Spots can be very distressing, both for teenagers with oily skin and adults with drier skin. Bath Spa Skincare strongly believe that the causes as well as the symptoms need to be addressed and the top tips below provide an holistic approach for improving spot-prone skin. The causes of blemishes are discussed in detail further down this article.
Top tips for clear, smooth skin
1. Gentle natural skincare is very important. Make sure your skincare routine is helping to gently clean and exfoliate your skin to prevent bacteria and blockages. Using harsh cleansers and scrubs can exacerbate the situation by stripping and irritating your skin, which can then overcompensate with more sebum production and inflammation. Also, make sure your skincare doesn’t contain too many synthetic chemicals, some of which may can act as xeno-estrogens in the body and some of which are comodogenic i.e. they can block pores. Also make sure your skincare products are high in antioxidants, and if you find sun screens make your skin worse try ones that use zinc oxide rather than chemical filters and make sure you wear a hat and sunglasses.
2. Improve your gut health. Gut flora influences the skin; one study1 found that 54% of acne patients have significant alterations to the gut flora (the reason perhaps being that gut microbiota influences sebum production and quality through the release of neuropeptide substance P). Also a study on those with acne roseacea found that small intestine bacterial overgrowth (SIBO), a condition involving inappropriate growth of bacteria in the small intestine, was 10 times more prevalent than in non-roseacea controls. The correction of SIBO led to a marked clinical improvement. A number of other studies2 also suggest that a significant number of acne suffers have high intestinal permeability compared with those with no acne. So we would highly recommend you take a probiotic and prebiotic supplement and eat probiotic foods every day (e.g. fermented foods and beverages like sauerkraut, kim chi, beet kvaas, sheep’s yogurt, cortido etc.) and prebiotic foods that stimulate the growth of beneficial bacteria (e.g. onions, garlic, artichokes and fruits and veggies high in soluble fiber - sweet potatoes, brussels sprouts, asparagus, avocados, apricots etc.). Also significantly reduce sugar.
3. Harmonise your hormones. Unbalanced hormones are the main cause of spots and acne and the causes of hormonal imbalances are discussed in detail further down this article. But how can you balance your hormones?
- Don’t let your blood sugar and insulin levels get out of control. Eat low glycaemic load (GL) and glycaemic index (GI) foods every 3 - 4 hours, cut right down on refined sugar and processed carbohydrates and eat plenty of foods containing chromium, magnesium and zinc which help to regulate blood sugar levels (e.g. wheatgerm, pumpkin seeds, leafy green vegetables, cinnamon). If you have a chromium deficiency it can be hard to replenish by food alone so it would be worthwhile considering a supplement with chromium picolinate, magnesium and zinc (also biotin).
- Improve digestive health with probiotics and prebiotics (see 2. above)
- Supplement with natural androgen binders (i.e. the androgens will bind with these rather than your skin cells)-and help regulate your hormones. Diindolylmethane (DIM) extract from cruciferous vegetables, agnus castus (chaste berry) and saw palmetto have helped many people. Vitamin B5 and vitamin A are also thought to help bind androgens but do not over dose on vitamin A! Agnus castus also helps to balance progesterone and estrogen. Do not take any of these if you are pregnant and consult your doctor, especially if on any medication.
- Improve liver function by cutting down on caffeine and alcohol and increasing herbal teas (particularly liquorice, nettle, dandelion, burdock) and water and supplementing with milk thistle.
- Significantly increase your intake of omega 3 and DHA rich foods to help both oily and dry skin e.g. salmon, trout, sardines, flax seed oil, hemp oil, ground flax seeds, supplements etc. and possible eat phyto-estrogen rich foods e.g. flax, all beans, peas, nuts, sesame, sunflower seeds. These can potentially help convert bad estrogens into good although their is still some debate on this.
- Alkalise your body. Eat alkalising foods such as almonds and green leafy vegetables and think about supplementing with chlorella or first thing every morning drink a large glass of warm water with a teaspoon of apple cider vinegar in it (with a straw to protect your teeth).
- Exercise regularly but do not over-stress your body as your adrenal glands will produce more androgens.
- De-stress. Stress hormones can also block the utilisation of progesterone and unbalance your hormones.
- Do not give up on the above as it may take a few months to see results. If you are very distressed by your spots consider seeing a doctor. They will likely prescribe a topical antibiotic as a first resort to clear skin of bacteria and then if this doesn’t work go down the oral route with anti-biotic and birth control pills and eventually Acutane, a very powerful medication that could have side affects. They may also prescribe a retinoic acid cream which is only available by prescription, this is a powerful type of vitamin A and can work for some people and cause severe irritation in others as well as making the skin more sun sensitive (the upside is it one of a handful of anti-ageing ingredients that can actually work!)
What causes spots?
Very simplistically the skin is producing too much or too thick sebum, pores get clogged and bacteria gets trapped causing infection and inflammation. So how come you can still get spots on beautifully clean, exfoliated and also normal - dry skin?
Overgrowth of the bacteria Propionibacterium acnes (p.acnes) is associated with spots and acne. P.acnes can be a friendly bacteria and has a useful function living deep in the hair follicles but if it becomes trapped in the hair follicle it will multiply with no means of escape and that’s when inflammation and spots occur. So what causes the bacteria to get trapped? Dead skin cells and, most importantly, sebum.
Male and female hormones have a great bearing on sebum and its the clogging sebum which is the main culprit of spots. Hence, hormonal imbalance is seen as the key cause of spots. But what causes hormonal imbalance and why do so many adults get spots without oily skin?
1. Excess Androgen
If your body produces too many androgen (male) hormones, or doesn’t eliminate them effectively, these can bind to receptors in the skin. Skin cells on our faces are often very androgen-sensitive, and possibly more in some people than others. When androgens bind to the skin receptors they cause excess sebum production, enlarged pores and also a thickening of skin cells around the base of the hair follicle causing blockages. They also cause sebum to become thicker and more viscous (as opposed to estrogen which makes it runnier) so it’s more likely to get stuck lower in the hair follicle and cause more blockages than if it were able to flow easily to the surface. This could explain why dry-feeling skin can still get spots. One bonus to androgens is that they can increase collagen, increasing skin strength.
Androgens are produced in both the ovaries mid cycle and also in the adrenal glands. Insulin resistance and stress can cause excess androgens to be produced and poor liver function can mean they are unable to be effectively removed.
A person with insulin resistance will experience elevated insulin levels which decrease the amount of sex hormone binding globulen (SHBG) the body produces and SHBG is crucial for binding free androgens, otherwise they are free to bind with skin cells. Insulin resistance is thought to be one of the causes of Polycystic Ovary Syndrome (PCOS), so when people think their spots are caused by PCOS, underlying this could be an excess of androgens possibly caused by insulin resistance.
Insulin resistance may be caused by a genetic predisposition but also by:
- A high GI and GL diet i.e. excess sugar and processed carbohydrates
- A chromium, magnesium and/or zinc deficiency. Either through the diet or from an overgrowth of the yeast-like fungus Candida albicans which prevents the digestive tract absorbing the right nutrients.
- Lack of exercise.
2. Imbalance of progesterone and estrogen
Progesterone balances estrogen and suppresses androgens. If progesterone is low compared to estrogen there will not be not sufficient progesterone to suppress excess androgens in the body as well as the estrogens. Hence ‘estrogen dominance’ can cause spots as the good estrogens (which make sebum more fluid, decrease pore size and increase plumping and smoothing hyaluronan) are loosing to the androgens to bind with the skin receptors.
The imbalance of progesterone and estrogen can be caused by low progesterone levels or from overly high estrogen levels.
Progesterone levels vary monthly but can be lowered through illness and stress. It also naturally declines more rapidly between the ages of 35 and 50 than estrogen does.
The main causes of excess estrogen are ‘bad’ estrogens from the environment (xeno-estrogens) e.g. from hormonally injected meat, pesticides, plastics, vinyl, car interiors, bad skincare and cosmetics ingredients and also from stress, cysts, obesity and liver problems.
Although a very complex subject, recent research means it is possible to significantly help balance your hormones naturally.
*Disclaimer: No medical claim is implied or intended in relation to the products or information above. This article is intended as a helpful guide and contains suggestions based on years of personal experience, current knowledge and research. At the moment the law requires that unless a substance or product has a medical license, no claim can be made as to its efficiency for a medical condition.
1 Klin Med (Mosk). 2001;79(6):39-41: Impact of the impaired intestinal microflora on the course of acne vulgaris
2 Acta Derm Venereol. 1983;63(6):538-40. Fibrin microclot formation in patients with acne