What's going on with my skin?

Acne can occur at any age but is most commonly associated with teenagers. This can be a difficult time with lots of changes occurring both physically and emotionally. It’s often put down to hormonal imbalances and whilst this can be true, there may be other factors involved and it is important to address the correct underlying cause.

Whilst the appearance of pimples on the skin, especially on the face, shoulders and back is often associated with Acne vulgaris, it is important to get an accurate diagnosis because there are other conditions that cause similar symptoms.

Acne rosacea – This condition is most common in middle aged women. It is a chronic inflammatory skin condition that causes redness and recurrent pustules predominantly over the central area of the face including the nose and the mouth. The underlying cause may be a disruption to the innate immune response with increased inflammation triggered as a result. There is also the potential of dietary triggers.

Folliculitis – This condition causes inflammation of the hair follicle and is usually cause by a bacterial infection such as Staphylococcus aureus. It is more common in areas covered by tight clothing, following waxing or shaving and can occur following long-term antibiotic therapy for acne and steroid creams that effect the skin integrity.

Keratosis pilaris – causes small tiny bumps on the upper arms, thighs and buttocks. There is a build-up of keratin, a protein that forms the outer layer of skin and makes up hair, leading to the formation of a rough plug. Increasing dietary intake of essential fatty acids and vitamin A is often recommended to improve skin integrity.

Acne vulgaris – This can be triggered by many factors including stress, hormonal dysfunction as well as diet with the result being abnormal sebum production and keratinisation that promote the proliferation of bacteria such as Propionibacterium acnes. The sebum contains fatty acids that encourage this leading to inflammation and the production of painful, red bumps on the skin. The role of hormonal involvement occurs due to testosterone production and specifically a potent form called DHT that binds to receptors in the sebaceous glands where the sebum is produced. Nutritional and herbal medicine aimed at reducing the effects of testosterone on sebum production as well as making dietary modifications aimed at lowering the intake of foods that cause high blood glucose and insulin levels, increasing dietary intake of micronutrients such as antioxidants can reduce outbreaks.

As is often the case with skin conditions, the health of the gut also plays a vital role. It helps to regulate the levels of circulating hormones such as testosterone by excreting them via the bowel. A healthy microbiome, the colony of bacteria found in the colon, is crucial for this to occur and imbalances can lead to the reabsorption of active testosterone back in to circulation, leading to an increased pool of active hormone as well as the effects that occur in the skin as mentioned above. Dietary intake of adequate fibre in the form of fresh vegetables and wholegrains is really protective and can play an important role in the treatment of skin conditions such as acne.

The stress response is also an important factor as increased production of the hormone cortisol can lead to a cascade of events that can result in alterations to glucose metabolism and imbalanced hormone production in males and females.

Often there is stress associated with skin conditions such as acne vulgaris related to self-image and this can be increased due to the unrealistic expectations created by social media. This can impact on decisions about what treatment to choose with few options offered by mainstream medicine other than topical retinoids, topical and oral antibiotics and the oral contraceptive pill. These options may produce positive results, but they are often not without dramatic side effects including problems with menstruation, depression and altered immune function.

Something that is foundational to Naturopathy is to ‘first do no harm’ and to ‘begin with the least intervention’. Treating skin conditions is approached in this way – firstly by assessing the whole person including diet, lifestyle and other influencing factors such as emotional state, environmental exposures and genetics. Treatment will initially support the integrity and function of the skin, including the effect of hormone production. The treatment is aimed at healing the condition by rebalancing systems and improving function; it is not just removing the symptoms. There is always a bigger picture and it is always important to address this as part of the treatment.

If you are experiencing a skin condition and you’d like to find out how naturopathy can help you, please contact me for a consultation.

Larissa Gilroy - Naturopath