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Before we get into specific root causes for acne, we need to establish naturopathic philosophy generally. The body is designed to heal itself. Any physical ailment is a result of either an obstacle to cure preventing healing, the lack of building blocks the body needs in order to heal, or both.
Common Obstacles to Cure for Acne: Toxic Insults
Obstacles to cure very often involve toxins of various kinds which the body has not been able to entirely eliminate. These may include environmental toxins, such as solvents that accumulate from skincare products, environmental toxins that disrupt hormones, or mycotoxins from mold. That’s not an exhaustive list, but they’re some common possibilities.
Toxins may also include cellular byproducts of metabolism that can’t be eliminated properly or fast enough. These might include excessive levels of sex hormones, particularly estrogen and testosterone and its metabolites, or toxemia from imbalanced or overgrown gut flora.
Toxins get processed through the liver and then eliminated through the bowels, ideally… but if the liver is overloaded, toxins that should exit through the “front door” instead climb out the “window,” as it were… where the window, in this case, is your skin.
Common Obstacles to Cure for Acne: Immune System Dysfunction
When we speak of an obstacle to cure, we must also consider potentially dysfunctional behavior of the immune system. The immune system should identify, attack, and remove foreign invaders—that’s its appropriate action. An inappropriate response might include an overreaction to something that should be benign. In the case of acne, very often food sensitivities are to blame. I’ve also in cases seen hypersensitivity to one’s own normal yeast flora as a cause (though just as often, there’s a true yeast overgrowth in the gut, which should be treated differently.) Those who struggle with a yeast issue of either overgrowth or hypersensitivity are often the cases who mention that sugar makes their acne substantially worse. A sugar trigger might instead be due to an IgG immune response against sugar itself, or due to insulin resistance.
Inflammation (of acne or anything else) can also occur due to the excessive circulating toxins mentioned above—after all, the immune system’s job is to attack and remove what doesn’t belong. If its best efforts are ineffective toward this end, you’re left with a cycle of perpetual inflammation. (Think of your foot after you step on a thorn. It’s going to continue to swell and hurt until you pull out the thorn.) In the same way, treating the inflammation of acne lesions may help the symptom, but isn’t addressing the root cause.
Excessive stress can also be an obstacle to cure for almost anything. Since cortisol is the body’s stress tolerance hormone and also its anti-inflammatory hormone, in cases of high stress, there’s perhaps not enough cortisol left to handle an inflammatory insult (which might have, at other times, been handled just fine). Nearly every case of acne I’ve ever seen mentions worsening of symptoms in times of high stress. Effective stress management techniques are important here.
Common Missing Building Blocks for Acne
Building blocks missing for healing might include micronutrients; in the case of acne, often low essential fatty acids can play a role, as can low levels of Vitamin D, Vitamin A, Vitamin B6, or zinc. There are other possibilities too, but these are most common.
Low levels of fiber (mostly found in veggies) may dovetail with high toxic load, as mentioned above: fiber is critical for toxin elimination via the gut, assisting with bulk. Adequate water intake is equally important, for the same reason. Again, if the toxins can get out the “front door,” they don’t need to climb “out the window.” If you’re constipated, you’re probably toxic, too.
Low levels of certain hormones might also be the problem, such as progesterone and thyroid. This can lead you down a different rabbit trail (why are progesterone and thyroid low? These diagnoses are never primary either!)
Adequate good flora are necessary to keep the bad or imbalanced flora in check, as well. Because of this, if you don’t regularly consume fermented foods, probiotics can be very helpful.
While there are a number of effective herbs (both oral and topical), oils and essential oils, and facial masks for acne, most of them are helpful on the level of symptom management. As with anything else, long-term treatment depends upon finding and removing obstacles to cure, and restoring any missing building blocks for healing.