December 4, 2023

Acne Help, Please!

How do I treat acne? Let’s look at the causes of acne for effective and long lasting treatment options.

Acne can be something that affects us at any age. Most commonly acne affects us in our teenage years and is attributed to hormonal changes and excess sebum. Whether you are in your teens or 30’s having acne is not fun and can lead to reduced self esteem and isolation.

There are many different over the counter and prescription creams to treat acne, pharmaceutical options and other topical treatments and procedures. Maybe you have a tried one or a variety of these available options but still struggle with acne? Treating the cause may be your next best option…

What is the cause of acne? Let’s dive in…

The skin is a first-line barrier from our external environment and is continuously interacting with it. The total skin surface is one of the largest epithelial surfaces continually interacting with microbes3. The skin microbiome needs to be robust to keep bacterial pathogens, viruses, parasites, and fungus from invading and taking control of the environment. How is the skin microbiome kept in check? ….

Welcome the gut microbiome! The gastrointestinal (GI) tract is one of the largest assimilations connecting the host to its environment. In other words, when the gut microbiome is out of whack the skin microbiome is affected. And vice versa!

Why am I talking about the gut when asked about the cause of acne? Great question!

The gut and skin barrier share a lot of the same characteristics. The inner surface of the gut and the outer surface of the skin are both covered by epithelial cells (ECs) which have direct contact with the exogenous environment3. EC’s are the first line of defense between the internal and external environment followed by keratin, sebum, and the low skin pH all keeping external pathogens at bay.

The microbiome provides a multitude of benefits such as shaping the immune system, protecting against pathogens, breaking down metabolites, and maintaining a healthy barrier6.

The gut microbiome is the largest endocrine organ, producing at least 30 hormone-like compounds, e.g., short chain fatty acids, secondary bile acids, cortisol, and neurotransmitters such as gamma-aminobutyric acid (GABA), serotonin, dopamine, and tryptophan, and melatonin2. Many studies illustrate a biodirectional link between gut health and skin homeostasis.

For example, psoriasis and inflammatory bowel disease (IBD) are both associated with increased permeability of the epithelial layer of the skin as well as intestinal permeability and immune dysfunction4. Both IBD and psoriasis are characterized by intestinal permeability and dysbiosis.

70% of our immune system resides in our guts!

So what about acne?

Gut and skin are connected via the immune mechanism. As the the gut becomes inflamed the mucosal barrier becomes weak allowing for pathogens and their toxic compounds to be released into the blood and lymph.

This signals an immune response, low lying but constant. As the gut microbiome becomes more and more permeable due to reduction of “good” bacteria and overgrowth of “bad” bacteria the immune response will become increasingly depleted allowing for inflammation and disruption of our other microbiomes such as the skin. In other words, a permeable and inflamed microbiome leads to inflammation throughout the body.

In general, acne patients have decreased diversity of the gut microbiota2. In clinical practice, skin symptoms such as acne are associated with intestinal symptoms like bloating, constipation, diarrhea, and food sensitivities to some degree.

Does lifestyle play a role?

Absolutely! A western diet is associated with increased rates of inflammatory skin conditions such as acne and allergies. Diet plays a HUGE role in the balance of our microbiomes. This balance is what controls our immune functioning inside the gastrointestinal tract.

Dietary modifications that lower glycemic load are shown to improve the pathogenesis of acne5. Patients with acne were found to have a deficient gut microbiome when compared to controls1.

What other lifestyle factors can affect your skin?

Stress! Long-term constant stress has been shown to decrease beneficial bacteria in our guts and increase mucosal membrane permeability. Stress can be external, coming from human interactions, physical stress (exercise/work/injury), or environmental toxins.

Stress can also be internal from covert infections like viruses, bacterial pathogens, parasites, fungus or toxins. A combined approach that looks for and treats internal stressors and helps to modify for external stressors is the best.

Another important factor to consider is cleanliness. We can become deficient in “good” bacteria that allows for pathogenic overgrowth through diet, toxin exposure, and excess stress but also through excessive cleanliness.

An overly hygienic lifestyle prevents microbial stimulation and can cause a skewed immune response2. The old saying goes, “God made dirt and dirt don’t hurt!”

What is a functional approach to acne treatment?

As a functional practitioner I think of the body as one system working together. Acne is a symptom of something deeper going on. As I have described in this article there are many factors that can contribute to the development of acne: gut health, immune dysfunction, diet, stress, toxins and genetics.

The functional approach finds and treats internal imbalances and combines that treatment with a personalized lifestyle protocol.

Wave on Wave Health & Acne

If you’re in need of Acne or have any inquiries related to skin health issues, please don’t hesitate to reach out to Wave on Wave Health in Melbourne Beach, Florida at 815-701-6507. We are dedicated to helping you address your skin concerns.

If you are struggling with an inflammatory skin condition such as acne, psoriasis, eczema, or rosacea schedule a FREE consult today!


  1. 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 Derm Venereol. 2018 Aug 29;98(8):783-790. doi: 10.2340/00015555-2968. PMID: 29756631.
  2. De Pessemier, B.; Grine, L.; Debaere, M.; Maes, A.; Paetzold, B.; Callewaert, C. Gut–Skin Axis:Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms 2021, 9, 353.
  3. Gallo RL. Human Skin Is the Largest Epithelial Surface for Interaction with Microbes. J Invest Dermatol. 2017 Jun;137(6):1213-1214. doi: 10.1016/j.jid.2016.11.045. Epub 2017 Apr 8. PMID: 28395897; PMCID: PMC5814118.
  4. Shaykhiev, R.; Bals, R. Interactions between epithelial cells and leukocytes in immunity and tissue homeostasis. J. Leukoc. Biol.2007, 82, 1–15
  5. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007 Jul;86(1):107-15. doi: 10.1093/ajcn/86.1.107. PMID: 17616769.
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