If you have struggled with acne, you understand the frustration of thinking "I have finally found the solution," only to realize after a few weeks that this was not the miracle you were hoping for. The truth is that acne is not fully understood, but there is research out there that gives us a glimpse into what is causing those pesky pimples and pustules. In part 1 of this series on acne, we will explore what we do know about the causes of acne and give a simple overview of steps you can take today to start addressing your break outs!
What is Acne?
Simply put, acne is a bacterial infection caused by the P. acnes bacteria. Ok, so let's kill the bugger! Well, not quite . . . there are over 70 strains of P.acnes and what you might not know is that some of those strains actually help fight off acne! Our skin is covered in bacteria, but before you get grossed out, realize that a lot of this bacteria is actually beneficial to your health and your skin. All this bacteria is what we call our skin's flora (or microbiome). There is also evidence that shows that the presence of the "bad" strain of P. acnes does not necessarily result in blemishes although people with break outs were more likely to have a "bad" strain and less likely to have certain "good" strains. So you can see already how this gets complicated!
Since P. acnes can be found on both clear and acneic skin, the questions we need to be asking are what causes the "bad" strain of P. acnes to cause a break out? Why do some people's pores get clogged and promote acne more easily than others? Why do some people have crystal clear skin without doing much, while others have severe chronic break outs and can't seem to find a solution?
What P. acnes wants
The unwanted type of P. acnes strives in low oxygen areas (like inside our pores) and is fueled by our skin's sebum. So, to no ones surprise, clogged pores is a great place for P. acnes to thrive! When P. acnes settles in a clogged pore and starts wreaking havoc, this causes damage to the skin. Your body fights this infection, which results in the creation of pus (whiteheads), redness and inflammation (aka a pimple).
Why pores clog
What causes pores to clog? The quick answer is excess sebum and dead skin cells. Once your pores are clogged by excess sebum and dead skin cells, P. acnes can thrive and cause havoc. But everyone has sebum, and everyone sheds dead skin cells, so again, what is the difference that results in clear skin versus acne? The answer is complex, but involves genetics, diet, environmental factors, stress levels, and also your skincare routine. All of the above influence either your hormones, the balance of your skin's microbiome, and your skin's barrier function which are what I like to think of as the conductors of your skin's health when it comes to acne.
1. Hormones and Sebum Production
Hormones can mess with your sebaceous glands, which can result is excessive sebum production. Did you struggle with acne as a teenager? If you are a woman, ever wonder why you might be prone to break outs at that time of the month? During these times in our lives, our hormones are in flux. As our hormone balance changes, certain hormones like testosterone and progesterone can cause sebum production to increase and fluctuate. Read more about hormones and acne in part 2 of this series.
2. Our Skin's Microbiome
The health of your skin's microbiome is what determine's its ability to fight off bad bacteria. This flora can be affected by a few things. First, our gut health. Seems weird that the bacteria in your gut would affect your face, but they do! So eating healthy is a great way to start improving your skin (more on this below). Other things that affect your skin's flora (or microbiome) health is using broad spectrum antibacterial cleansers, being "too" clean, your skincare products, and sweat. Read more about the skin's microbiome in part 3.
3. Our Skin's Barrier Function
Healthy skin is hydrated, glowing, and even toned. Flaky skin, redness, itching or burning and acne are all symptoms of failing skin barrier function. Dehydrated skin is a main symptom when our skin's barrier fails to work! Making sure your skin is hydrated is key to having healthy, clear skin.
Determining your imbalance and finding balance
So how to do you determine what, if anything, is out of balance and causing your acne? The severity of your acne, whether is be the occasional white heads and/or black heads versus pustules and nodules, and the frequency of the break outs can be a window into what is causing your acne. If you are a woman and tend to only break out during your menstrual cycle, then it is most likely that your break outs are caused by your natural hormonal cycle, which in turn causes excess sebum production which can clog pores. If you have fairly regular white heads and/or black heads, but they are few and minor, this might indicate that your break outs are caused by an unhealthy skin barrier and possibly an unbalanced skin microbiome. If you have chronic pustules and/or nodules, you are most likely dealing with a whole body imbalance which could include hormones, your skin's flora and your skin barrier.
Determining your imbalance is a personal journey that will require time, patience, and monthly, or at least seasonal, revisits. We will explore more about how to determine your imbalance in part 5 of this acne series.
The good news is, whichever type of acne you are dealing with, you can bring balance back to your body and your skin. The solution to acne is multi-faceted, and depending on your body, can change over the months, seasons and years. Being in tune with your body and determining the source of imbalance is important in your journey to healthy skin, but also understanding how to treat those imbalances.
First step to clear skin
A first step you can take today, even if you are totally unclear as to where you stand on the balance scale, is to start nourishing your body and cut out inflammatory and unhealthy foods. Pick one of the suggestions below or all, but choose something that you know you can stick to (being ambitious is great, but the #1 reason a diet fails is because it isn't being followed!)
- Remove any products from your skincare ritual that dry or irritate your skin
- Drink plenty of water every day!
- Cut out most of the processed sugar and complex processed foods out of your diet (an occasional treat is fine, but don't make it a daily habit!)
- Make sure you eat fruits and veggies every day
- Include foods high in zinc (like spinach and pumpkin seeds!) and omega-3 (flaxseeds, sea vegetables and walnuts) in your diet
- Include fermented foods rich in probiotics.
- Exercising once in a while is also not a bad idea :) Exercising promotes healthy circulation which helps your body remove toxins and also keeps your body and mind in a healthy state.