Most women remember the scene in My Big Fat Greek Wedding when Tula awakes on her wedding day with a blemish the size of Mount Olympus in the middle of her face. But contrary to her father’s belief, Windex is not the cure for any skin ailment—and it certainly isn’t a natural solution to hormone-related acne. A beauty-from-the-inside-out approach makes so much more sense!
For women with hormone-related acne, it’s no laughing matter. Options being offered to women today for acne leave you in a quandary if you want to live a natural lifestyle. Accutane, synthetic hormones, and antibiotics are not benign drugs and come with side effects and risks—not unlike Windex. There are effective alternatives to this standard treatment that get to the root of the problem and restore normal function—especially when the real problem is hormonal imbalance.
In order to understand how to treat acne in women, we first need to the look at the two types of acne and the four underlying causes.
What is black, white, red, and inflamed?
There are two different types of acne: noninflammatory and inflammatory. Noninflammatory acne is characterized by the formation of blackheads and whiteheads on the surface of the skin. Deep, painful, red blemishes are generally absent. Scarring is rare with this form of acne.
Inflammatory acne is characterized by the deep, painful, red blemishes on the face and sometimes on the back. This type of acne is generally more severe and will cause scarring.
Both forms of acne can be affected by hormone balance in women.
Oil, bacteria, inflammation, and blocked pores: the four horsemen of acne
Increased production by the oil glands, infection by a bacteria called Propionibacterium acnes (also known as P. acnes), inflammation, and dead skin cells blocking our pores are the four underlying causes of acne. The first three root problems are affected by both the reproductive and stress hormones in your body. Systematically addressing each root issue is the key to restoring balance and maintaining a clear complexion.
Hold the oil
Increased oil production can either be genetic (thanks mom and dad) or can be caused by too much testosterone. If you have irregular cycles, hair growth on your chin, upper lip, chest, and upper arms, then increased testosterone is the cause of excess oil production. Ninety-three percent of women with long, irregular cycles and male pattern hair growth have a disease called polycystic ovarian syndrome. Increased testosterone, insulin resistance, and estrogen dominance (in which there is too little progresterone to balance the estrogen) are the hallmarks of this disease. Acne caused by increased testosterone in women with PCOS can only be corrected if these three hormone imbalances are restored to normal. One natural way to directly reduce testosterone levels that has been proven in randomized trials is to drink two cups of spearmint tea daily.
Insulin resistance is a major factor in the increased production of testosterone by the ovaries. An indirect way to lower testosterone is to decrease insulin resistance with the following lifestyle changes and supplements: low glycemic index diet, inositol, chromium, alpha lipoic acid, citrus peel extract, and spices like cinnamon and turmeric.
If you have PMS, painful heavy periods, or infertility, then you are dealing with the third hormone imbalance associated with PCOS, estrogen dominance. Bioidentical progesterone supplementation starting three days after ovulation and continuing for nine days can break the estrogen dominance, thereby decreasing insulin resistance and lowering testosterone. Lowing testosterone is good for your skin and you will decrease your other hormone-related symptoms in the process!
Push back P. acnes
Hormone imbalance weakens the immune system and makes the body less able to deal with infection. Certain bacteria cause acne to grow rapidly in the oils produced by the skin and flourish in the context of a suppressed immune system. P. acnes, referenced earlier, is the name of the particular bacteria involved in acne. In severe inflammatory acne, this bacteria triggers oxidation and the free radicals that feed inflammation. Antibiotics are frequently prescribed to get rid of the bacteria, but there are herbal supplements with similar antibacterial effects. In a study published in Food Chemistry in 2010, yerba mate and du zhong inhibited the growth of P. acnes and decreased inflammation in the skin.
The role of inflammation
Thanks to recent research, the fundamental role of inflammation at all stages of a pimple forming is becoming very clear. Oxidation and free radical formation in the skin are key factors in the clogging of pores, the development of whiteheads, and the deep red blemishes of severe acne. Decreasing oxidation on the surface of the skin and throughout the body is important to effective acne treatment.
Topical creams and gels containing antioxidants like zinc, nicotinamide, and green tea have been shown to be more effective than clindamycin. Ways of reducing systemic inflammation and oxidative stress include supplementing with a combination of 25 mg zinc, 750 mg nicotinamide, 1.5 mg copper, and 500 mcg folic acid. In the Nicomide Improvement in Clinical Outcomes Study, this combination taken for eight weeks produced at least moderate improvement in 79 percent of the study participants.
Researchers believe that this success is due to the antioxidant qualities of these supplements. Another impressive study showed an 80-percent improvement in 79 percent of the study participants after 12 weeks of a daily combination of 45 mg zinc, 180 mg vitamin C, 18 mg mixed carotenoids, 45 IU tocopherol (vitamin E), and 390 mcg of chromium. Because these antioxidant combinations are having positive effects on the skin, it is reasonable to assume they are having a beneficial effect on the entire body—including hormone balance. So much better than Windex!
Vitamin E has long been known to decrease oxidation and inflammation in the skin. Not coincidentally, vitamin E concentrations are low in the skin of women with acne. Supplementation with vitamin E has been shown to decrease the number and severity of blemishes after eight to 12 weeks of therapy. For women with painful periods and acne that flares just before menstruation, vitamin E can have a double benefit—400 IU of vitamin E taken for five days before a woman’s period decreases her pain by over 70 percent!
In addition to supplements and dietary changes, you need to minimize and manage your stress. Chronic stress leads to the release of cortisol, which has a negative effect on acne by promoting oxidation and increasing insulin resistance, which lead to elevated testosterone and decreases the immune system’s ability to control the growth of bacteria like P. acnes. After you do everything you can to eliminate stressors and implement good time management techniques (check out the book Time Management from the Inside Out), the next step is to learn how to deal with the stress that is left.
Learned optimism is a thinking pattern and a skill to help you minimize the amount of cortisol your brain triggers when you hit the daily speed bumps life throws in your way. Changing the way you think is the most difficult lifestyle change you need to make, but it is essential if you want to restore balance to your body and clear up your skin!
You don’t have to be resigned to the standard treatments for acne (or even the remedies that Tula’s father recommends). A systematic approach that addresses the major underlying causes of acne and restores natural balance and function will not only leave you looking great, you will feel better too. That’s the virtue of a beauty-from-the-inside-out approach to your skin care!
By Laurie Heap, MD