How To Cure Acne Overview

By Seppo | Acne basics

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The web is filled with bad acne advice. Q&A sites are full of well-meaning but simplistic advice about how to cure acne. Often how to cure acne questions are answered with put toothpaste on it or use this homemade skin care recipe type of advice. While there’s some truth to such answers and they miss the complexity of acne, and therefor fail to be useful to other than a handful of lucky people.

The truth is that acne is a very complicated condition. The complex causes vary from genetic sensitivity to hormones to skin irritation. This means that you probably have to do more than apply toothpaste on your skin to get over it. Lucky few will find simple solutions, but the vast majority will have to do more.

In this post I want to give you an idea of what you have to do to get over acne.

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Hormone balancing

All acne is hormonal. Because of genetics acne-prone skin is far more sensitive to many hormones. This causes excessive sebum production and skin cell growth and ultimately leads to blocked pores and pimples.

I talked about this in detail in the hormonal acne page. In summary, the hormones responsible for acne are androgens (male sex hormones), insulin and insulin like growth factor 1 (IGF-1). Aside from dangerous prescription drugs there’s not much we can do to androgen levels. But the good news is that insulin and IGF-1 multiply the effect of androgens on the skin, and there’s a lot we can do to insulin and IGF-1 levels.

  • Eat a diet that’s low in sugar and refined carbohydrates. Sugars and refined carbohydrates spike insulin and IGF-1 levels. Focus on complex carbohydrates. You can use glycemic index to guide your food choices.
  • Eat a balanced diet. I recommend 50/30/20 ratio as a starting point. That means 50% of your calories should come from carbohydrates, 30% from fat and 20% from protein. This is not a strict rule, but rather a guideline to start from.
  • Saturated fat in moderation. Eating too much saturated fat can cause insulin resistance and thus aggravate hormonal acne. It doesn’t mean saturated fat is bad or forbidden, but that you should keep it in moderation.
  • Get enough sleep.
  • Exercise regularly.

Skin friendly diet

What you eat can affect your skin, though the diet-acne relationship is not as strong and common as many people claim. How much diet affects the skin varies between people a lot. That’s why I’m not a fan of strict dietary regimens, because often they are useless (in curing acne) and adhering to them causes a lot of stress.

However there are some things that I would recommend for everybody to at least try.

  • Avoid dairy. The relationship between dairy products and acne is stronger than for any other food. Dairy products increase the androgen, insulin and IGF-1 levels, and that’s why there are many studies linking dairy consumption to acne. The only exception to this is homemade yogurt. The fermentation process reduces the levels of IGF-1 in yogurt and makes it safer to eat. Yogurt is also great for gut healing.
  • Try gluten-free. Gluten can trigger acne and other skin conditions. Contrary to what many natural health proponents and acne gurus claim gluten is not a problem for every acne patient. The best estimate is that 18% of acne patients may have problems with gluten. That’s why I recommend trying gluten-free diet for 3 to 4 weeks.
  • Avoid foods you are allergic/sensitive. Such foods cause a lot of inflammation in the body and can trigger acne.

These tips are a good starting point, and probably cover most diet changes you have to do to cure acne.

Gut healing

There’s a good reason to believe gut problems are linked to skin problems, see the gut-skin axis page for reason why. That’s why you should make gut healing as part of your acne treatment program. Things like:

  • Consume probiotic bacteria, either from supplements or fermented foods (preferably homemade).
  • Avoid antibiotic use. Antibiotics often destroy the probiotic bacteria in the gut, and this opens the door for harmful bacteria and leads to gut problems. Use antibiotics when absolutely necessary. Especially avoid long-term antibiotic use as a way to get over acne (it just makes the problem worse long-term).
  • Eat fruits and vegetables. Plant fiber feeds probiotic bacteria and keeps the gut moving.
  • Pay attention to any digestive problems you may have. Digestive problems are the first step to gut problems (and ultimately to acne). If you experience flatulence, constipation, stomach pain or other digestive problems, seek guidance and address the issues. You can’t have healthy gut if your digestion doesn’t work properly.
  • Manage stress levels. Stress is really detrimental to gut health.
  • Get sufficient sleep.

Topical treatment

Acne is more than skin deep, but it’s also skin deep (if this makes any sense). Because we acne patients for a bit unlucky in the genetic lottery our skin is far more sensitive to hormones. Genes also cause the immune system in the skin to be a bit trigger-happy. It reacts too strongly to bacteria on the skin, and this causes excessive inflammation on the skin.

Luckily we can mitigate these problems with smart use of topical treatments. Topical green tea is a fantastic example.

Here are few things to look for:

  • Salicylic acid (or something similar) to manage hyperkeratosis and keep the skin pores open.
  • Benzoyl peroxide to keep bacteria under control. But be careful with BP as it can also cause a lot of problems for sensitive skin. Make sure it’s buffered with soothing ingredients.
  • Green tea or other ingredients that can reduce the effect androgens have on acne-prone skin.
  • Good facial moisturizer to keep the skin barrier intact.

As you choose your skin care products, keep in mind that they can also contain irritating ingredients.

If you want a simple solution, I highly recommend Exposed Skincare. Of all the acne treatments I’ve seen it has by far the best formulation, and that’s why I use it myself.

Stress management

We already talked about stress earlier in this article. But because stress has such a negative effect on the skin I want to have a dedicated chapter to it. Several studies have demonstrated a clear (causal) link between stress and acne. For example studies on students show more acne during exam periods.

Aside from the indirect effects already talked, stress also has a direct effect on the skin. Studies have shown that Neurotransmitter known as substance P increases sebum production, creates inflammation in the skin, and increases skin cell growth. In other words, it contributes to the three primary causes of acne.

Stress is serious, and you should take it seriously. For many acne patients it’s much better to work on reducing stress than to improve diet.

Oh my god! I have to do all that??

I know that I covered a lot of issues in this post. And all this may look scary at first glance. But we can’t get over the fact that acne is a complicated condition. That’s why simple cookie-cutter approaches fail.

Acne has both internal and external causes, and that’s why you need to attack it from both sides. The things I listed on this page are known factors behind acne. But there are also lots of differences between acne patients. So everything here may not be relevant for you. For example gluten is only a problem for a portion of acne patients. Similarly, there are a lot of people who can eat a lot of sugar with no effect to their skin.

What I have here is not a step-by-step recipe for clear skin (there is no such thing) but a starting point. You have to do little detective work. Start implementing the changes and see what works for you and what doesn’t.

I wish I could give you simpler answers, but I’m afraid they don’t exist. So rather than giving you simplistic answers, I prefer to tell you what really works – even if it takes some work and dedication.

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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

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(8) comments

Tim November 7, 2012

Oh, the promised land! Just a couple of questions related to this

1) How much does natural juices, without any artificial sweeteners and/or sugars spike insulin/IGF-1-levels? The ones the Berry Company produce, with super-berries such as goji, blackberry, raspberry and the likes are incredibly delicious and bring (one would assume) lots of antioxidants and good stuff, but they are still very high in natural sugars. I really indulge in these, but perhaps it doesn’t do much good if I drink 0,7-1 liter pr. day?

2, Do you have any experience (both personal and in terms of reading) with keratosis pilaris? I know that it really isn’t acne pr.se, but it seems to me that many acne-sufferers also have to deal with this. Personally, I have had these colorless/white bumps on my arms for ages, and added to the fact that my acne is mostly on the chest,back and sometimes small ones on the middle part of my face ( I have read that the sebaceous glands (oil glands) are larger and most numerous on the mid-back, chest and mid-section of the face), I do have a suspicion that hyperkeratinization/excess sebum-production seems to be my main concern here. Of course, any acne sufferer would be dealing with those two things, but I still ind it kind of weird that my face doesn’t seem to be oily at all.

3) A bit stupid this one, but approx. how long does it take for a zit to form? Ideally, They should come signed,sealed and delivered with either “Snickers” “Allergen” “Overeating” “Mr.Insulin” (well..ideally they shouldn’t come at all), in which way you could say “okay,fair enough, I’ll cut back on that one next time”, but sometimes I just scratch my head thinking “ey, that wasn’t fair”, when I’ve been following most of the guidelines. I know it’s most likely a result of a more complex picture, but it would still be easier if one could keep track on when it was form and the plausible causes.

4) The kefir that I buy is ecological, making a point out of the fact that they don’t use any funny stuff when they feed their cows. In which case, there’s no point worrying about IFG-1levels and all the other bad stuff you’d expect from dairy products..?

Reply
    Seppo November 7, 2012

    Hi Tim,

    Glad to hear you found the promised land here :)

    Here are brief answers to your questions.

    1) In my books fruit juices are not that different from sodas. Yes, they have vitamins and antioxidants and that’s good. But sugar from them is just as bad as sugar from any other source. Since all the fiber has been stripped out the sugar is absorbed very rapidly, same as sodas.

    So how much they increase insulin and IGF-1 levels depends on the sugar content. 0.7L is quite a bit. I would treat them almost as sodas. Glass of OJ or other juice in the morning isn’t bad, but I wouldn’t drink much more than that.

    2) Not really. I also haven’t come across it in the studies I’ve read. I frequently read about psoriasis and eczema in acne studies but rarely about keratosis pilaris.

    I would rather not comment on it as I really don’t know. But I would search keratosis pilaris and hyperkeratinizaation at Google Scholar or PubMed. That should get you started.

    3) Honestly speaking, I don’t know. I know derms say it takes weeks for a pimple to form, but my anecdotal experience doesn’t agree with that. I believe that a pimple can form in a day or two after ‘offending cause’.

    Anecdotally I’ve also noted that I get a breakout within a day or two of eating something that messes up my gut. I think I have an issue with raw onions and leek. Anyway, I tend to notice that breakout follows quickly after bloating or other digestive symptoms. Of course this is anecdotal, so take it for what it’s worth.

    4) Well, yes and no. Cows milk even without any funny stuff contains a lot of growth hormones. It also stimulates increase in IGF-1 levels, it’s not known for sure whether this is due to absorption of IGF-1 from milk or a endogenous response to drinking milk.

    I have no doubt that the funny stuff makes milk worse for acne, but milk is designed to make baby cows grow and that’s why it’s very hormonally active.

    Reply
Kelsey February 19, 2013

Hey seppo-
I cleared my skin with the help of your online guide. It’s been over 3 years clear now :) I can eat wheat/fruits/veggies/rice/beans/corn even SUGAR- no breakouts.
I only have to Avoid two things: dairy of any kind & added oils/fats. (Looking back I at ALOT of both of those)
A splash of olive oil to cook my veggies/taking a fish oil pill will make my face very oily and breakout within a day… Could you explain why this is a trigger for me?
Thanks :)
-Kelsey

Reply
    Seppo February 20, 2013

    Glad to hear you’ve gotten over your acne Kelsey, and even better that you can live more or less a normal life while doing it!

    I’m afraid I can’t explain why little bit of fat would cause such an extreme reaction in you. Perhaps you have problems digesting fats? Whatever it is yours is quite a rare case, most people break out from sugar and refined carbohydrates.

    The human biology is so complex that exceptions like this are bound to happen.

    Reply
Tony April 7, 2013

Hi Seppo,
I really appreciate the website, its a great new perspective for me on acne, which ive battled for 20 years!
I understand why you advocate limiting fats, but can you expand on why you limit protein to only 20% of calories? I need to eat something which gives satiety, im avoiding FODMAPS and also exercise alot!

Many thanks in advance!
Tony

Reply
    Seppo April 8, 2013

    Without resorting to supplements or eating egg whites it’s actually quite hard to get more than 20% of your calories from protein. That said, you should take the 50/30/20 ratio only as a guideline. I’ve mentioned it since quite a few studies show nice reduction in insulin resistance with such a diet and there’s some concern that eating too much fat can impair insulin sensitivity, but the evidence for this is not very strong so there’s some uncertainty about it.

    My advice would be to eat a reasonably balanced diet, perhaps emphasize fat over the other macros. I wouldn’t go overboard with protein. Amino acid called leucine activates mTOR proteins in cells. mTOR is sort of master regulator for acne. For proper activation it needs a steady supply of insulin/IGF-1 and leucine, restriction of either will reduce its activity. I wouldn’t say this means you have to avoid protein, just don’t go overboard with it.

    Reply
Tony April 8, 2013

Thanks for the quick reply Seppo! Good mTor info. Perhaps i will cycle high and low protein days for a trial.
50% of carbs seems actually quite difficult to attain for me as i try to eat paleo style usually.
If i assume i only need 2000 calories per day(not much given i excercise daily), that would be 1000 calories needed from carbs, which is 250g of carbs, thats alot of sweet potato! im limiting fruit somewhat. I guess white rice maybe be a good substitute.
That said i will eat any way that clears my acne!

Reply
    Seppo April 8, 2013

    I used 50% carbs as a guideline since studies show good results with ratio like that, but I’m sure paleo style diet with more fat would also work. So if you prefer to eat a bit more fat and protein then by all means do so.

    Reply
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