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Tried to get rid of acne unsuccessfully? The functional medicine approach to acne may help

A picture of a woman with clear acne-free skin from the functional medicine approach to acne

Discover the functional medicine approach to solve acne for good.

Frustrated and fed up from trying potions, lotions and treatments to get rid of acne that haven’t worked?

Not only is acne frustrating and embarrassing to have. The common treatments used to clear up acne don’t work for everyone, and some come with risks to your health and well-being. 

However, there are often overlooked, safer solutions that can clear up acne for good - without any potential side effects or scarring.

In this article, you’ll discover the functional medicine approach to acne, that includes the most effective, natural ways to get rid of acne for good that your GP or dermatologist may not know about.

The functional medicine approach to acne article overview

The main types of acne (and how to know the difference between them)

We all know what acne, or pimples, look like - unsightly looking white heads, black heads or raised red lumps that sit under the skin. 

While it’s common to have the odd pimple here and there, when we talk about acne, it tends to be a more severe presentation of pimples, whether on the face, back or chest, that can hang around for a long period of time. This type of acne is called Acne vulgaris, that typically presents in the t-zone on your face, with a mix of whiteheads, blackheads and general redness around the affected area.  

Then there’s Acne conglobata, also known as Cystic Acne, which are large, hard raised bumps under the skin that may never erupt into a pimple. These cystic forms of acne tend to penetrate deeper into the skin layers, and are often painful to touch. This type of acne is typically more persistent, as each individual lesion can last weeks, sometimes months.

Cystic acne tends to appear along the lower half of the face around the jawline, as well as the chest, neck, back and shoulders.

a visual presentation of the types of acne

It’s no secret that having acne can give a hit to your self confidence, mental health and sense of self. If they’re on your face, they’re there for the world to see, in a time of your life where making friends, partners, and building your network and career is a priority. 

Unfortunately, there’s a real stigma around acne. It’s assumed that if you have acne, you aren’t clean, and aren’t taking care of yourself. This is often untrue, as many people with chronic acne eat a healthy diet, and wash their face regularly. We’ll explain more about why these two factors may not solve acne later on.

Acne isn’t just for teenagers - surprising stats on adult acne

For more than 50% of teenagers who experience acne at the onset of puberty, most acne cases will clear up as they near the end of high school.  

For some people though, acne persists well into their 20s and 30s, and sometimes well into their 40s and 50s. 

Outside of teenagers with acne, the largest age group of people with acne is women between the ages 20 and 35, with up to 50% of women experiencing some degree of acne (1).

In adult acne, the character of the acne is predominantly cystic, with the location of acne tending to move down the body. Teenagers tend to get acne in the t-zone area (forehead, chin, nose, mouth), whereas adult acne tends to occur in the lower half of the face, so cheeks, jaw, mouth, chin down - sometimes the neck, chest, cleavage, shoulders & back. 

While most teenagers know their acne will eventually clear up as they age (for most people, anyway), when acne persists into adulthood, or starts in adulthood, all those lump, bumps and pimples can be even more frustrating.

For those with adult acne, there’s no light at the end of the tunnel to be seen, making the whole situation much more stressful, which can make acne worse. We’ll explain why soon.

The functional medicine approach to acne starts with one key question: ‘Why? What’s causing or driving the expression of acne in this person?’. 

Identifying the cause and other factors that contribute to acne, and addressing them, is the key to getting rid of acne for good. 

Thankfully, our understanding of how acne comes about is fairly well understood, and there are several ways to clear up acne for good.

Unfortunately, some causes of acne are often overlooked, or not entirely understood, by conventional medicine practitioners, leaving many acne sufferers frustrated by acne they can’t seem to get rid of.

The functional medicine approach to solving acne starts with one key question: ‘Why? What’s causing or driving the expression of acne in this person?’ Click To Tweet

ACNE CAUSES

The main cause of acne (the functional medicine perspective)

Of course in teenagers, the most common cause of acne is hormone imbalances, and this is usually the case with adult acne too. This is why women suffering with acne might see an increase or decrease in size and severity of their acne around the commencement of their menstrual cycle. 

While in conventional medicine, hormonal imbalance is identified as a key cause of acne, rarely is the question asked - why is this imbalance occurring, and what can be done to restore balance? 

As mentioned before, based on the functional medicine approach to acne, understanding why an imbalance exists in a person is key to solving a chronic health issue like acne. Getting clarity on the ‘why’ helps determine the best course of action to restore hormonal balance, and therefore resolve acne.

Watch Melbourne Functional Medicine practitioner Rebecca Hughes discuss the root cause of acne here:

 

First, identifying which hormone - or hormones - is out of balance needs to be prioritised, followed by determining why they’re out of balance. 

 

1. Oestrogen dominance

Oestrogen dominance occurs when oestrogen levels are in excess relative to progesterone. Oestrogen and progesterone work like two sides of a seesaw that moves up and down throughout the body’s hormonal cycle, and a delicate balance between the hormones is required to maintain health. A disruption in the oestrogen to progesterone balance can mean that you have normal oestrogen and low progesterone, or high oestrogen and normal progesterone. An oestrogen dominant state can have far-reaching effects in the body - one being acne (2).

Oestrogen dominance can be caused by:

  • A missing cofactor for an enzyme (COMT: catechol oxygen methyltransferase) that breaks down the active form of oestrogen into an inert form, resulting in excess oestrogen levels, particularly damaging forms of oestrogen, circulating in the body (3)
  • Exposure to environmental toxins that mimic oestrogen (called ‘xenoestrogens’, such as those found in plastics and pesticides) that disrupt hormone balance (4)
  • Taking the oral contraceptive pill. Yes, sometimes the oral contraceptive pill can cause acne, even though it can be used to treat acne. There are women who start taking the oral contraceptive pill for contraception that end up with acne due to this (5)

Key signs/symptoms of oestrogen dominance include:

  • Mood swings
  • PMS
  • Headaches
  • Anxiety
  • Weight gain
  • Bloating

The functional medicine approach to acne recognises oestrogen dominance as a key cause of acne. Here are the symptoms
The Melbourne Functional Medicine approach to acne recognises oestrogen dominance as a key cause of acne. Here are the symptoms of oestrogen dominance.

2. Androgen excess

Androgen excess is characterised by excess androgenic hormone testosterone that increases the production of sebum (oil) in the skin, and overproduction of keratin - a protein in skin cells - that can block pores (6).

Excess testosterone can be caused by:

  • Polycystic ovarian syndrome (PCOS) (7)
  • A genetic polymorphism (mutation) that increases the activity of enzyme 5-alpha-reductase that converts testosterone into the more potent dihydrotesterone form (8)
  • Stress - causing the adrenals to secrete more androgens (testosterone) (9)

Key signs/symptoms of excess testosterone: 

  • Dark, thick hair growth on face, neck, chest, abdomen
  • Irregular periods
  • Acne
  • Android 'apple' body shape (a higher waist circumference)

 

signs of excess testosterone when taking the functional approach to acne.
The Melbourne Functional Medicine approach to acne recognises excess testosterone as being a cause or driver of acne. Here are some of the key symptoms of excess testosterone.

How your family’s health can indicate a root cause of acne

The functional medicine approach to acne also considers your family's health.

This is because those with acne persisting past their teenage years may have genetic or familial tendencies towards hormonal imbalances. 

Does your family have hormonal related health conditions? They may also present with acne, though there are many other signs of hormonal imbalances such as:

  • Polycystic ovarian syndrome
  • Premature balding in men
  • Male pattern baldness in women
  • Prostate hyperplasia
  • Prostate cancer

A genetic tendency to have increased activity of enzyme 5-alpha-reductase, increases conversion of testosterone to dihydrotestosterone (DHT) - a more potent form of testosterone - has been linked with these conditions (10).

The food and acne connection - what’s the truth about a poor diet causing acne? Do dairy and sugar cause acne?

You might be wondering ‘Why me? I eat a healthy diet, and I still have acne! And somehow, my friends who eat junk food and drink alcohol, don’t!’.

There’s a belief that junk food and high sugar diets cause acne, possibly because teenagers, the biggest acne sufferers, tend to have a poor diet. While a high carbohydrate diet can cause an increase in the conversion of testosterone to the more potent form (DHT) which contributes to acne (11), healthy eaters also get acne, showing that diet plays a smaller role in acne than often thought. 

Diet can be a cause of acne (12), although more commonly, it’s a contributing factor more than a sole cause. 

It’s likely that this small group of people are sensitive to changes in insulin-like growth factor-1 (IGF-1) which can be in high glycemic index (high sugar) diets, or diets containing dairy products that contain IGF-1. 

Receptors for IGF-1 are present in the sebaceous gland in the skin that’s responsible for producing sebum. When IGF-1 binds to these receptors, it stimulates sebum production.  

Many patients who come to our clinic have previously tried a low glycaemic index diet, and removed dairy from their diet, hoping this will cure their acne. 

It can certainly be a contributing factor, though rarely are these factors the sole cause, which is why most people trying this approach fail.

The other diet-related factor that can play a role in acne is food sensitivities. This is where the body creates an immune-mediated response to a food (or foods), however sensitivities tend to simply make acne worse, rather than cause it (13).

The Melbourne Functional Medicine approach to acne includes considering diet and how that impacts acne

The role detoxification plays in skin health

Your body has sophisticated detoxification pathways made up of your liver and gallbladder, kidneys and urinary tract, bowels, lungs, lymphatic system, and skin. Each of these organs plays a critical role in keeping hormones in balance (14).

Here are some ways that hormones imbalances can arise from suboptimal detoxification:

  • The liver isn’t able to break down and eliminate hormones and xeno-oestrogens effectively, resulting in more potent/toxic forms of oestrogen and testosterone (15)
  • The gallbladder isn’t producing enough bile to take hormones from the liver and send them to the bowels for elimination - leading to excess hormones in circulation (16)
  • Constipation (characterised as less than 1 bowel movement per day) leads to reabsorption and recirculation of toxic broken down hormones into the bloodstream (17)
  • Dehydration causing reduced ability for the urinary system to excrete water-soluble breakdown products of hormones (18)
  • Reduced detoxification in the lymphatic system (a network of vessels that run just under the skin alongside our blood vessels) and skin (19)

A graphic showing the process of detoxification
The Melbourne Functional Medicine approach to acne includes assessing a person's detoxification and elimination efficiency of hormones, given hormonal imbalances are a key cause of acne.

 

So when taking the functional medicine approach, looking at all systems of detoxification, not just the skin, is important. Pinpointing what pathways in the detoxification system are under-performing will determine what treatment is required - whether that’s to support digestion to eliminate constipation, or provide herbs and nutrients to support the liver’s ability to break down and eliminate hormones, to ensuring the person is well hydrated. 

The Melbourne Functional Medicine approach to acne

CASE EXAMPLE: Sally

Six months ago, Sally, a health professional from Melbourne, experienced a terrible bacterial infection in her throat, and needed to take several rounds of antibiotics to deal with the infection. Since then, her bowels haven’t functioned the way that they used to. She became constipated, only moving her bowels every 2-3 days. Shortly after, Sally started getting a lot of pimples on her face around her jawline. For Sally, having regular bowel movements was important to help eliminate broken down hormones rather than have them recirculate and disrupt her normal hormonal balance. So once Sally’s constipation was addressed, her skin cleared up. 

The connection between acne and stress

Having acne is a stressful situation for most people. And unfortunately, stress can make acne worse, and in some cases, even cause it. 

As stress speeds up processes, people who are stressed tend to have increased oil production in the glands in their tissue, leading to excess sebum production in their skin.

Skin is also a hormonal organ, and there’s some research to suggest that stress can influence how local androgens in the skin - like testosterone - behave (20)

Stress plays a role in body systems and therefore at the local level of acne formation.

Long term stress can even cause imbalances to the reproductive hormones oestrogen, progesterone and testosterone (21).

Stress can also cause the adrenal glands to produce more testosterone, can activate testosterone receptors in the skin, and contribute to menstrual cycle disruptions (22).

Stress causes rises in cortisol, which is a natural response in the short term. However, chronic stress can create consistently high levels of cortisol which needs to come from somewhere, and might be preferentially manufactured at the expense of progesterone. So stress can contribute to oestrogen:progesterone imbalances, by causing a low progesterone state (23).

Melbourne Functional Medicine practitioner Rebecca Hughes explains the role of stress in acne:

Why gut health can influence your acne

Beyond constipation leading to hormonal imbalances, there are other gut-related factors that can contribute to the production of acne. 

This is because the skin is connected to the digestive system by the immune system. The gut-immune-skin axis can be influenced by:

  • An imbalance in intestinal gut flora (called ‘dysbiosis’) through exposure to antibiotics, toxins or other stressors that reduce beneficial flora in the gut and skin (24).
  • Immune cells that live in the large intestine are sent to the skin if it’s exposed to an allergen. Once in the skin, the immune cells cause inflammation that can impair the skin’s integrity, allowing for bacteria to enter and spread (25)
  • Small intestinal bacterial overgrowth (SIBO) - a condition where bacteria normally found in the large intestine take up residence in the small intestine, with symptoms that include bloating, constipation, diarrhoea, skin conditions, food sensitivities, fatigue, and depression (26)

Intestinal hyperpermeability, also known as leaky gut, resulting in food sensitivities, as proteins from foods can enter the bloodstream and cause an immune response, causing systemic inflammation as well as increasing inflammation in the skin. Often, low stomach acid, where proteins aren’t able to be broken down effectively, is also present. In fact, as many of 40% of acne sufferers have been shown to have low stomach acid levels (27.)

As many of 40% of acne sufferers have been shown to have low stomach acid levels Click To Tweet

ACNE TREATMENTS

What conventional treatments exist for acne (and the pros and cons of each)

The most common conventional treatments are effective to varying degrees. However, there are downsides to some of the treatments. 

The first strategy most people with acne try is a skincare product that targets acne prone skin, perhaps prescribed by a beautician, or through word of mouth. 

They might also see a beautician for chemical peels like glycolic acid, dermabrasion, laser treatment, blue and red light treatment, or extraction facials. These therapies can be effective for treating acne, however not everyone clears their acne up through these methods. This is likely due to needing to address the underlying causes of acne described above.

For those who don’t solve their acne through topical treatments, they’ll typically see their GP for help, or ask for a referral to a dermatologist. 

Your GP has three acne eliminating approaches:

  • The oral contraceptive pill
  • Roaccutane (isotretinoin)
  • Antibiotics

Again, some of these do work for solving acne, however often, the effects aren’t long lasting, and they come with their risk of side effects. 

Let’s go through each one.

The oral contraceptive pill

Of course, if you’re a man, the pill isn’t going to work for you! The pill is often prescribed to women because their acne coincides with either an erratic/irregular menstrual cycle or heavy bleeds, or they have skin flare ups around their period.

The way the pill works is that it masks a woman’s natural hormonal environment. As hormonal imbalances are often the cause of acne, if you took away the pill, the acne would return. So, the pill is masking the problem of acne, rather than solving it. 

Some patients we see in our clinic have been using the pill for years - sometimes 10 years or more - to control their acne. Often, they’ve been on the pill since they were a teenager, and now they want to fall pregnant. They’re concerned about their acne coming back in the interim, and how acne will impact their esteem and mental health. 

These women are caught in a catch 22 situation of wanting to get off the pill so they can fall pregnant, yet they don’t want their acne to come back. 

So the pill doesn’t solve acne, it just puts it off for a while (28).

And of course, there are possible side effects with taking the pill, such as low mood and weight gain, that all women want to avoid! (29)

The oral contraceptive pill, a common treatment for acne

Roaccutane

Roaccutane is a synthetic derivative of the nutrient, Vitamin A. This drug works in about 50% of cases, however it doesn’t always work in the long term in those 50% of cases (30)

Acne is formed where oil builds up in the sebaceous gland, along with an abnormal, rapid shedding of skin cells that cause the gland to get blocked. Bacteria sitting on the skin then multiply, then suddenly you’ve got this microbe filled, pus filled lesion - a pimple - on your skin. 

Roaccutane works by significantly reducing sebum/oil production in the skin, and the overproduction of keratin, to stop pimples from forming. 

One of the well known side effects of Roaccutane is liver damage. This is why when your GP prescribes this drug, you’re required to do a liver function test. 

Roaccutane is teratogenic - which means it can also cause damage to unborn babies (31). So, when women are taking it, they’re encouraged to take the pill at the same time to avoid falling pregnant. Any drug that can cause harm to a foetus is a heavy duty drug, and perhaps should be used with extreme caution.

Roaccutane also causes several adverse effects while you’re taking it (32). Because the drug dramatically reduces oil production, it dries out oils everywhere. Therefore, a lot of people experience:

  • Dry mouth
  • Dry nasal passages
  • Blood noses
  • Dry lips that often crack and split
  • Photosensitivity (will easily get burnt from the sun)

Often these types of symptoms can be just as frustrating as the acne - causing people to hole up at home feeling depressed. Some patients report that they feel depressed, and there have been some incidences reports of suicidal ideation while on Roaccutane (33)

Roaccutane is often promoted as a solution that’s going to solve acne immediately, however that’s often not the case. Many people have taken a course of the drug 3 or more times, and their acne keeps returning. 

So, Roaccutane isn’t a one size fits all solution, and you have to question the safety of taking a drug like that multiple times.

Antibiotics

Antibiotics are typically prescribed for acne for a 6-12 month period, with the aim of targeting the bacterial strain, Propionibacterium acnes (Corynebacterium acnes), that’s been identified as the microbe involved in inflammation in acne. 

The idea is that if you don’t have the environment for the bacteria to grow, it halts the process of acne formation.

However, this approach only treats one part of the problem - a microbe causing inflammation. As shared above, there are other factors to consider, which is why often when people stop taking their antibiotics, the inflammation and acne returns. 

The other downside to this treatment is that antibiotics don’t just target one strain of bacteria - it impacts the entire microbiome (34)

What is the microbiome, and why is it important?

Your microbiome is a unique collection of microbes that live on your skin and in your body that influence your digestive health, immune health, brain health, skin health and more. Your microbiome is unique to you - just like your genetics. Disrupting the microbiome by using antibiotics can have long term consequences for your health. With chronic antibiotic use, it’s now thought that your microbiome may never fully recover to its natural state (35).

The proprionum acnes bacterium that’s deemed to be responsible for causing acne is just part of the flora on the outside in our skin. There are many other strains of bacteria that live on the skin, and emerging research is showing that the disruption of the balance of flora are implicated in the progress of many skin diseases, including acne, atopic dermatitis, psoriasis etc, and that many are identified as helping to promote skin health (36)

Wiping out bacteria is like clear filling a forest.

It changes the entire environment, and can make it difficult to reinoculate the skin with the right balance of bacteria, which may negatively affect the health and integrity of your skin in the long term (37).

Therefore, antibiotic treatment isn’t an ideal solution. 

This brings us onto the next strategy that isn’t always the best idea - and our advice may seem counter-intuitive - cleansing.

 

Wiping out bacteria is like clear filling a forest. Click To Tweet

Why cleansing your skin isn’t the best way to clear up acne (and can make things worse!)

You’ve seen the ads for antibacterial cleaning products, such as ones containing benzoyl peroxide like Clearasil. Clean skin is pure skin. The idea is that the more you clean, the clearer your skin will be, as you’re clearing away ‘nasty’, ‘dirty’ bacteria. Though when it comes to acne, it can be making the situation worse rather than better. 

This again, in part, is because of the microbiome on the skin.  By over-cleansing you’re removing the good bacteria, as well as the ‘bad’, that can help your skin improve. 

a woman cleansing her face - acne

Therefore, treating acne with antibacterials, both topically and internally, may be a flawed approach, because you’re continually killing off bacteria that might be helping, and therefore disrupting the entire skin microbiome (38)

The other reason people with acne tend to over-cleanse, is because they’re concerned about oil production, and want to reduce it, given it causes acne. Unfortunately, many acne cleansing products are drying, making it effective as its job, however it removes the top protective layer of oil on the skin that forms part of the skin’s integrity (39)

When the skin’s integrity is compromised, it becomes vulnerable to exposure of bacteria getting into the skin (40), that your skin wouldn’t normally be exposed to. It can also cause more inflammation and irritation, which acne already has, making acne worse. This is especially the case of pimples that have erupted.

The best way to treat acne topically is to treat it gently. Go back to basics and use a gentle cream based cleanser, gentle toners like rose water, and moisturising the skin rather than stripping it. In doing so, the skin’s integrity will improve, irritation and inflammation will reduce, thereby improving the skin’s appearance.

Tests that help pinpoint the cause of acne you’re probably missing

 

Hormone testing

The first step most people take is to get their reproductive hormones tested by their GP. 

The key hormones to have tested are oestrogen, progesterone, sex hormone binding globulin, and testosterone - even for women. 

However, while this test can be helpful, there are two limiting factors:

 

1. The timing of the test isn’t considered.

Often, doctors don’t check where a female is in her menstrual cycle. There are different ranges of normal for a cycle, depending on whether she’s in her first, mid or last half of her cycle. Ideally, it’s most useful to test a woman’s hormones on day 19-21 of a typical 28 day cycle, day 18 if you have a shorter cycle, or day 23 if you have a longer cycle.

 

2. It only shows total amounts of hormones

As this test measures the level of hormones in the blood, it only tells us the total amounts of those hormones. What it doesn’t show is what’s happening to these hormones when they are sent to the liver to get broken down and excreted. 

In our clinic, we use a more comprehensive urinary metabolite hormone test that gives a greater insight into your hormones. 

This urine test shows the total amounts of hormones as well as for the metabolites (break down products) of hormones. Your hormones get broken down by the liver to be excreted in your urine. If they remain in circulation, they can cause problems like acne, irregular cycles, or excessively dark hair growth. 

This test can show how much testosterone there is, as well as how much is being converted into an inert form, called epi-testosterone, and how much is being converted to the more potent form, 5a-DHT. As mentioned earlier, some people have genetic tendencies to converting testosterone to the more potent form, which is a key driver of acne. 

From there, we can determine whether there’s too much oestrogen versus progesterone, whether oestrogen isn’t being broken down properly by the liver, or perhaps that testosterone is being converted to a more potent form. 

Watch Melbourne Functional Medicine practitioner Rebecca Hughes explain what tests you should get to determine a hormonal imbalance in acne:  


 

Check for PCOS

Women may also want to look at the regularity of their menstrual cycle, as well as having a pelvic ultrasound to rule out PCOS. 

This is because acne in women in their 20s and 30s is a sign of adrogenisation, which is an increase in testosterone (an androgenic hormone) that’s one of the diagnostic criteria of PCOS.  The other 2 criteria are irregular or absent cycles, and cystic ovaries. You only need to meet 2 out of 3 of these criteria to be diagnosed with PCOS (41)

 

Food sensitivities

As food sensitivities can play a role in some acne cases, these can also be tested to determine whether certain foods are a problem. Alternatively, an elimination diet can be undertaken to identify sensitivities (42).

 

Gut health analysis

If there are potential imbalances in the digestive system, tests can be used to determine the state of your gut health, such as a comprehensive stool test to look for dysbiosis or intestinal permeability, or a breath test to identify if small bacterial overgrowth (SIBO) is present (43).

The functional medicine approach to acne - solutions to resolve acne

So now we have a clearer picture of the key causes and factors that drive acne, as well as the conventional approach and key tests that can pinpoint underlying factors. 

Now let’s move on to how to turn things around, starting with a focus on improving the skin’s integrity.

A picture of natural skincare solutions for acne

Key nutrients your skin needs to accelerate healing (and how to prevent scarring)

Anyone with a chronic skin condition needs to make more skin cells than someone with healthy skin, because they’re constantly repairing damaged tissue. So it’s important to speed up healing time, alongside reducing localised inflammation in the skin. 

Some of this can be done through diet, however often the nutritional intake from diet alone isn’t enough to meet the increased demand of nutrients required for skin healing (44).

Providing the skin with all the nutrients it needs to speed up healing time and restore the skin’s integrity, such as vitamin A, Zinc and essential fatty acids is often helpful. 

So, now we have a clearer picture of the key causes and factors that drive acne, as well as the conventional approach and key tests that can pinpoint underlying factors. 

Now let’s move on to how to turn things around, starting with a focus on improving the skin’s integrity.

Vitamin A can reduce sebum and keratin overproduction, whereas zinc helps to accelerate skin healing, tissue regeneration and strengthens the immune system to protect against bacterial infection (45)

Zinc can also reduce the conversion of testosterone to DHT, thereby reducing sebum and keratin production (46).

Docosahexanoic acid (DHA) is an essential fatty acid that’s abundant in the skin. Supplementation of DHA may reduce insulin-like-growth factor (IGF-1) in the skin and halt the overproduction of keratin that leads to pimple formation (47).

Of course, a big concern those with acne have is scarring. There are two different types of scarring:


Pitted scarring

This kind of scarring affects the surface or architecture of the skin, resulting in a pitted look to the skin. This kind of scarring is permanent, and is often caused by picking pimples.


Post inflammatory hyperpigmentation

This is the laying down of scar tissue that causes pigmentation in the skin. Depending on the colour of a person’s skin, scarring can be red, purple or sometimes even black. This kind of scarring can be caused by picking pimples, yet is often due to poor healing time, so even if the lesion isn’t active anymore, it can hang around for 2-3 months while it resolves. Thankfully, this scarring will eventually disappear.

The nutrients mentioned above can help to speed up healing time, as well as some anti-inflammatory herbs and other compounds to reduce hyperpigmentation. 

The anti-inflammatory herb liquorice, as well as anti-inflammatory niacinamide and hydroquinone are often used topically (48). Hydroquinone is used primarily as a whitening agent to reduce redness on the skin (49).

And of course, avoiding picking pimples is key, as difficult as that can be when you have pus-filled pimples on your face. Try being mindful about how you’re treating your acne. Extraction facials from a beautician is a better alternative, as they’re being done with the correct equipment in sanitary conditions, thereby avoiding further infection (50).

Once acne is healed (as in there are no more active lesions), and you aren’t taking any Roaccutane or Vitamin A (because both make skin photosensitive - resulting in potential damage to the skin (51)), laser treatment may be an option for reducing pigmentation too. 

However, not all laser treatments are safe or effective. One treatment we endorse is Cuetera, which is a gentle treatment that activates collagen production to speed up the laying down of collagen on the surface of the skin, thereby speeding up healing time (52)

a woman getting skin treatment for her acne

Another emerging technique that’s received both good and bad press is skin rolling, where micro trauma is caused to the skin by lots of tiny little needles. The length of the needles changes, and people can do this themselves, though it started out being a technique exclusively done by dermal therapists. 

The notion behind skin rolling is that it stimulates collagen synthesis and speeds up repair. Skin rolling should only be done on skin when there is no active acne, as the skin is already traumatised. It’s best to have this process done professionally, as care is taken to do this in a sanitary environment, to avoid contamination of bacteria in the skin that’s being broken.

Pulling it all together: the functional medicine approach to acne

As you can see, there are many factors that can contribute to acne, and the course of action depends on your unique circumstances. This is why the functional medicine approach is personalised, assessing your health history alongside your genetics, diet and lifestyle, to determine the root cause of your acne. 

Once that’s identified, a personalised treatment plan will be created to address the cause and resolve the acne for good. 

So a functional medicine practitioner will look at: 

  • Your health history, including family health and genetic factors
  • Hormonal production and metabolism
  • Detoxification efficiency (skin, bowels, liver, kidneys, lymphatic)
  • Stress and the endocrine system
  • Digestive system health (microbiome)
  • Immune health and inflammation
  • Dietary factors - insulin sensitivity, food intolerances
  • Nutritional status
  • Supporting skin health from the inside out - to accelerate skin healing time

Functional testing will be done to determine any hormonal imbalances, particularly oestrogen, progesterone, sex hormone binding globulin, and testosterone, to see how well the body is producing, breaking down and eliminating them. 

Once this is determined, your treatment plan will take a targeted approach - whether that’s to improve the production of an enzyme involved in hormonal metabolism, to support pathways of detoxification and elimination. 

So unlike the conventional approach that seeks to artificially balance the hormones, and suppress the normal production of hormones through the contraceptive pill, the functional medicine approach seeks to rebalance the hormonal system so that hormones are no longer driving the occurrence of acne. 

Your practitioner will also consider lifestyle factors such as sleep, stress reduction and exercise. For example, sleep is important for healing and repair, and exercise will enhance sweating, which is a key way the skin detoxifies. 

Using this approach, patients are more likely to see a significant improvement or resolution to their acne, because it considers and addresses all the possible factors involved in acne production.

This approach also helps people understand what caused their acne and why, so long after they’ve been in treatment, if acne comes back, they know what to do to reverse it. 

The Melbourne Functional Medicine approach to acne

CASE STUDY: Andrea

Andrea* from Melbourne had been struggling with acne for 9 years - since she was 16 years of age. Over the years she had taken 3 courses of Roaccutane, and several rounds of antibiotics. Each time, it worked while she was taking either drug, but as soon as she stopped treatment, the acne returned. Andrea was a health professional dealing with her own patients every day, and it was having a big impact on her personally and professionally. She didn’t like her workplace very much, and wanted to look for another job, however having acne was affecting her self confidence in terms of applying for other jobs. After urinary hormone metabolite testing, some hormonal imbalances were identified. Her family history also pointed towards hormonal imbalances - her parents had each had acne, and there were issues with fertility and miscarriages on one side of her family, therefore it was likely that genetics played a role. The urine testing showed that detoxifying oestrogen was a challenge, that she had an oestrogen - progesterone imbalance, and slightly high testosterone levels. After addressing those balances using herbal medicine, nutrients, and lifestyle factors, Andrea’s skin started clearing up. Andrea has now been acne free for the last 4 years - without any recurrence like she experienced with Roaccutane and antibiotics.  

(*not her real name)

How to get rid of acne for good (and steps you can take right now)

Some steps you can take to start improving your acne are:

  • Stop over-cleansing. Use more gentle, soothing, moisturising types of skincare treatments. If you can’t seem to break away from using antibacterials, use it in a spot like fashion - apply it with a q-tip just to those areas you want to apply it. Use a gentle cream based cleanser, gentle toners like rose water, and moisturise the skin rather than strip it.
  • Make sure you’re well hydrated. Drink at least 2 litres of water a day. All systems of detoxification need fluid to function properly. Water is needed for good bile flow, to soften the contents of stools so you can evacuate easily, to help produce sweat to clear out the skin, and the urinary system needs water so it’s able to dilute everything that it’s trying to flush out (53). Your urine colour and smell will tell you if you’re dehydrated or not. If your urine is a strong yellow colour, and it has a strong smell, you need to increase your water consumption.
  • Get sweaty. Exercise enough to induce sweat to encourage detoxification of your skin. Exercise can also increase sebum production, which those with acne want to avoid, however optimising detoxification in the skin is important for skin clearing.
  • Manage stress. Stress can contribute to acne by influencing hormones that increase sebum (oil) production, and can cause or drive an imbalance between oestrogen and progesterone.
  • Get your hormones tested. See your doctor and get your hormone levels tested as a bare minimum. Consider the more comprehensive urinary hormone test through a functional medicine practitioner.
  • Get a holistic assessment by a functional medicine practitioner. Understanding the root cause and drivers of your acne is the first step to acne resolution.

Our clinic regularly treats patients with stubborn acne by using the functional medicine approach to acne. This approach is personalised to every person, because each person is completely unique in terms of their body chemistry, diet, genetics and lifestyle. 

So, having a healthcare practitioner assess your overall health, perhaps run a few tests to check your hormones, or determine whether your diet and lifestyle are causing your acne, can solve your acne problem and get rid of acne for good. 

Acne might take 2 or 3 months to improve, and up to 6 months to completely resolve, though in some cases it may take longer. 

If you’d like to get rid of your acne for good so you can stop hiding out and socialise, go for that job, or start dating again, book a discovery call with us to find out more.

infograph showing the functional medicine approach to acne

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