Acne

At the cellular level, acne is caused due to increased sebum production, increased production of keratin, colonization by Cutibacterium acnes, and inflammation (Park & Oh, 2019) (Abozeid et al., 2022) (Lichtenberger et al., 2017). Factors that affect acne include: • Genetics • Hormone imbalance - This often occurs when oestrogen levels are disproportionately high relative to progesterone or when there is an excess of the androgenic hormone testosterone. Additional factors that contribute to hormonal acne include exposure to environmental toxins known as xenoestrogens, which mimic oestrogen, and the use of oral contraceptive pills. • Skin microbiome imbalance - An overgrowth of Cutibacterium acnes can trigger acne (Abozeid et al., 2022). • Diet - Certain foods like dairy, sugary and processed foods may exacerbate acne. (Abozeid et al., 2022) (Bungău et al., 2023) • Stress - Stress can increase cortisol levels and trigger acne. • Vitamin and other micronutrient deficiencies - Deficiencies in vitamin A, zinc, and omega-3s may contribute to acne. • The body’s detoxification pathways include the liver, gall bladder, urinary tract etc. which play a crucial role in eliminating waste products and toxins. Any dysfunction in these pathways can also contribute to acne (Ditre & Whitney, 2011). Constipation and dehydration are other factors that can impair the body's natural detoxification processes and trigger acne. • It has been noted that the gut microbiome and its dysbiosis may also play a role in acne pathogenesis (Park & Oh, 2019). The gut-immune-skin axis contributes to acne development, as gut dysbiosis (e.g., SIBO) can increase gut permeability, allowing toxins and inflammatory metabolites to enter the bloodstream. This triggers systemic inflammation, enhancing sebum production and Cutibacterium acnes overgrowth, leading to acne. The interplay of these factors mandates a root cause analysis and a holistic approach to acne management tailored to the individual.

The main symptoms of acne include (Park & Oh, 2019): • Comedones (blackheads and whiteheads) • Papules and pustules - red, inflamed lesions with or without pus • Nodules and cysts - large, painful lesions under the skin Acne is not contagious, although sharing makeup, towels, and other personal care items can spread acne-causing bacteria.

Conventional acne treatment typically involves topical and/or oral medications such as retinoids, benzoyl peroxide, antibiotics, and in severe cases, isotretinoin. Certain skincare treatments, such as light-based therapies and chemical peels, can help manage acne but should be used cautiously under professional supervision as they have potential side effects include skin irritation, redness, and changes in pigmentation. It is important to avoid tight fitting clothes and harsh skincare products during treatment. Excessive use of skincare products and over-cleansing are often overemphasized in acne management. Basic hygiene with gentle cleansing and targeted treatments is usually more effective, as overdoing it can disrupt the skin barrier and worsen acne. Diet - Follow an anti-inflammatory diet, avoiding sugars, dairy, wheat, processed foods. Increasing intake of omega-3 rich foods may help reduce acne. Trans and saturated fats (butter, margarine, fried foods etc) and salt intake should be limited. It is also important to stay well-hydrated, manage stress effectively through yoga, mediations etc., get regular sun exposure (without sunscreen), maintain a consistent sleep schedule, and engage in exercise to promote sweating, which supports skin detoxification.

Vitamin A - Crucial for skin health and helps reduce sebum production (Abozeid et al., 2022) Zinc- Anti-inflammatory and supports skin regeneration Omega 3 fatty acids - Help reduce inflammation Probiotics - Improve gut health and reduce inflammation Nicotinamide - Has anti-inflammatory and sebum reducing properties L- Glutamine - indirectly improves skin health by supporting gut integrity 3,3'-Diindolylmethane (DIM) - Regulates hormones and reduces acne Vitamin D - Regulates inflammatory pathways and supports skin health Magnesium, Vitamin B6, Ashwagandha have also shown potential benefits. Natural herbs like tea tree oil, calendula, neem, licorice root have anti - inflammatory and anti - microbial properties.