (the acid mantle) also keeps bacteria and other microbes out.
Your body is covered in sebaceous glands (except for the soles of your feet and palms of your hands) and the highest concentration of these glands are found on your face, especially on your forehead and your chin. The back is another area with plenty of sebaceous glands. These areas also have the highest incidence of acne.
Sebum is essential for the healthy function of your skin, but when there is too much sebum you get oily skin.
However, you can have oily skin without getting acne, so too much sebum can’t be the sole cause of acne.
Sebum overproduction is an important factor when it comes to acne (sebum production is 59% higher in acne sufferers than in those with clear skin), but it’s only one piece of the puzzle. For acne to develop, the sebum has to be abnormal.
Sebum is made up of various lipids (fats) and fatty acids, and wax and cholesterol esters.
There’s a whole bunch of them, but we really only need to concern ourselves with linoleic acid which is an omega-6 fatty acid, and squalene which is a lipid.
Researchers have found that the sebum produced by acne sufferers has a lower concentration of linoleic acid compared to the sebum produced by normal skin. The more sebum the skin produces the less linoleic acid it contains.
In fact, studies have shown acne sufferers having as much as a 65% reduction in the linoleic acid levels in their sebum compared to the sebum from normal skin.
Why is this important?
Linoleic acid is necessary for a strong pore wall. Without sufficient linoleic acid, the pore wall develops holes and is far more likely to rupture, allowing some of the material contained in the pore to spill out into the surrounding area and cause inflammation.
You may have seen squalene listed as an ingredient in some skin care products. that’s because it’s an essential component of healthy sebum and therefore of healthy skin. But if squalene is damaged, it’s no longer beneficial, and is, in fact, comedogenic, (a substance that produces or aggravates acne).
How does squalene get damaged?
Through oxidation which turns normal squalene into squalene peroxide.
When skin cells are exposed to squalene peroxide they increase production of keratin, a protein which binds skin cells together.
Too much keratin causes skin cells to stick together in clumps, so instead of dead cells being pushed out of the pore individually one at a time, the clump gets stuck and plugs up the pore.
And that’s not all. Excess keratin makes the pore wall brittle.
Along with the holes in the wall caused by linoleic acid deficiency, the excess keratin ensures that the pore walls are as fragile as they could possibly be.
When researchers applied squalene peroxide to animal test subjects, (on rabbit ears) the animals developed acne. And the more oxidative damage the squalene underwent, the more severe the resulting acne.
When squalene peroxide levels in sebum were measured in a 2014 study, the researchers found that sebum from those with acne contained an eye popping 79% more squalene peroxide than the sebum from those with normal skin.
And there’s more bad news. As the skin produces more sebum, there’s more squalene present to undergo oxidation and become comedogenic.
So why is the squalene oxidizing?
Lack of Antioxidants
Healthy skin contains abundant levels of antioxidants which prevent oxidation. In acne sufferers those antioxidant levels are greatly reduced.
Once again, research highlights the magnitude of the problem.
A 2009 study found that among study participants, those with acne had much lower levels of antioxidant vitamins, (33% less vitamin A, 40% less vitamin C, 45% less vitamin E, and 65% less beta-carotene) than those without acne.
All of those important nutrients are obtained from the diet. And, as well as their antioxidant function, those nutrients have many other jobs to do in the body. Low levels mean you’re storing up health problems.
If you don’t take in enough nutrients, you won’t have a strong antioxidant capacity. But, even with a relatively nutritious diet, you can still find yourself without enough antioxidant capacity to keep your skin healthy because other conditions like allergies, food intolerances and stress gobble up huge amounts of antioxidants.
Sun exposure is another reason for oxidation in the skin. So a good sunscreen is a must.
Let’s stop for a minute and go over what we’ve just discovered.
- Sebum is a normal secretion present in healthy skin.
- The linoleic acid in sebum is essential for pore wall integrity but those with acne have lower levels of linoleic acid and therefore weaker pore walls.
- Squalene, another component of sebum, turns into highly comedogenic squalene peroxide when antioxidants are depleted.
- Acne sufferers overproduce sebum and have high levels of squalene peroxide.
Okay, so far so good, but what’s causing the sebum overproduction in the first place? Hormones that’s what.
Acne Hormones 1 – Androgens
Your body produces numerous hormones but when it comes to acne we want to look at two androgenic hormones – testosterone & Dihydrotestosterone – and insulin and estrogen.
Androgens are most well known as male sex hormones, but females also produce testosterone and dihydrotestosterone.
Higher levels of these androgens correlate with higher sebum production because these hormones directly affect the sebaceous glands which produce sebum. The more testosterone and dihydrotestosterone present, the larger and more active these glands become.
If your doctor or dermatologist tests your hormone levels, they will look for these elevated androgens, and often that will be exactly what they find.
But not always.
Studies show that up to 40% of women with acne have higher than normal testosterone levels. But what about the 60% of women with acne that has testosterone levels that are considered normal?
Well, when those tests are done, it’s the testosterone levels in the blood that gets measured. But skin can make its own testosterone, and this doesn’t show up on the test results because those testosterone are in the skin and not the blood.
Enzymes in the skin convert the precursor hormones dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) into testosterone and dihydrotestosterone.
What other links do we have demonstrating the effect of these androgens?
- Women with polycystic ovary syndrome have very high levels of androgenic hormones, and they often develop acne. One study found that almost 40% of women with acne also had polycystic ovary syndrome.
- Around 50% of anabolic steroid users suffer from acne. Anabolic steroids are androgens.
- Gender reassignment procedures involve the administration of sex hormones.
A 2014 study found that female to male transgender patients taking testosterone experienced a large increase in acne scores. While acne disappeared in male to female transgender patients taking anti androgens and estradiol valerate (an estrogen).
Androgens are clearly implicated in acne. But once again, we need to know why the skin is converting these precursor hormones into testosterone at an elevated rate. And that brings us to insulin.
Acne Hormones 2 – Insulin & IGF-1
Insulin is a hormone produced in the pancreas and it allows the sugars and other nutrients in your bloodstream to enter your cells where they are used for energy.
When you eat carbohydrates your body responds by producing insulin. The more carbohydrates you consume, the more insulin your body has to produce.
Insulin is also released when you eat dairy products. And surprisingly, milk (according to one study) stimulates a larger insulin release than white bread.
Not all dairy products have this effect by the way. Butter which is all fat, and cream which is high in fat, barely have an effect. It’s all down to the amino acids which make up the protein in dairy products.
Another hormone – Insulin-like growth factor 1 (IGF-1) – is linked to acne, and levels of this hormone increase with protein intake.
However, IGF-1 only becomes a problem when insulin levels are too high. Under normal conditions, the vast majority of IGF-1 is bound to insulin-like growth factor binding proteins which make it inactive.
When insulin levels are elevated, more IGF-1 is released, and at the same time less of the binding protein is produced, this results in higher amounts of unbound, active IGF-1 in the bloodstream. If you’re eating protein rich dairy while your insulin levels are high, you stimulate the production of even more IGF-1.
How do these two hormones affect acne?
Insulin and IGF-1 cause the skin to produce more sebum, and the liver to release more of the testosterone precursor, dehydroepiandrosterone (DHEA).
The converting enzymes in the skin which turn testosterone precursors into testosterone, ramp up their activity in the presence of insulin. More insulin equals more testosterone precursors and busier converting enzymes.
These hormones also result in a reduction in the production of a testosterone binding globulin. When testosterone is bound to this globulin, it is inactive and can’t contribute to acne, when it’s unbound, it’s free to wreak havoc on your sebum producing sebaceous glands.
So, insulin and IGF-1 directly cause increased sebum production, they trigger the release of the testosterone precursor DHEA, and they reduce the production of sex hormone binding globulin causing more of the testosterone in the bloodstream to be active.
Current research has established a link between insulin resistance (caused by chronically elevated insulin levels) and acne, with studies showing higher insulin levels and/or insulin resistance in those with acne.
Alright then, now we know that a carbohydrate and dairy rich diet is directly linked to excess sebum production via the action of insulin and IGF-1 both directly and through the release of testosterone precursors.
That excess sebum is deficient in linoleic acid which weakens the pore wall.
The abundance of squalene in all of that sebum becomes oxidized due to lack of antioxidants and turns into comedogenic squalene peroxide.
In a nutshell, we’ve got too much damaged sebum.
Finally, with regard to hormones, let’s see how estrogen ties into acne.
Acne Hormones 3 – Estrogen
Estrogen is a female hormone and lower levels of this hormone are linked to acne. Estrogen counters the sebum boosting effects of androgenic hormones.
Studies show that the lower the levels of estrogen, the more severe the acne.
Acne breakouts often worsen during the phase of the menstrual cycle when estrogen is at its lowest.
The consumption of dairy products has been linked to lower estrogen levels.
Women with acne, taking birth control pills containing estrogen, typically see a roughly 50% reduction in acne symptoms after 6 months.
What factors are implicated in low estrogen levels?
- Excessive exercising
- Extreme Diets
- Ovarian cysts
- Age (estrogen decreases with age)
- Pituitary gland problems
Other symptoms of low estrogen include:
- Low libido
- Irregular periods
- Increased urinary infections
- Hot flashes
- Tender breasts
- Mood swings
If you think you might have low estrogen levels, ask your doctor for a test.
Bacteria is usually the first thing that comes to mind when people think about acne.
But bacteria aren’t the cause of acne, it’s the final piece in the puzzle.
Your pores are home to a type of normally harmless bacteria called Cutibacterium acnes or C. acnes (known prior to a 2016 reclassification as Propionibacterium acnes or p. acnes).
These bacteria don’t live on the skin’s surface, they are naturally present deep in the pore itself.
Once the pore becomes clogged with clumps of dead skin cells (due to keratin), sebum builds in the pore and provides an enormous banquet for the bacteria.
Faced with a huge food supply, the bacteria gorge themselves and multiply rapidly, adding to the mass inside the pore.
Bacteria, like all living organisms, produce waste products (toxins) which also build up in the blocked pore causing irritation and inflammation, and resulting in those characteristic red swollen pimples.
Eventually, the pore reaches its limits, unable to hold any more dead skin cells, sebum, bacteria or toxins.
The inflexible, fragile walls can’t expand, instead, they burst like a breached dam and the gunk from the pore flows out into the surrounding tissue causing more inflammation and the formation of cysts and nodules.
Now that we understand the mechanism behind acne, it’s much easier to put together a plan to fight the problem, but it should be clear that there isn’t a simple fix.
So let’s move on and see what the options are.
Switch to a Low Carb – Low Dairy Diet
Altering eating habits is easier said than done, but those hormones we talked about earlier need to be brought under control.
There is an eating plan with oodles of science behind it which can help, it’s called The Blood Sugar Diet – BSD.
The BSD was developed by Dr. Michael Mosley and he based the diet on studies carried out by Roy Taylor, professor of medicine and metabolism at Newcastle University. Professor Taylor found that a low calorie diet could reverse type 2 diabetes by restoring normal insulin function, and normal insulin function is what you want if you have acne.
The BSD is an 8 week program for anyone with high insulin levels, pre-diabetes or type 2 diabetes. The diet imposes a strict 800 calorie a day limit on your food intake, but the recipes and meal plans are so well put together that you won’t feel hungry.
And, as well as restoring normal insulin levels, this diet will really shed some pounds! Clear skin and a couple of dress size down – that’s got to be worth 8 weeks of your time.
You’ll find lots of information at the Blood Sugar Diet website. Or you can buy the book, The 8-Week Blood Sugar Diet, which covers the entire program and the methodology and research behind the diet, along with all the recipes and meal plans. If you want to get started right away, grab the Kindle version.
You don’t need to stay on this diet forever. Once the initial 8 weeks are up, you transition to a maintenance plan which should keep your insulin at normal levels. You can even switch to the very doable 5:2 diet.
Boost Your Antioxidants
While the BSD is a healthy eating plan, it’s still a good idea to do everything you can to boost your antioxidant levels and prevent squalene damage.
If you recall, the antioxidants mentioned earlier were vitamin A, vitamin C, vitamin E, and beta-carotene.
Vitamin A & Beta-Carotene
Beta-carotene is a plant based source of vitamin A, but it’s one that your body has to convert before it can be used. Unless you’re a vegan, it’s better to take real vitamin A in the form of retinol.
Retinol is found in food sources like liver, fish and eggs.
Beta-carotene is found in plant based foods – fruits and vegetables.
For every 6 units of beta-carotene in your food or supplement, only one unit of retinol is produced by your body, and that presupposes that you have a healthy gut, you may produce much less or none at all.
The best source of supplemental vitamin A is cod liver oil. Yes, it’s yucky and gross, but luckily you don’t need to take it from the spoon these days.
Modern Cod Liver Oil Capsules are taste and odor free, and you won’t get any fishy aftertaste if you burp. Phew!
Most fruits and vegetables contain vitamin C but you would need to eat a lot of very fresh, uncooked produce to get enough to do you much good. Vitamin C content begins to decline after harvesting and vitamin C is destroyed by cooking.
By the time typical supermarket fare makes it to your plate, there really isn’t much vitamin C left.
The RDA for vitamin C is very low and it’s based on the amount needed to prevent scurvy rather than the amount for optimal good health. Many people don’t even manage to reach that low daily intake.
Nobel Prize winning biochemist, Linus Pauling, considered vitamin C deficiency to be at the root of many modern ills including the surge in heart disease.
For boosting vitamin C levels, supplementing is the best option.
The great thing about vitamin C is its low cost, meaning it’s affordable even if your income is stretched thin. If you only get one antioxidant on this list, get vitamin C.
Vitamin C is simply the ascorbic acid molecule. You can safely ignore expensive vitamin C supplements claiming to include vital co-factors. You don’t need those. All of the vitamin C research of any importance has used ascorbic acid.
You can take vitamin C as a pill or as a powder dissolved in water. If you opt for the powder, in addition to taking the vitamin internally, you can mix it with a little water and apply it straight to your skin as a vitamin C serum for additional acne fighting power.
Some things to note:
If you mix vitamin C powder into a glass of water, you must drink it through a straw so that the liquid doesn’t contact your teeth and erode the enamel.
Excess vitamin C will be excreted via your urine and your stool. That means if you take too much in one go, you will most likely experience diarrhea.
Your body uses vitamin C for hundreds of functions and when you’re unwell, under stress or combatting acne, your body will use many times the amount it would normally require.
Start with 1 gram in the morning, and if that doesn’t cause any issues, have another gram at lunch, and another before bed.
After a few days, you can increase the dose to 2 grams at a time. Keep increasing the dose every few days until the vitamin C generates that telltale gurgling in your belly. At that point go back to your previous dose.
When you’re taking several grams of vitamin C at a time in plain, still water it can be pretty sour and hard to take. The drink is much nicer (it’s actually pleasant) if you use carbonated water.
As you acne resolves, you’ll probably find that you tolerate less vitamin C (because your body doesn’t need as much), to reduce the dose as you need to.
The best food sources of vitamin E are generally fairly calorific and are unlikely to fit into the daily allowance in the Blood Sugar Diet. So again, supplements are the way to go.
But, if you prefer food sources, or don’t plan to follow the insulin lowering diet, then get your vitamin E from the following foods (RDA = recommended daily amount) :
- Sunflower seeds – 7.4 mg per 1 oz serving (165 calories) 49% RDA.
- Almonds – 7.3 mg per 1 oz serving (164 calories) 49% RDA.
- Avocado – 4.2 mg per fruit (322 calories) 28% RDA.
- Spinach – 3.7 mg per cup cooked (41 calories) 25% RDA.
- Butternut Squash – 2.6 mg per cup cooked (82 calories) 18% RDA.
- Kiwi – 2.6 mg per cup (110 calories) 18% RDA.
- Broccoli – 2.3 mg per cup (55 calories) 15% RDA
- Olive Oil – 1.9 mg per tablespoon (119 calories) 13% RDA.
Most vitamin E supplements aren’t complete vitamin E. Complete vitamin E comprises 4 tocopherols – Alpha, Beta, Delta and Gamma, and the corresponding 4 tocotrienols.
The most common form found in supplements is d alpha or dl alpha tocopherol. Vitamin E supplements prefixed with d are naturally derived, those prefixed with dl are synthetic.
There’s little point taking a form of vitamin E that only gives you one eighth of the nutrient’s components. And this is especially true when you understand that it’s the tocotrienol isomers of vitamin E that have the most antioxidant activity, having 50 – 70% more potency than tocopherols.
To make sure that you’re taking the best vitamin E supplement, make sure you choose one with the full complement of 4 tocopherols and 4 tocotrienols.
Besides normalizing insulin levels and maximizing antioxidants, what other steps can you take to get rid of acne?
Exfoliate to Release Those Dead Skin Cells
Exfoliants fall into two broad categories. Physical and chemical.
Physical exfoliants include things like crushed seeds and nuts, sugar, salt, microbeads, oats and so on.
Chemical exfoliants include fruit enzymes and naturally derived mild acids. Salicylic acid is a chemical exfoliant, and it’s an acne treatment often prescribed by doctors. Other chemical exfoliants include alpha-hydroxy acid and glycolic acid.
These all work by breaking the bonds holding skin cells together.
Since you’re dealing with the overproduction of sebum, salicylic acid is the best exfoliant to use, the others are better suited to dry and normal skin types.
Salicylic acid has a greater ability to push through the oils in your skin and actually get to the skin cells plugging up your pores. Salicylic acid will also help with inflammation, reduce sebum production, and tackle bacterial overgrowth.
You’ll find a vast range of salicylic products on the market, from soaps and cleansers to moisturizers and chemical peels, making it difficult to know which product and which strength you should use.
If possible, get a recommendation from your dermatologist or doctor. Otherwise, start with a safe and effective product like Paula’s Choice Skin Perfecting 2% BHA Gel Salicylic Acid Exfoliant.
Look Into Anti Androgens
Anti androgens block the action of testosterone in the skin. You’ll need to ask your doctor about anti androgens because these are a prescription only medication.
A commonly prescribed anti androgen is spironolactone.
Research has shown that spironolactone is very effective, with one study demonstrating that low dose spironolactone led to significant improvements in 33% of participants, a complete clearance for another 33% and a partial improvement for 24.7% of the women in the study.
This treatment also reduces sebum production.
Essential Oils Can Help
Essential oils are highly concentrated plant extracts comprising numerous, naturally occurring, beneficial botanical chemicals.
There are two essential oils that stand out for acne treatment.
The first is tea tree essential oil (Melaleuca).
Tea tree oil is a potent antibacterial with proven efficacy against p. acnes bacteria.
After exfoliating with a product containing salicylic acid, apply diluted tea tree oil to your face.
In a clean container, mix 1 oz (30 ml) of carrier oil with 12 drops of tea tree oil. This makes a 2% dilution which is both safe and effective. If you find that it causes any irritation at all, add another 1 oz of carrier oil to the mixture to make a 1% dilution.
Suitable, noncomedogenic carrier oils include jojoba oil, argan oil, hemp seed oil, and sweet almond oil.
The second essential oil worth mentioning is German Chamomile. (Matricaria chamomilla)
This essential oil is one of the most potent natural anti-inflammatories available. Once again, dilute the oil before use and apply to your skin up to twice a day to help reduce pain, inflammation and redness.
Chamomile will also help with stress reduction. Stress uses up a lot of antioxidants, and that’s one reason why breakouts occur when you’re experiencing tough times.
Chamomile will make you feel better and it will free up antioxidants for other purposes.
Acne is a skin disorder with deep and complex roots. Topical treatments and medications absolutely help and should be used, but to eradicate acne, instead of continually managing the symptoms, the root cause needs to be addressed, and the best ways to do that are by changing your diet and loading up on antioxidants.
If you don’t want to change your diet right away, try the antioxidants first, because preventing squalene oxidation may be all that you need to do to see some improvement. But if that’s not enough, please do give the insulin regulating diet a chance.
In a way, acne is like obesity. Everyone wants the quick fix wonder pill or potion, when in reality often the only thing that will work is a suitable diet.
As Hippocrates, the father of medicine said over two thousand years ago – Let food be your medicine and medicine be your food.
Good advice then, still good advice today.
“This article is due to be re-visited, proofread and updated a maximum of 3 years from its original upload date by Dr. Kimberly Langdon, M.D. All the content and media has been uploaded by Lily Greene our webmaster, who is also is in charge of page design.”