Discovering the What, How and Why Behind What May be Driving Your Acne.

Acne vulgaris is more than just a cosmetic or exterior concern — it is a sign of what is happening inside your body. While many treatments focus on the skin’s surface, the real key is looking deeper and discovering what is actually driving your breakouts. I like to use the analogy of acne as a tree with deep roots - the breakouts you see on your skin are the leaves and branches that change through the seasons, but underneath, the roots below the surface — hormonal imbalances, poor gut health, inflammation, underlying conditions, stress, and skincare habits — are what truly influence its growth. Just trimming the branches (topical treatments) won’t fix the problem; you have to nourish the roots to create lasting change in the leaves and branches (aka your skin!). When all these elements work together, we begin to achieve clear, glowing skin. In this blog, we’ll explore the foundations of what acne is, its’ different types, and the driving factors that can be linked to your acne.


What is Acne?

Acne vulgaris is a skin condition that occurs when hair follicles (pilosebaceous unit) become clogged with oil known as sebum, and dead skin cells, leading to cutaneous inflammation. It often appears on the face, chest, and back, but can appear anywhere there is a hair follicle. While acne is commonly associated with teens, there is NO age limit to who acne can affect!


Types of Acne

Comedonal Acne – Blackheads and whiteheads. 

  • Whiteheads (Closed Comedones): These tiny, closed bumps are caused by blocked pores filled with oil and dead skin cells. They get their name due to the white tip appearance. 
  • Blackheads (Open Comedones): Open pores that lead to oxidized melanin and sebum, resulting in the dark/black pore appearance. Remember, they're not caused by dirt!


Inflammatory Acne

1. (Papule, pustule) – Red, swollen pimples due to bacterial overgrowth, inflammation & often hormonal fluctuations.

  • Papule: A papule does not have a visible centre with pus/debris. Papules often develop into pustules in about 2-3 days. This transition is caused by an inflammatory reaction where WBCs rush to the area to help fight the C. acnes bacteria (Cutibacterium acnes). This stage can range from mild to severe. 
  • Pustule (pimple): Bumps with a white or yellow centre filled with pus/debris. These pimples can collapse, which further leads to inflammation within the surrounding skin - this can lead to the worsening development of cysts or nodular acne.  

2. Cystic or Nodular Acne – Deep, painful nodules that can often lead to scarring.

  • Cystic: The most severe form, these painful lumps are filled with fluid. This type of acne can lead to scarring and has the most risk for complications of the skins surface.
  • Nodular: Painful, solid lumps beneath the skin caused by deep inflammation. These can take 1-3 weeks to fully heal. 

Why is Your Acne Not Improving: The Driving Forces Behind Acne Vulgaris

Understanding the influencing factors that may be driving your acne, ultimately helps to guide treatment and get longer lasting results. People often think that acne is driven by a deficiency in their skincare routine, so they invest thousands of dollars on products, and yet they see minimal results. The same also goes for conventional medications such as oral contraceptive pills, antibiotics, Accutane, spironolactone, etc . YES, there is a time and place and they CAN help your acne, but do the results last if you stop taking the medication? In my experience, NO, not always, and acne often returns in full force. This is because there is more behind what is driving your breakouts, there is something internal that must be addressed to get to the root issue of your acne. Let’s look at the different layers that can trigger acne: 


Layer 1: Hormones 

  • Sex Hormones - balance between estrogen, progesterone, androgens [testosterone, DHEA], prolactin
  • Chronic Stress/Adrenal function - Corticotrophin-releasing hormone [CRH], cortisol 
  • Blood sugar regulation - insulin, glucose, insulin growth factor-1
  • Thyroid function - under-functioning thyroid 


Layer 2: The Gut  

  • Nutrient deficiencies
  • Food sensitivities - leading to inflammation & disrupted gut lining 
  • Gut motility - diarrhea/constipation
  • Gut infections/imbalance - parasites, fungi, bacterial [H. Pylori], SIBO (small intestinal bacterial overgrowth)
  • Stomach acid - low or high


Layer 3: The Body’s Superhero’s - Detox Pathways 

  • Bowel movement
  • Liver function
  • Skin barrier - sweating! 
  • Menses 
  • Kidney function 
  • Lymphatic drainage
  • Lungs
  • Poor sleep - recharge, repair 


Layer 4: Genetics, Environmental, Skin Care

  • Genetics - some people are predisposed to being at higher risk of acne development
  • Exposure to pollution, endocrine-disrupting chemicals (found in plastics, skincare, and cleaning products)
  • Heavy metal exposure
  • Personal Care Routine - including skin & hair care products 


Layer 5: Medication Influence 

  • Antidepressants - lithium and amoxapine
  • Antibiotics - tetracycline, streptomycin, and co-trimoxazole
  • Corticosteroids 
  • HRT (hormone replacement therapy) - estrogen, testosterone 
  • Birth Control - IUDs (copper & levonorgestrel IUD), etonogestrel implants


Layer 6: Underlying Medication Conditions (this list is not exhaustive)

  • PCOS (polycystic ovarian syndrome), puberty, PMS, endometriosis, Pregnancy
  • Hypothyroidism
  • Chronic Stress
  • Underlying Infections 


Final Thoughts

Acne isn’t something you can ‘fix’ overnight and often requires a comprehensive approach looking beyond just the surface level treatments. This requires balancing the entire system - inside out and outside in! Think of the tree analogy - when you plant a tree, you nourish the soil first to help support the roots, so you can then watch that tree flourish above ground. By addressing detox pathways, hormonal health, gut function, the skin barrier and nutrient levels, you create a strong foundation for clearer, healthy skin.


Remember, your skin and root cause are unique to YOU. Your success to clear skin relies on proper investigation and a tailored plan specifically to what your body and skin needs. 


By taking this whole-body approach, we can move beyond temporary solutions and truly support our skin’s health from within. Let’s embrace the layers of acne-clearing and work toward lasting, radiant skin!


References

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