Pimples can be embarrassing for teenagers and adults alike. The modern treatment of acne requires a holistic approach.
Acne is a very common condition that involves the formation of comedones (“pimples”) in the skin. The known causes of acne in both western medicine and naturopathic medicine are summarized as the “four pillars of acne”: clogged pores, as well as increased oil, bacteria and inflammation. Interestingly, in Ayurveda the very same “pillars” are understood as imbalance of the doshas and so increased kapha and/or increased pitta together with slight increase in vata can lead to the various forms of acne. Significant overlap also exists between the four pillars and the way acne is perceived in traditional Chinese medicine (TCM) which views acne as increased qi and the end result of unbalanced diet, increased heat and invasion by external factors (bacteria, chemicals and such) as well as stasis.
Not surprisingly treatment of acne in all four disciplines can be related to at least one of the four pillars. Read more about acne in western medicine, Ayurveda, TCM and naturopathic medicine.
Acne is a skin disease typical of adolescence and early adulthood. Studies have estimated that greater than 90% of adolescents will develop some form of acne. Acne typically affects the face and can affect the neck, chest, and the back too. There are two groups of acne lesions known as inflammatory and non-inflammatory lesions. Inflammatory lesions are red bumps, pus-filled whiteheads, and deep red lesions known as inflammatory nodules. Non-inflammatory lesions are not as red and tend to be skin-colored, such as comedones. Acne can lead to dark spots on the skin and to scarring.
Acne is caused by four main factors:
Acne is the most common skin disorder in adolescents and is also the most common skin disorder seen in dermatology practice. People are most affected on the face, though the arms/shoulders, back and upper chest are often involved. Acne is summarized as four “pillars” that include:
These four pillars combine to create what is known as acne. The severity of symptoms varies from person to person, and treatment is often dependent on the severity of those symptoms.
The imbalances seen in acne are due to:
1) Imbalanced pitta
2) Imbalanced kapha
3) Slightly imbalanced vata
Kapha is responsible for the production of oil (also known as sebum) from the oil-producing glands in the skin. Excess oil production is one of the key factors in the development of clogged pores and blackheads. These are known as comedones. Studies have shown that those who produce more oils from their skin’s sebaceous glands are more likely to have acne .
This is what leads to inflamed lesions such as the red bumps, the pustules (whiteheads) and the deeper red bumps known as inflammatory nodules
Vata is responsible for how quickly the oil is made and released from the oil-producing glands. Although excess in kapha is what leads to excess oil production, vata is also important for how quickly the oil is made and released.
Some people have more inflammatory lesions on their face such as red bumps, deeper nodules, and pustules. This is known as pitta dominant acne. Other people have more of the comedones, also known as clogged pores and blackheads. This is known as kapha dominant acne. Most people have a mix of both inflammatory lesions and comedones and so most have a mix of vata and kapha characteristics to their acne also one type will typically be dominant compared to the other.
Just as there are many different types of acne, Traditional Chinese Medicine (TCM) understands that people develop acne from different underlying causes. Chinese medicine doctors consider the appearance of the skin such as the location of the acne, the presence of white heads and black heads, inflammation, cysts, and overall health to determine the root imbalance of acne. Heat, toxicity, dampness, qi and blood stagnation are all common causes of acne.[3,4]
Studies show that over 90% of adolescents may experience acne , and it is commonly seen around the time of puberty. Infants and neonates also commonly develop acne that is temporary and due to circulating hormones from the mother after birth. Acne tends to affect those that are in their teenage years and in their 20s. However, acne can sometimes last into the 30s and 40s.
Hot and humid climates
Heat and humidity have been associated with breakouts of acne.[7,8]
Humid and warm weather can aggravate acne. Humid weather increases kapha and warm weather increases pitta. Practices that expose the skin to heat and sweating such as high heat yoga and sweating under headbands can worsen acne as well since this can create a local environment that can aggravate kapha and pitta.
Invasion of external pathogens
This describes bacteria, chemicals from cosmetics, or extreme weather conditions that may aggravate the skin.
Fluctuations in hormones like progesterone are thought to stimulate the oil glands to produce more oils and may account for acne that flares with menstrual periods.
Hormone imbalances are a factor in acne development. In Chinese medicine this is due to Qi and Blood stagnation.
If your parents or siblings have had acne, there is a greater chance that you will acne as well.
Those that have a higher kapha and pitta in their base constitution have a greater risk for developing excess kapha and pitta. For example, those that naturally make more skin oils are at increased risk for the development of acne .
Digestion provides a method for the body to eliminate toxins and stay healthy. Constipation, diarrhea, bloating, abdominal pain, or acid reflux can all point to imbalances in the stomach. The gut-skin connection may be from imbalances in the intestinal bacterial that affecting the skin bacteria levels leading to acne development.
Exercise is commonly thought to worsen acne. However, one study found that exercising did not increase the chances of breakouts on the body acne.
Several studies have shown that milk intake, specifically skim milk, and foods that have a high glycemic-index may be related to worsened acne.[12-15]
In those people that are predisposed to having acne, diet can be important. Foods that increase kapha can worsen acne. Two examples are milk and high-glycemic foods and both have been correlated with presence of acne in observational studies . There are no prospective randomized studies that have assessed the role of milk or high-glycemic foods and acne.
Eating high glycemic index foods, those that are sugary and simple carbohydrates, too many dairy products, and poly unsaturated fats, has been shown to worsen acne.[17,18] In Chinese medicine eating too many sweet foods and dairy leads to the development of dampness.
In addition, occupations requiring exposure to high heat, such as furnace workers or smelters, and occupations with exposure to petroleum-based products, cutting oils, or coal tar have increased rates of acne.
Products that clog pores
Products that cause the pores on the face to clog can worsen acne. Please read our section what it means to be non-comedogenic.
Products that aggravate kapha
Creams that block the skin’s pores can increase kapha in the skin and cause further formation of comedones. Some examples include thick moisturizers such as petrolatum.
Stress tends to flare acne and previous studies have shown that acne can flare during time of increased psychological stress.[20-22]
Stress and frustration cause Qi stagnation which is why periods of stress can cause a break out.
Acne is a chronic condition that typically improves with age although it can stay persistent into the 30s and 40s. Therefore, the treatments require daily maintenance, as there is no cure for acne.
The typical treatments for acne include either topical, oral, or a treatment that combines both oral and topical treatments. Acne is not an infection but antibiotics are frequently used to help control inflammation and reduce the number of Propionibacterium acnes bacteria.
Typical strategies are to decrease kapha, decrease pitta, and keep vata from increasing.
Chinese herbal medicine focuses on correcting the underlying imbalance which is causing the acne. Contemporary research shows herbs that common treat acne may also work through antibiotic, anti-inflammatory, antioxidant, and anti-sebum properties.
Treatment of acne is typically based on the severity of acne and can vary between those with mild, moderate, or severe acne. The goal of each form of treatment against acne is generally targeted against at least one of the four pillars.
Several essential oils are known to reduce pitta and kapha. One example is tea tree oil that has been shown to balance all three doshas . Tea tree oil preparations have been shown to improve acne . Essential oils carry the risk for causing skin allergies and essential oils should be diluted in a carrier oil and then test on a small portion of the skin before they are used.
Herbs and supplements that either decrease kapha and pitta or balance the three doshas may help reduce the presence of acne lesions. Herbs that keep kapha and pitta from increasing include turmeric and neem.
Acne from lung heat is often treated with herbs that release the exterior and clear heat from the lungs such as herbal formula Pi Pa Qing Fei Yin.  Niu bang zi (burdock seed) is an herb commonly used for for clearing lung heat and it has also shown an antibacterial effect on the bacteria Propionibacterium acnes the bacteria that causes acne.
When the heat in the stomach is more pronounced, the formula may include huang lian (coptis rhizome) which clears heat, toxicity, and dampness from the stomach. This herbs are well known for their anti-inflammatory and has show antibacterial capabilities against p. acnes, the bacteria that causes acne.
Heat toxicity is a reflection of acne inflammation. Herbal formula Wu Wei Xiao Du Yin (Five Ingredient Decoction to Eliminate Toxicity) has herbs that attack p. acnes such as zi hua di ding as well as herbs that reduce inflammation such as jin yin hua (honeysuckle) and ye ju hua (wild chrysanthemum).[26,27]
For acne that worsens with your periods, herbs to move qi and blood stagnation such as yi mu cao (Chinese motherwort), dang gui (Chinese angelica root) and dan shen (saliva miltiorrhiza) are great for moving blood and balancing hormones.
Herbs may also be used topically in creams, washes, and herbal facials. Dian Dao Shui (Upside down cream) is a classical topical formula which includes huang lian (coptis rhizome) and sulfur (liu huang). Topically, huang lian and it’s active ingredient berberine, has also been shown to reduce the production of sebum that leads to the clogged pores.. Green tea has also been shown to topically fight acne bacteria.
Naturopathic approaches to herbals include the following
Acupuncture is very common method of addressing the acne. Acupuncture may be located around the acne or throughout the body to address specific imbalance. It is often combined with herbal therapies to enhance the effect of treatment. Electro acupuncture has also been shown to reduce androgen hormones which have been associated with acne. Learn more about acupuncture for acne.
Detoxification is a common practice in the naturopathic approach to skin treatment. The skin is one of the detox organs, and this happens generally through sweating. Saunas can help to increase the mobilization and release of toxins through the skin. The liver is also an organ of detoxification, and most naturopathic practitioners will include liver support with treatment.
The diet should focus on foods that do not increase kapha and pitta. Milk increase kapha and a switch to non-dairy based alternatives may be helpful. Other kapha increasing foods include fried foods and meat and both have been associated with increased presence of acne .On the other hand, low glycemic load diets reduce kapha. Low glycemic load diets can be helpful for reducing acne [13,24]. Mediterranean diets are known to reduce the effects of pitta and kapha with a focus on light vegetable and fruits with a low to moderate amount of dairy and food containing refined sugars. A case-control study showed that those that ate a Mediterranean diet had lower incidence of acne .
Diet is typically one of the first methods of acne treatment used in naturopathic medicine. The ideal diet would closely resemble a Paleolithic diet [17,44,45], which focuses on increased vegetable, fruit and fish intake, and avoidance of sugars and symptom causing foods like. Low glycemic-load diets may improve acne [13,46]. Additionally, reduction of milk and dairy intake has been correlated with improved acne[46,47].
Stress aggravates vata and reduces ojas, thereby making the skin more susceptible to inflammation. While hot yoga is not recommended, other types of yoga can reduce stress and keep pitta from increasing.
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