Naturopathic treatment of acne is a very exciting topic because there are many different effective options to decrease severity. You probably have not discussed most of them with your family physician or even dermatologist. You might have come across these ideas out there in the Wild West of the internet, but not known whether or not to trust the source of the information, or been overwhelmed by the sheer volume of ideas people are promoting.

These natural treatments are especially important if you have already tried all the topical treatments and medications available.

Here is an important message I would like to be very clear about: all the topical treatments in the world will not fix an underlying cause. There are two main underlying causes when it comes to acne: hormone issues and digestive issues.

If you have tried it all and it has not worked, then there is an underlying cause that has not yet been resolved. When you have acne that has resisted all attempts at symptom relief, it is important to look for an internal cause. If your acne came on as an adult, there is an underlying driver. If your acne was fine on birth control and then got worse when you stopped birth control, look for the reason why.

One very important cause of treatment-resistant acne is something called polycystic ovarian syndrome (PCOS). Often, a patient present to me with the main concern of acne and we uncover that the patient is dealing with PCOS, which has much farther-reaching consequences than acne alone.

PCOS is the most common endocrine disorder in women. It affects up to 10% of women in their reproductive years. It has implications for day-to-day life, fertility and long-term health. To be diagnosed with PCOS, there must be two of the following present:

  • reduced number of ovulations (often causing irregular periods)
  • elevated androgens- observed in the patient’s symptoms or found with blood tests
  • ovaries with multiple cysts shown by ultrasound

Women suffering from PCOS skip ovulations and in extreme cases, don’t ovulate at all.

Finding an effective treatment for PCOS is important not only for fertility, but for long-term health as well. Women affected by PCOS are more likely to develop low bone mineral density, mood disorders, diabetes and heart disease.

PCOS has a very positive prognosis with naturopathic treatment. Seeing improvement in the frequency of ovulation takes time and consistent application of the treatment recommendations, but it is worth it- for fertility, for reducing the symptoms of high androgens such as acne, and for long term health.

I will talk about the other underlying cause, digestive system problems, when I talk about diet, below.


Diet Part 1 – Easy Changes


There are three diet changes that are fairly easy to make that can decrease acne severity. The first is to keep your servings of dairy below three per week. The other, tragically, is to avoid both juice and chocolate entirely.


Diet Part 2 – Advanced Blood Sugar Regulation


A more advanced diet change is to lower the glycemic index of your diet. Glycemic index (GI) refers to how quickly a food converts to blood sugar. The higher the GI, the quicker the conversion. You can use a table to pick out higher GI index foods you eat on a regular basis and come up with lower GI swaps.

You may need to adjust the number of calories, the quantity of carbohydrates, or the proportion of carbohydrates in your diet. I ask many of my patients to keep a diet diary using an app that tracks calories and macronutrients so we can see what their numbers are and make adjustments accordingly.

Results of these adjustments can be monitored using the blood tests fasting glucose and fasting insulin. We can run those two results through a calculator to see how well your body is doing at controlling blood sugar levels, and see improvements over time.


Diet Part 3 – Blissful Digestion


If you have digestive symptoms – loose stool, constipation, bloating, abdominal pain, excessive gas or excessive gurgling – your digestive system is probably contributing to the severity of your acne.

There are a few different theories as to why this might be the case. Perhaps food sensitivities are generating inflammation. An upset digestive system is probably not supporting a healthy microbiome. Elimination of metabolites and toxins happens, in part, through the intestines.

There are a different treatment options for getting to digestive bliss, and the choice of treatment plan depends on what symptoms you are experiencing and what type of changes work with your lifestyle.

The FODMAPs diet works well and is now well-researched for people with irritable bowel syndrome.

Testing for food sensitivities using an IgG antibody test is another recommendation I make for digestive symptoms. This test looks at a particular type of immune system reaction to a large panel of different foods. If your reaction to a food is high, then you stop eating that food.

Many different herbs can have a positive impact on digestive symptoms. For example, peppermint oil can reduce irritable bowel symptoms.

Resolving digestive issues helps reduce the severity of acne, and you feel better overall.


Hygiene Simplicity


Streamline your hygiene. There are countless products out there, but when it comes to what the scientific research says, all we know for sure is that washing your face twice per day is a good idea.

Use a mild liquid cleanser that contains no fragrance and lukewarm water. Avoid cleansers or exfoliants with physical abrasives.

A chemical exfoliant is a good idea and the clear winner is benzoyl peroxide. Benzoyl peroxide needs to be used at a concentration between 2.5-5%, and it needs to be used daily, not as a spot treatment.

If you try any product and it causes stinging or redness, discontinue it.


Supplements or Nah?


Three cautions about any supplement you are considering:

  1. Hype and value do not go hand in hand.
  2. A particular supplement might work in a particular circumstance that does not generalize to every person dealing with acne.
  3. Even the best-evidenced supplements will not work for every individual.

Supplements that have enough evidence for me to recommend them are zinc, probiotics, omega 3’s and lactoferrin.

Additionally, it is helpful to have your vitamin D level tested and to correct it if there is a deficiency.

Vitamin B12 can aggravate acne. However, if you have been tested and need to correct a deficiency, it is very important to take it because it is an indispensable component of red blood cells.


Monitoring your success


As any acne sufferer knows, acne varies a lot from day to day. It is important to give the treatment plan you choose a fair trial before deciding whether it is working for you or not. A fair trial is twelve weeks. Most of the treatments mentioned here will have an effect more quickly than that, but their maximum effect is not seen until approximately twelve weeks. Take pictures so that you do not have to rely on your memory. Pick your plan and commit to it for twelve weeks.


Acne and mental health


Dealing with acne puts you at higher risk for anxiety and depression, so let’s both be gentle and kind with you.

I would really like you to know: you are beautiful. So beautiful. Your complexity, your history, your mix of traits and quirks. . . there is so much to you, and it’s wonderful. You did not come to this life to look perfect.

There are things you can do to manage your acne, but you cannot completely control it. You received a genetic inheritance that you cannot change. You, and all of us, are exposed to pollutants in the environment that we cannot evade. Sometimes it is necessary to be in a stressful situation. You can do what you can do, but you cannot do everything. Do what you can, and make peace with what you cannot.

When you feel discouraged, zoom out. Remember the last time you had a nice chat with someone. The last time you were out in nature. The way your cat purrs when you pet her. There is so much to enjoy and experience that has nothing to do with the state of your skin. From a broad perspective, every single one of us is perfect just as we are. There is nothing you need to do or accomplish.

If you find yourself dwelling on your skin, or changing your plans because of how you skin looks, please let myself or any other clinician in your life know so that you can get connected with supports.

Thanks for listening; you probably were not expecting a lecture on self-love!

Acne can respond very well to these natural therapies. If you have not seen the progress you were expecting, then it is important to look for an underlying cause such as PCOS. Stay tuned into your mental health as you undertake this journey.

Dr. Andrea Hilborn, ND is a naturopathic doctor in Kingston, Ontario.