Dr. Rahima Hirji, ND

What makes acne particularly challenging is that so many factors can contribute to it. Genetics, for instance, can be a big factor. If there is a family history of acne, then the likelihood of developing acne is increased. We see this a lot in the severe cases of acne.

If there were a parent with severe acne, that would be more challenging to treat because of that genetic component. And then hormones. Especially going through puberty or pregnancy, a big change in hormones and an increase in androgens can lead to excessive sebum production.

Sebum is this oily substance produced by the sebaceous glands on your skin. In excess, it clogs up pores and can lead to acne.

Another factor can be related to the skin flora. That is the bacteria on your body. Your skin has its own microbiome. And when you start to see imbalances in that microflora, you’ll see certain types of bacteria that, when not controlled, or if the diversity of the skin microbiome isn’t balanced, that bacteria can be problematic and can lead to the aggravation of acne.

Diet, cosmetics and stress are also really important when it comes to acne. So really, there are multiple different things that you want to look at when you’re trying to help somebody with acne.

The impact of diet on acne is not always as clear as we would like it to be. But there are definitely some dietary factors that we know can worsen acne.

One of the things that can help with treating acne is focusing on a diet that is low in glycemic index. Foods that take longer to break down into sugar don’t impact insulin secretion as much. Typically, high glycemic include white bread, sugar, and processed foods that easily break down and rapidly spike blood sugar levels. An increase in insulin has been linked to higher sebum production. On top of the increased insulin, these foods can also lead to increased IGF-1 or Insulin-like Growth Factor 1 production. IGF-1 can aggravate acne because it increases inflammation while also increasing sebum production.

It becomes a vicious cycle because the insulin will increase the production of IGF-1, which will increase the secretion of insulin, and all of that contributes to excessive inflammation and severe sebum production, worsening acne.

Focusing on a Mediterranean-type diet, ensuring you have lean protein, good fats, low glycemic carbs, whole grains, fruits, vegetables, and nuts will help you control inflammation and insulin secretion.

Certain foods also contribute to the worsening of acne. Dairy is one of them. What’s interesting about dairy is that its impact is worsened when consumed in excess. Most individuals can have about three servings a week, maybe up to six servings of a higher-fat dairy, and it won’t aggravate their acne. But as soon as you start having acne and consuming dairy products daily in copious amounts, that’s when you really see the aggravation of acne. I’ll often tell my patients to limit it to three servings a week and focus on good quality, higher-fat types of dairy.

Chocolate has also been shown to exacerbate acne. When treating a patient with acne, I ask them to eliminate chocolate completely. And unfortunately, this applies to all types of chocolate. So not everyone’s happy to hear that piece, but there’s definitely a correlation between chocolate and acne.

Several supplements have been shown in the research to reduce acne and inflammation. At the top of that list is zinc. Zinc reduces inflammation and the severity of acne, especially if there is a zinc deficiency.

It’s not always easy to test if you’ve got a zinc deficiency. But there are ways that you can do that. There’s the Zinc Tally test and also some blood tests. It’s important to start low and go up slowly with zinc because excessive zinc can also have some adverse effects.

The other one that has been shown to be helpful is Omega-3 for its anti-inflammatory properties. These are the fats we find in fatty fish and certain plant sources like flax seeds, chia seeds and walnuts. Even supplementing with an omega three fatty oil is beneficial. You do want to be careful as there are various qualities of Omega-3 or fish oil supplements that aren’t necessarily what we’re looking for in treating acne.

About the microbiome, probiotics can be really helpful for the gut, but then they can also impact the microbiome on the rest of your body. That includes your skin health, so probiotic supplements or foods containing probiotics, like yoghurt, kefir and fermented vegetables, may be worth considering as part of an overall acne management approach.

Vitamin D is especially helpful if there is a deficiency. Most people in Canada especially need to supplement with vitamin D because we’re too far North to make enough – even in the summer, contrary to popular opinion. Just correcting that deficiency can often help to manage acne.

Lastly is lactoferrin. This is a new one that’s coming up. It is one of the proteins from whey. New research shows that it can be helpful when it comes to treating acne. But what is important when we’re talking about supplements is you need to give the supplements enough time to work. They’re not going to work overnight.

It is also important to take supplements properly. Ideally, under the management of a health care practitioner because while they’re not usually going to cause huge adverse side effects, that doesn’t mean they’re 100% safe for everybody, especially In high doses. Before you dive into it, you want to put together a complete plan, including supplements, diet and lifestyle.

When it comes to topicals, they are an integral part of the overall treatment plan. You cannot get as much leverage out of topicals if you’re not doing all the other things right.

If you’ve got a terrible diet and your blood sugar is out of control, the topicals will have some value, but it needs to be part of a complete approach. When it comes to using topicals for acne, I like the ones that are exfoliating.

Things like salicylic acid or niacinamide help unclog pores that can get clogged up with sebum. These products have been shown to help, but the problem with some is that they’re a bit too strong. They do a good job of exfoliating but leave the skin quite dry, compromising the moisture barrier.

Often, people will stop using them because their skin feels uncomfortable. And if not used properly, it can lead to other issues. Therefore, I like to focus on products that have multiple ingredients.

For instance, some of the new products will incorporate the exfoliant but also include things to negate the side effects of those exfoliants. We have launched a product with salicylic acid but added seabuckthorn to it. The seabuckthorn negates the drying properties of the salicylic acid by adding probiotics and prebiotics to moisturisers.

The new products coming out are quite exciting from this standpoint. And what’s also important is that sometimes you might have to try a few different products. Give each product at least three or four weeks, and make sure you’re using the products correctly. Everybody’s skin and skin needs are different