Acne is a complex and hard to treat skin condition. At the Australian Centre for Functional Medicine, we have developed a novel, comprehensive and effective approach to tackle this disease.
Acne is a prevalent skin condition among teenagers and young adults, characterised by pimples, blackheads, whiteheads and red, tender bumps in the skin. In Australia, more than 93% of people aged 16-18 years suffer from some degree of acne, which affects mostly the face and forehead and the chest, upper back, and shoulders.
The Australian Centre for Functional Medicine offers a comprehensive and effective approach to treat this hard-to-treat condition without the many side effects of standard medical practice.
What is acne?
Acne is a complex inflammatory skin condition influenced by three key factors: excessive production of sebum, accumulation of dead skin cells in pores and excessive growth of the skin bacteria Propionibacterium acnes. When these three factors collide, a change occurs in the skin microenvironment, triggering a chronic inflammatory reaction that results in pimples and other skin problems characteristic of acne (Taylor 2011).
While these three factors essentially cause acne, environmental triggers are also known to worsen this condition.
Triggers of Acne
There are two main types of factors known to influence acne development: environmental and intrinsic factors. Intrinsic factors such as age, hormone levels, being pregnant, being overweight, lack of exercise, and having a family history of acne are factors that can increase your chances of developing this condition.
If you already suffer from acne, there are several environmental factors that act as triggers, worsening your condition (Dreno 2018).
These include:
- Certain foods
- Certain medications
- Stress
- Air pollution
- High humidity
- Physical stress to the skin, like squeezing pimples, or scrubbing the skin too hard
Another important factors that can both cause and worsen your acne is bacteria. The human microbiota is being recognised as an important factor driving the pathology of this disease.
The Microbiota-acne connection
The role of the human microbiota on acne pathology has been a topic of active research. Microbes from the gut and the skin have been implicated with different aspects of acne development.
Studies have shown that the skin bacteria Cutibacterium acnes and Staphylococcus epidermis and the fungi Malassezia are associated with the development of typical acne pathology. For a long time, the prevalent idea was that acne was particularly caused by an overgrowth of the bacterium C. acne, associated with increased levels of sebum production during teenage years. However, in recent years, studies suggest that acne pathology is more complex, involving the interaction of different sub-types of C. acnes and S. epidermis. While the molecular mechanisms involved are not fully understood, one key concept consistently reported among studies is the importance of skin dysbiosis. Under optimal conditions, both C. acnes and S. epidermis have beneficial roles in the skin. For example, both C. acnes and S. epidermis are known to produce antimicrobial chemicals, which help our innate immune system fight harmful microbes and maintain skin health and homeostasis. However, when dysbiosis occurs, even these beneficial, commensal species can become pathogenic.
Dysbiosis of the skin microbiome, caused by alterations from the normal diversity and richness of these bacteria, act as a trigger for innate immune system activation. This leads to cutaneous inflammation and the development of well-known acne pathologies (Ramasamy 2019, Dréno 2020).
Recently, studies are also pointing to the gut and its rich microbial milieu as an important factor in acne development. One study found that patients with moderate to severe acne had lower levels of Actinobacteria and higher levels of Proteobacteria in their gut, compared to healthy people, with no acne (Yan 2018). Similarly, another study found lower diversity of Bacteroidetes and an increased ratio of Bacteroidetes to Firmicutes in acne patients relative to people with no acne (Deng 2018).
The key factor linking gut dysbiosis with acne development is not fully understood, but it may involve intestinal permeability. One of the key functions of the gut and the gut microbiota is to prevent the passage of harmful microbes into the bloodstream and the rest of the body. A healthy gut and gut microbiota help maintain an effective barrier against pathogens. However, when gut dysbiosis occurs, levels of intestinal permeability increase, which can lead to the passage of inflammatory mediators into the bloodstream. Gut dysbiosis can occur through multiple factors, from your own genetic makeup to poor eating habits and other environmental factors. Regular use of broad-spectrum antibiotics, such as clindamycin, cephalosporins, and fluoroquinolones, can also lead to gut dysbiosis (Kriss 2018). Another factor influencing gut dysbiosis is stress, which has been shown to alter the composition of specific gut microbes, such as Lactobacillus and Bifidobacterium. These alterations to the composition of gut microbes result in abnormal production of neurotransmitters, like acetylcholine, serotonin, and norepinephrine, which enter the bloodstream and cause systemic inflammation (Lee 2019). Gut microbes are also important players in the optimal function of the (HPA) axis, which is the body’s main system to regulate stress (Frankiensztajn 2020) and can influence multiple health problems, including anxiety, depression, obesity, diabetes, and autoimmune diseases. Please read about the extensive role of the HPA axis in our health in our research and innovation section.
Alterations to the normal gut microbiota, commonly known as gut dysbiosis, may also be linked to unhealthy dietary patterns characteristic of the Western diet, which has been linked to acne development (Clatici 2020).
Focus on: Western Diet and Acne
In Australia and other developed countries, the so-called Western diet is a popular choice. This diet is characterised by a high intake of fat, sugar, meat and dairy products and a low intake of fibre rich foods. At a cellular level, following a western diet has been shown to overstimulate a cellular pathway involving the mammalian target of rapamycin complex 1 (mTORC1), possibly through imbalances in the gut microbiota (Noureldein 2018).
mTORC1 is part of a protein complex involved in cell growth and metabolism, influenced by environmental inputs such as nutrients and growth factors. Extensive research has shown that mTOR has an important role in regulating fundamental cellular processes like protein synthesis to autophagy. At the same time, altered, dysfunctional mTOR signalling is linked to acne, cancer and diabetes progression, and aging (Saxton 2017). Alterations to the normal functioning of the mTOR pathway may affect important biological processes, such as cell proliferation and differentiation, lipid synthesis, and sebaceous lipogenesis (Clatici 2020). These altered biological processes can influence acne development and worsen the symptoms.
How is acne treated? The standard approach
Patients affected with acne are commonly treated with topical creams and gels, like Retin-A, Differin, Renova, and Tazorac. These prescription drugs work by unclogging pores and may provide temporary relief of typical acne symptoms. Oral antibiotics, like doxycycline, tetracycline, minocycline, or erythromycin are also prescribes, with the goal of killing the bacteria that causes inflammation around and inside the blocked pores.
In some cases, even oral contraceptives are prescribed as a means of attempting to regulate hormonal imbalances, but these drugs also bring significant side effects, like nausea, vomiting, stomach cramps or bloating, diarrhea, hair growth in unusual places, alterations to menstrual flow, among many others. Even acne is a potential side effect of oral contraceptives.
In severe cases of acne, doctors may prescribe a medication called isotretinoin, which was originally marketed as were Accutane® and Roaccutane® but is now available in genetic form. This drug is meant to reduce sebum production, inhibit bacterial growth, reduce inflammation, shrink sebaceous glands and reduce follicular occlusion. The drug, however, is also associated with significant side effects, and should not be used with people suffering from liver or kidney disease, high blood fats, diabetes or depression. Other side effects include multiple skin problems, including acne flare-ups, temporary hair loss, dry skin and skin infections.
Acne and Functional Medicine: a novel and comprehensive approach
At the Australian Centre for Functional Medicine, we take a different approach to the treatment of acne. Our approach to functional medicine considers current research findings and seeks to fix the underlying factors driving this disease, not just ameliorate the symptoms.
The first step for any acne patient treated at the Australian Centre for Functional Medicine is testing. We perform comprehensive testing to understand the key factors driving a patient’s acne pathology. Testing at the Australian Centre for Functional Medicine is focused on the gut, breath, stool, and urine. We also perform comprehensive blood testing and a full review of hormone levels, including cortisol and melatonin.
Another central aspect of our approach to acne treatment is diet. Most patients will need to go through an “Elimination Diet”. The goal of this diet is to guide patients in eliminating food groups that may contribute to their acne. These foods contain high levels of salt and refined sugar, industrial seed oils and poor-quality fats, and food additives and preservatives, which together can affect the optimal function of our gut, cause gut dysbiosis and promote inflammation.
Patients at the Australian Centre for Functional Medicine are coached on making better lifestyle choices to align with their treatment path. These changes are based on current research findings and on the success of our previous acne patients, which may include eating a more nutrient-dense diet, adding probiotics and prebiotic-rich foods, and improving sleep quality with an exercise schedule. Below is a summary of what the recent studies are saying:
- A high-sugar diet and dairy products are risk factors for acne development (Melnik 2009). For example, different studies have determined that consuming more than 100 grams of sugar per day, drinking soft drinks more than 7 times per week, and consuming dark chocolate daily are all significantly correlated with acne development (Ghodsi 2009, Huang 2019, Vongraviopap 2016).
- Various studies have shown that sleeping less than eight hours per day is a risk factor for acne (Schrom 2019, Wu 2007, Yang 2020)
- Psychological stress and depression are significant risk factors associated with acne. Studies have shown that people who suffer from acne consistently are under higher levels of stress compared to people with no acne (Dreno 2020, Zari 2017).
Beyond diet, sleep and stress, many other factors may be influencing your acne. The environment where you live, your day-day lifestyle activities, and even your social relationships may influence your acne (Yang 2020, Dreno 2020).
At the Australian Centre for Functional Medicine, we take a modern and effective approach to Functional Medicine, backed by current research and supported by state-of-the-art testing. This approach will help identify the main factors driving acne development in each patient and allow us to design the best possible treatment, specific for each patient.
References
- Taylor M, Gonzalez M, Porter R. Pathways to inflammation: acne pathophysiology. European Journal of Dermatology. 2011 Jul 1;21(3):323-33. Read it!
- Dréno B, Bettoli V, Araviiskaia E, Sanchez Viera M, Bouloc A. The influence of exposome on acne. Journal of the European Academy of Dermatology and Venereology. 2018 May;32(5):812-9. Read it!
- Ramasamy S, Barnard E, Dawson Jr TL, Li H. The role of the skin microbiota in acne pathophysiology. British Journal of Dermatology. 2019 Oct;181(4):691-9. Read it!
- Dréno B, Dagnelie MA, Khammari A, Corvec S. The skin microbiome: a new actor in inflammatory acne. American Journal of Clinical Dermatology. 2020 Sep 10:1-7. Read it!
- Barnard E, Li H. Shaping of cutaneous function by encounters with commensals. The Journal of physiology. 2017 Jan 15;595(2):437-50. Read it!
- Yan HM, Zhao HJ, Guo DY, Zhu PQ, Zhang CL, Jiang W. Gut microbiota alterations in moderate to severe acne vulgaris patients. The Journal of dermatology. 2018 Oct;45(10):1166-71. Read it!
- Deng Y, Wang H, Zhou J, Mou Y, Wang G, Xiong X. Patients with acne vulgaris have a distinct gut microbiota in comparison with healthy controls. Acta dermato-venereologica. 2018 Jul 1;98(7-8):783-90. Read it!
- Clatici VG, Voicu C, Barinova E, Lupu M, Tatu AL. Butterfly effect and acne—The role of diet. Dermatologic Therapy. 2020 Jun 15:e13832. Read it!
- Saxton RA, Sabatini DM. mTOR signaling in growth, metabolism, and disease. Cell. 2017 Mar 9;168(6):960-76. Read it!
- Noureldein MH, Eid AA. Gut microbiota and mTOR signaling: insight on a new pathophysiological interaction. Microbial pathogenesis. 2018 May 1;118:98-104. Read it!
- Lee YB, Byun EJ, Kim HS. Potential role of the microbiome in acne: a comprehensive review. Journal of clinical medicine. 2019 Jul;8(7):987. Read it!
