All About Skin: Naturopathic Care for Acne Vulgaris

Acne vulgaris is a skin condition involving your oil (sebaceous) glands. Although all age groups may be affected by its many variants, the peak incidence is during adolescence. Acne vulgaris affects 85% of the adolescent and young adult population, particularly those who are biologically male1 or females with hormone imbalances. Pimple breakouts may be seen on the face, trunk, neck, and back, which are sites with high numbers of sebaceous glands. Acne vulgaris is often mild and self-limiting, but severe forms may produce scars and hyperpigmentation (dark spots) that may be difficult to manage without professional care.₁ This may occur with improper treatments and self-medications! Albeit not life-threatening, acne may have severe implications on emotional well-being as breakouts affect cosmetic appearance, causing those with acne to feel extra self-conscious and with reduced self-confidence in social settings.
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Understanding Acne Vulgaris

​Acne develops when cells which are normally supposed to slough off and shed from your skin build-up inside your hair follicle. Over time, this accumulation of dead skin cells creates a sebum plug, which is favorable for the growth of the bacteria causing acne: Cutibacterium acnes. It is important to note that Cutibacterium acnes normally live on your skin and do not cause disease when balance is maintained. However, dysbiosis of your skin’s microbiome and lack of diversity between your normal flora can trigger an immune response, leading to inflammation.₃ Additionally, the microorganisms in your gut, through its connections with your skin’s flora, may trigger your breakouts!₃ Harsh rubbing or picking your pimples can also lead to further inflammation, worsening your pimples. Using occlusive ingredients on your skin and hair, such as pomade, may trigger your acne breakouts!
 
Your hormones have important roles to play in the development of acne, as women with higher levels of androgens may have severe breakouts compared to those with lower levels. Androgen receptors are found all over your skin and affects the growth of your sebaceous glands, as well as sebum (oil) production.₃​ Given that higher amounts of androgens, such as testosterone (which may be familiar to you as the primary male hormone but is also produced in women and those assigned female at birth) facilitate sebum production, this may inevitably support the colonization of Cutibacterium acnes, triggering your breakouts! This is precisely why boys and individuals assigned male at birth may have intense acne breakouts during puberty!
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Signs and Symptoms

Acne presents with open and closed comedones, which may be familiar to you as blackheads (open comedones) and whiteheads (closed comedones). When inflamed, these may develop into papules (solid spots bulging on the skin), nodules (solid spots that are larger than papules), and pustules (small bumps containing white blood cells).₁​ Breakouts are typically found on body areas where your sebaceous glands are most abundant. These include your neck, face, chest, shoulders, and upper back.

Allopathic Options

The market offers a wide variety of options to manage acne, from topical medications to laser or invasive treatments. A patient with acne is typically managed with retinoids and salicylic acid, which are applied directly onto the skin. In severe cases, topical or oral antibiotics may be given. Although effective, some retinoids may cause severe birth defects and other problems during pregnancy and should be avoided when you are pregnant or breastfeeding.₁

Oral contraceptives are often prescribed when the cause of your breakouts is hormonal imbalance.₁ Treatments are typically prescribed in a progressive manner until effective. However, it can take weeks to months for the treatment to take effect and improvements to be observed. Additionally, acne treatments may cause dryness, redness, and even unwanted irritation that will make your skin more sensitive, if not properly used. Generally, these medications act to suppress your symptoms, not target the root cause of your problem. If toning down on your acne medications is your goal, naturopathic doctors are committed to helping you rebuild your overall health to prevent future flares and support your body throughout the withdrawal process. 
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Improving Your Skin Health
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It is undeniable that we become conscious of our looks as we grow older. Having good and flawless skin increases our confidence, especially in social situations. Skin health has become a hot topic, with people paying hefty amounts in treatments and products. Although with a great number of promising benefits and ingredients, anything you apply to your skin may cause more harm than good when not guided by a skin health expert! That being said, the development of acne can be triggered by over-developed skin care routines. It is important to note that each of your products are packed with ingredients that may be beneficial on its own but can cause detrimental effects when combined with other products. Additionally, applying too much skin products may clog your pores and worsen your breakouts! The key is to taper down on these intense rituals that can disrupt your natural microbiome and oils, with the guidance of your health care provider. Avoiding harsh scrubs or aggravating products can also help minimize irritation. Also, manipulating or picking on your lesions is never a good idea! This may cause further irritation and can lead to infections and scarring (worst case scenario!). 
 
As previously mentioned, the development of acne can also be triggered by fluctuations in your hormones. When this occurs, it is important to reduce inflammation by regulating your hormone levels! A solid understanding of how your hormones work and how your body keeps these in check can unlock more effective, faster, and tailored options for your acne problems.₂​

Botanical Medicine for Glowing Skin
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• Tea Tree Oil – extracted from Melaleuca alternifolia, tea tree oil has antibacterial and anti-inflammatory properties and has been used for centuries to manage skin problems.₁ Tea tree oil has also been proven to be as effective as benzoyl peroxide in managing inflammation but with fewer side effects.₁ This means less chances of having dryness, skin redness, and itching, which can occur with benzoyl peroxide use! But a warning, remember to always dilute tea tree oil in a skin-safe carrier oil (like jojoba, sweet almond, or sesame) to avoid burning your skin and never apply it near your eyes. 
• Green tea – extracted from the fresh leaves of Camellia sinensis, green tea has anti-inflammatory, antibacterial, and antioxidant effects that will help tamp down your acne breakouts. Additionally, green tea helps reduce the production of sebum by inhibiting 5-alpha-reductase, preventing its excessive build-up and formation of oil plugs.₁ Green tea also contains l-theanine which helps you manage stress and anxiety, and their related breakouts!
• Barberry – a lovely plant with inedible reddish fruit, the inner part of the root or stem of Berberis vulgaris is used for its anti-inflammatory, antioxidant, anxiolytic (anxiety-busting!), and antimicrobial effects helping to manage different types of infections. It manages acne through suppressing fat and lipid production in your sebaceous glands, preventing excessive build-up that may trigger inflammation.₁ While barberry can be a great short-term option while other natural options begin their work, it is important to only use this herb under the care of a licensed naturopathic physician with expertise in botanical medicine, because prolonged exposure can be harmful. 
• Mangosteen - a famous fruit in Southeast Asia, mangosteen belongs to the Garcinia mangostana tree that exerts strong antibacterial activity against Staphylococcus epidermidis and C. acnes, which are bacteria that can cause acne!₁
• Aloe Vera – as a widely used herbal remedy due to its anti-inflammatory, antibacterial, astringent, and healing activities, aloe vera helps minimize unwanted effects from tretinoin administration!₁ This can help soothe your skin, as well as reduce redness and irritation from the use of topical medications!

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Seed Cycling

Seed cycling is an interesting and effective option to help manage menstrual irregularities and polycystic ovary syndrome (PCOS), which can cause hormonal imbalances and ovarian problems in women who menstruate. As a traditional approach, seed cycling helps maintain hormonal balance through incorporating the use of seeds which contain antioxidants, vitamins, and minerals, healthy fats, proteins, and carbohydrates, all of which promotes normal levels of your hormones throughout all phases of your ovarian cycle.₄ These seeds include sunflower, pumpkin, flax, and sesame. Flax and pumpkin seeds are rich in phytoestrogens, which help nurture healthy estrogen levels during the follicular phase, while sunflower and sesame seeds contain phytoprogesterones that support optimal progesterone levels during the luteal phase. Seed cycling can also be beneficial in regulating thyroid hormone and prolactin levels in the blood, which is associated with weight gain when you are diagnosed with PCOS.₄
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The Naturopathic Approach

Acne vulgaris is a universal problem that has affected people’s self-esteem and confidence for years. Although it appears on the surface of your skin, acne vulgaris provides important insights into what's happening inside your body. This is a sign that you should start considering your optimal health. Rather than masking your symptoms with medications that may cause further irritation and inflammation, it is important to target the root cause of your problems to maintain long-term health and confidence. Discover the naturopathic approach to managing acne vulgaris with Natural Path to Wellness today!
 
 
REFERENCES:
 
1.      Proença AC, Luís Â, Duarte AP. The Role of Herbal Medicine in the Treatment of Acne Vulgaris: A Systematic Review of Clinical Trials. Evid Based Complement Alternat Med. 2022;2022:2011945. Published 2022 Jun 15. doi:10.1155/2022/2011945
2.      Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-248. Published 2016 Sep 2. doi:10.2147/CCID.S114830
3.      Branisteanu DE, Toader MP, Porumb EA, et al. Adult female acne: Clinical and therapeutic particularities (Review). Exp Ther Med. 2022;23(2):151. doi:10.3892/etm.2021.11074
4.     Rasheed N, Ahmed A, Nosheen F, et al. Effectiveness of combined seeds (pumpkin, sunflower, sesame, flaxseed): As adjacent therapy to treat polycystic ovary syndrome in females. Food Sci Nutr. 2023;11(6):3385-3393. Published 2023 Mar 25. doi:10.1002/fsn3.3328

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