I hear it a lot in my clinical practice: "I think my acne might be hormonal". In a sense all acne is hormonal. You may not have overt hormonal aberrations turn up on your blood test, but there may be something more subtle at play. Let me explain.
How is acne formed?
First, let's look at how acne is formed. We need three things to make pimples:
- A blocked pore
- Bacterial overgrowth (infection)
These three things happen in succession - one thing leads to the next. Pores become blocked with dead skin cells and sebum (your skins oil). Next a bacteria called Propionbacterium acnes (P.acnes) feeds on the excess sebum and overgrows, causing infection and inflammation. You then get a pus and an angry, red, inflamed bump - a pimple.
What causes a blocked pore?
Dead skin cells and sebum mix together and harden in pores, creating a plug, known as a comedone. You can tell you have comedones if you can feel bumps under your skin and/or see blackheads. Androgen hormones (male-type hormones including testosterone) control our sebum production in pores, and are also thought to cause skin cells to produce excess keratin so that they tend to stick together and plug the pore. So unless your pores are becoming blocked by some sort of chemical or oil that you are constantly in contact with, your acne is hormonal.
Where do androgens come from?
In women, androgens are produced by our adrenal glands and ovaries. Adrenal androgens can be elevated due to stress, or due to high levels of another hormone, called prolactin. Increased ovarian androgens are commonly caused by high insulin, irregular menstrual cycles and polycystic ovarian syndrome (PCOS). Androgens are delivered to the skin pores through the bloodstream where they lock into receptors (like a key in a lock), stimulating sebum production.
Although many female acne-sufferers have normal blood levels of androgens on blood tests, it is still thought that androgens are at play in their acne. In these women it is thought that there is a hypersensitivity to androgens inside pores, or that the androgen excess is produced inside pores rather than from the ovary or adrenal glands, bypassing the bloodstream. So in a sense, all acne is hormonal, whether your tests show a hormonal imbalance or not. Without excess androgens, there is no excess sebum and the P.acnes bacteria can't proliferate. Without the overgrowth of bacteria there is no inflammation and pus - no pimples.
Naturopathic treatment for androgens and acne
Luckily, there are many natural treatments to choose from when it comes to acne and androgens. These include herbs and nutritional supplements, however, the mainstay of acne treatment is a low-glycemic diet that provides plenty of vitamins and minerals, and stabilises blood sugar. The best way to do this is to include plenty of vegetables, nuts, seeds, whole grains, fish, legumes, eggs, lean meats and some fruits. See your naturopath for more guidance.
It's also best to see your naturopath for access to high-quality, effective supplements, and for guidance on which vitamins and minerals will work best for your individual situation but here are some of my favourites:
- Licorice and peony
These two herbs in combination reduce the formation of androgens by inhibiting enzymes involved in their production and blocking androgen receptors.
- Vitex agnus-castus
This herb reduces androgens by increasing progesterone (an androgen-blocking hormone) and decreasing prolactin. If you have PCOS this herb may NOT be the best choice for you - see your naturopath.
This mineral reduces the production of keratin in skin cells - the protein that causes them to stick together and block pores. It also has an antibacterial and anti-inflammatory effect. Zinc has also been shown to reduce hirsutism and hair loss in women with PCOS - symptoms that often go hand in hand with acne.
- Vitamin B5
Research shows that this vitamin significantly reduces acne after 12-weeks use. It is thought to do this by decreasing the proliferation of skin cells in the pore, softening skin and also though it's antibacterial effect.
- Fish oil
It is thought that the omega-3 fatty acids in fish oil may exert a beneficial effect on acne via their ability to reduce certain inflammatory factors. Research shows the reduction of these inflammatory factors can reduce the hyperkeratinisation of cells and thus reduce the blocking of pores. Not only that but omega-3 fatty acids form part of our skin cell membranes, helping our skin to stay soft, supple and hydrated. Thus they are integral for healthy skin. Be sure to get a high quality fish oil supplement that contains well below the allowable level of mercury, is sustainably sourced, and is guaranteed to be fresh, not rancid.
All the best on your health journey,
Josephine Cabrall is a naturopath with a special interest in PCOS and related hormonal disorders including acne, irregular periods and infertility. She practices is available for consultations at Brunswick Health, Melbourne.
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