The Holistic Acne Approach by @drjemimagrant

Like everything in medicine, good management is customised to your skin and you as a person, not from a checklist. In order to achieve good control, you must see a professional and have a consultation.

My general approach can be summarised as follows:

1. Start with your lifestyle:

   Your acne will not get better no matter what you do if you eat the wrong food, don't eat enough food, or if you are extremely stressed or anxious/depressed.

• Consider supplements such as zinc, omega 3 fatty acids and probiotics, especially if clinical examination supports this intervetnion. ( I am happy for you to start this before I see you- please take an oral zinc supplement with food as it can cause nausea).

• Consider dietry interventions supplements that optimise detoxification/elimination pathways such as greens powders welleco -  The Super Elixir and the Skin Elixir. This is especially important if you are constipted or have hormonal acne.

• Move your body for at least 30 minutes each day- enjoy it, don’t suffer!

• Consider your mental health:  if you pick your acne, no topical treatment or medication will work. You need to reduce stress and get some psychological assistance. 

  2. Consider your metabolic health and hormones

• Chart acne to menstrual cycle (in females) 

• Consider your use of recreational steroids and hormones (in males). If you take steroids or hormones from the gym, it will give you acne.

• Ask your doctor to examine your acne: yes doctors you need to touch your patients! Assess the anatomical site of acne (face, chest, back), the severity and look for scarring. Is the skin oily and thick, or sensitive and red? Are there any signs of insulin resistance (increased BMI, increased abdominal girth, hyperpigmentation in the axilla or neck folds?). Are there signs of peripheral zinc deficiency?

• Consider bloods to assess metabolic health: general nutritional status, hormonal profile, and insulin pathways. I just use plain old pathology bloods. I do not use expensive private labs or saliva tests at this stage as I am not convinced there is good evidence for this, and they are VERY expensive. But I will look into this more over time. 

3. Treatment Options

• Diet: It is important to consider the fuel you put in your body as medicine. Out food and lifestyle modulates gene expression, which is why you can change your appearance and general health through diet and lifestyle. Food and lifetyle should be seen as a medication- the safest and most cost effective of all medication!

• This is a list of evidence based advice for linking acne with diet: If you have a diet high in trans fats (takeaway food) or simple carbohydrates (bread, pasta, rice) - try to stay away from these foods. Increase grass fed meat and veggies/salads. I prefer a diet high in protein and low in carbs for acne and general hormonal health. Reduce sugary drinks and make water your drink of choice. If you have a lot of milk, reduce it and drink organic milk. Eat a handful of nuts a day.

• However there is no one diet for each person. Just do your best.

Medical Treatment Options:

• My general approach is to hit acne hard - if you have come all the way to see me, you have usually had acne for some time. I start with a combination of: prescribed topical retinoids (start a few times a week and increase slowly, and yes there is one I prefer over others), gentle exfoliating agents, and consideration of hormonal based medication such as the oral contraceptive pill or spironolactone. 

• Prescribed topical or oral antibiotics - not both! If you have mild acne, try topical retinoids and antibiotics first. If you have more severe acne, start oral antibiotics for 3 months only. Always combine antibiotics with other medications to reduce bacterial resistance.  

• For women: hormonal medications (such as the oral contraception) if desired and with a lot of discussion - the pill can be amazing for acne but it is a long term option with side effects. I also prescribe other hormonal options (e.g. spironolactone, with great results, however I usually only do this if you are not at risk of pregnancy.

• If we cannot gain acne control within 3 months, or you have severe active acne with scarring, I will refer you to a dermatologist for consideration of oral isotretinoin. This is really important- scarring is irreversible.   All beauty, skin, alternative skin practitioners and doctors need to on the same page here as our patients need to come first.

I have recently been offering the Hydrafacial/Gold Toning Laser combination as a short course for hormonal acne, with some great results. This is in additional to the above treatments. Honestly, I have been surprised!

• Finally, when acne is settled, I consider a course of vascular laser and Tixel or microneedling to address scarring. Sometimes I also treat depressed scars with subcision (beaking up scar tissue) and dermal filler treatment to lift the scar.

The most important thing, once more, is that everyone's acne is different.

There is no one acne diet, pill or treatment. Please have an open mind and don't feel bad if your acne needs medication to settle. Humans are a complex mix of genes and environment, and there are just some genes you can not manipulate with facials, peels and the best diet in the world.

I always follow the evidence based guidelines for acne, which were updated a few years ago. If you suffer from acne and want to refer to a summary that is easy to read - check out this journal article. Feel free to bring it to your GP!

https://www.hmpgloballearningnetwork.com/site/thederm/article/6866