I’m an adult. Why is my skin still breaking out? I hear this so often from my patients and I totally get the frustration. Growing up, I was a regular at the dermatologist’s office. As I entered high school, my painful, cystic acne had become severe- all over my chest, back, face, even my upper arms, to the point where I was embarrassed to wear sleeveless tops in the summer. It made an already awkward phase of life even harder. But when you have acne as an adult (either for the first time or continuing from your teenage years), you can feel even more self-conscious because it feels like you are the only one still having this problem.

Fast forward to my late 20’s- I was still dealing with acne (and was taking the birth control pill to keep it at bay), but began wondering what underlying disharmony was really causing it. Was there anything I could do? I asked my acupuncturist if taking herbs and having acupuncture for a few months before coming off the pill might help. We tried this, and 3 months later I cautiously went off the pill. I’m not going to tell you my skin remained flawless, but there was a huge improvement compared to the last attempt at stopping the pill. Between the Chinese herbs, getting regular facials, cleaning up my diet and using skin products that were gentler, the acne was very manageable.

I’m sharing my story with you because I want you to know that I get the severe emotional and physical toll that acne can have. I get that in many cases it’s not just a matter of vanity (those cystic bumps HURT). Acne can be really stubborn, and treatment can be frustrating and difficult. But I also want you to know that you CAN have healthy skin without harsh creams, antibiotics and other medications. You can get to the root of the problem and improve your skin holistically. If I did it, trust me- you can too.

Why Do Adults Get Acne?

You have probably heard the term “hormonal acne”. This is a bit of a misleading phrase, because in reality ALL acne is hormonal- whether you are 15 or 35, male or female. Specifically, acne is made worse by androgens, which are a group of hormones including testosterone and DHEA. Both men and women have these hormones, though they are at higher levels in men. During the teenage years, acne rates are higher in men, but past that, rates are higher in women. Just because you have acne does not mean your androgens are unbalanced or excessive (except for in rare cases, such as PCOS). Scientists believe that some people are simply more sensitive to the presence of androgens, which can have a genetic link.

Two things happen when you get acne: first, the hair follicle gets clogged with excess sebum (oil) and dead skin cells. The skin cells are very sensitive to androgens and in people with acne, they undergo “hyperkeratinization”- meaning they become excessively sticky and clump together. Androgens stimulate both sebum production and hyperkeratinization of the skin cells. At this point, you have a whitehead or a blackhead. Next, once the excess oil and skin cells are within the follicles, a bacteria named P. acnes is able to take over. Your body’s natural inflammatory process next creates redness, swelling (and now you have a papule, or small pimple) and in severe cases, the affected hair follicle becomes filled with pus (a pustule, commonly known as a zit). When this happens, the walls of the follicle itself can rupture, and the infection can spread beneath the skin (nodules and cysts are present at this point).

But Why Am I Always Getting Breakouts Before My Period?

Just before your period, the levels of estrogen and progesterone are at their lowest, which means androgens are at their highest relative to the other hormones.  This is why just before and during your period, breakouts can be the worst.

How Can Traditional Chinese Medicine Help?

In Traditional Chinese Medicine acne is called fen ci, or white thorn. There are many different causes and categories of fen ci, including excess heat, accumulation of dampness, lung qi disharmony and stomach qi disharmony. It’s not necessary for you to understand the details of each one of these patterns (that’s your acupuncturist’s job, after all), just to know that we are looking at the whole picture and making a diagnosis and treatment plan for each individual.

As far as acupuncture, I typically use acupoints to balance hormones and treat the underlying pattern, but I also have a special technique for acne. It’s called “Surround the Dragon”, and means that I insert thin acupuncture needles at a very superficial depth around, but not on the acne. This method uses a treatment principle that is widely accepted in science- microtrauma to an area speeds up cell turnover and attracts inflammatory cells and fibroblasts to get that tissue healed, increasing collagen synthesis as well. The method prevents new breakouts for the same reason- speeding up cell turnover prevents pores from getting clogged with dead cells and excess oil (sebum). Typically my patients come for this treatment once weekly to every other week.

Chinese Herbal Medicine for acne is also very personalized. First, we determine how much of your acne is due to heat or dampness or other “pathogenic factors”, and from there create a customized herbal blend which includes herbs for balancing your individual disharmonies, plus a few herbs specifically known to be helpful with acne. Normally after taking the herbs for a month people see improvement, but it is best to stay on the herbs for several months to ensure the improvement will remain in place long-term.

Another option is an herbal wash for your skin. There are many “heat clearing” herbs I utilize which in recent research have been shown to be antimicrobial and anti-inflammatory.

What Effect Can Food Have On My Skin?

I am a firm believer that a healthy diet is actually even more important than any cream, lotion or herbal preparation for healthy skin. Your body needs the correct balance of nutrients in order to minimize hormonal breakouts.

What Foods Should I Avoid?

Sugar (foods with a high glycemic index). It really exacerbates hormonal breakouts, not to mention sending your energy and emotions on a roller-coaster ride. It also makes other hormonal symptoms, such as cramps and PMS much worse. Foods with a high glycemic index quickly increase your blood sugar levels, triggering your body to release lots of insulin. Insulin can increase hormone levels responsible for acne.

You’ll want to reduce or eliminate things like fruit juices, dried fruits (all the water is removed, leaving only concentrated sugar and a little fiber behind), refined carbs and of course candies, cakes, cookies and soda. Another surprising one? So-called “healthy” juices and smoothies and flavored yogurt. Did you know that a Snickers bar has 27 grams of sugar, but a Black Cherry Chobani yogurt has 28 grams? Liquiteria’s Ginger Aid juice has 38 grams, and the Beets Me juice has 39 grams sugar. I love beet juice but personally I’d rather have a Snickers if I’m going to eat that much sugar! I’m not recommending you start obsessively calorie counting, but it is definitely worthwhile to check the nutrition label for how much sugar is in a product. I recommend trying to avoid things with more than 10-12 grams in a serving. As for the common idea that chocolate causes acne breakouts, the research is inconclusive. I think it depends on the individual- the sugar certainly can contribute, but for some people chocolate itself can cause breakouts.

Dairy. There is actually a decent amount of scientific research supporting the fact that milk and ice cream consumption can make acne worse. Chinese Medicine agrees- dairy is a food that creates “dampness” in the body, which correlates to sebum (oil) production.  If you’re just having a splash of milk in your morning coffee this probably won’t cause a problem, but if you’re eating meals with cheese and milk regularly, it might be helpful to cut down.

Traditional Chinese Medicine also recommends avoiding foods that create excessive heat (redness and inflammation) such as spicy foods and alcohol. Other foods that create dampness include fried and excessively oily foods.

Click here for research information on the link between high-GI foods and dairy and acne.

What Foods Should I Eat More Of?

In summary, eat more fruits and vegetables and all things unprocessed! Specifically, foods with a low glycemic index are also helpful, including vegetables, nuts, whole grain bread and legumes.

Equally important is making sure that you have regular mealtimes. If you eat breakfast at 8am but don’t have time for lunch until 3pm, your body is working really hard and dipping into its reserves of energy to keep you going. Same goes for if you skip breakfast altogether. This can cause blood sugar imbalances, exacerbating acne.

Are Any Supplements Helpful?

The three most commonly recommended supplements for acne are Vitamin A, Zinc, and Vitamin B complex. The research is inconclusive, furthermore, it is very rare for people with a balanced diet to actually have a deficiency in any of these vitamins. As far as Zinc, some studies show people with acne have lower levels, but this is not clearly a cause of acne- it may be that inflammation in the body “eats up” more zinc. Click here for a study regarding Zinc.

Other Tips…

• Regular Exercise– regular exercise where you are breaking a sweat helps to keep fluids moving through your pores, strengthen your immune system (thereby reducing infections from acne in your pores) and help you cope with the emotional toll acne takes. Be sure to immediately change out of sweaty clothes and wash your skin.
• Exfoliate, Gently. Acne happens when your pores get clogged with old skin cells mixed with oil (sebum). If you use a gentle exfoliant, you physically help your skin slough off the old skin cells and sebum. This is something you should do on a daily basis. Keep in mind, I can not emphasize enough to be gentle, especially if you are exfoliating over an area of recent acne breakouts. Being too vigorous can definitely make things worse and cause scarring. I am a huge fan of the Eminence Organics Strawberry-Rhubarb Dermafoliant, but experiment on your own!
• When it comes to skin care products, gentler is better. It might feel good for a few minutes to use a harsh, drying soap because your skin doesn’t feel oily any longer. But these soaps can definitely do more harm than good. Why? In terms of basic chemistry, soaps are a base (pH is greater than 7), but your skin’s natural oil composition is acidic (pH less than 7). This natural barrier, called the “Acid Mantle” helps ward off bacteria and infection, and is necessary for the skin’s integrity and ability to shed dead skin cells. Too much washing with soaps can damage the acid mantle. I recommend using a very gentle wash in combination with exfoliation instead.
• Regular facials can really help! I had no idea what a facial was growing up- I thought it was strictly something ladies did for pampering at a spa! Yes it can be relaxing, but it also helps tremendously with unblocking pores before acne has a chance to develop, and is something I have to give a lot of credit to for my clear skin today. I am a fan of both Pretty Please Skin Care and Ally at Eva Scrivo Salon.
• You must resist the urge to pick at pimples and zits! I get that there are times when you absolutely must, but trust me, the more time you give acne to heal on its own, the faster it will go away and the less it will scar. If you absolutely must, after a hot shower, use two q-tips to gently squeeze the pimple. Apply a gentle anti-acne serum afterwards and don’t touch it again.

Have more questions? Click the contact page to email me!