The skin is the interface between the individual and the world – “the vehicle through which we express, communicate and perceive” (1). Our psychological and spiritual health is affected by and, in turn, can affect the skin. This is why seeking proper treatment is so crucial to the many people who turn up at my practice with skin disorders, especially acne.
Holistic practitioners like myself have the time and the tools to consider skin from every angle. Through listening to the patient, we determine how dysfunction and imbalance in other organ systems is contributing to their condition. We look at diet, discuss relationships, heal the gut, support liver detoxification, boost lymphatic clearance, calm the nerves and improve sleep – our best anti-inflammatory medicine.
It’s not rocket science. It just takes a bit of dedication and motivation – something I see and admire in my patients, when so many of them have been trailed through treatments that not only haven’t worked but have left them depleted of their natural resources and despondent at the continuing poor state of their skin. So, with a few years’ experience in treating chronic skin conditions under my belt, here’s my two cents on acne.
Acne: all about hormones?
Elevated androgens (male hormone) are often seen in acne sufferers, and these act upon the sebaceous gland to increase sebum (oil) production. Higher levels of sebum support the proliferation of bacteria, most commonly Propionibacterium acnes, and inflammatory mediators are released by the bacteria into the follicle and surrounding tissue, causing redness, swelling and infection (2).
However, many acne sufferers have normal androgen levels with an increased sensitivity to the hormone at the sebaceous gland, due to elevated levels of an enzyme (5 alpha-reductase) that converts testosterone into its more active form (3). This is why herbs such as saw palmetto and nettle root, which act together to decrease this enzyme in the body, are often used by herbalists to treat acne. Zinc also does this, as well as being a crucial mineral for immune and skin health.
Acne has also been connected to emotional stress and high insulin levels, which make the skin more oily and prone to infection. Cutting out sugar and excess carbs can have a profound effect on the skin in more ways than one – which brings us to the concept of the gut as the focus of holistic treatment of acne.
The gut-liver-skin axis
From a holistic perspective, reducing inflammation in the gut decreases the toxic load on the liver, which enables the liver to detoxify the blood more effectively and in turn prevents any excess ‘toxins’ from being expressed in the skin.
The word ‘toxin’ has a bad rap, but it is recognised in mainstream medicine – rheumatologists acknowledge the capacity for ‘endotoxins’ (toxins arising from within the system) to affect the joints and contribute to arthritis (4).
Along these lines, it is essential to identify and eliminate any food intolerances, such as wheat or dairy, that are acting as toxins in the system and inflaming the gut. Digestion in the stomach may need to be enhanced with warming carminatives like chamomile and fennel, as a weak digestive ‘fire’ is also associated with a build-up of toxins (undigested proteins) in the digestive tract.
These large, reactive proteins irritate the gut and can ‘leak’ through into the blood, causing a systemic immune response. ‘Leaky gut syndrome’ is extremely common and is often at the root of inflammatory and autoimmune conditions affecting the skin and joints. A simple elimination diet and gut-healing tea blend of herbs like calendula, plantain and marshmallow root can work wonders in repairing the immune system from its very source – the gut.
Herbs for the liver, lymph and ‘damp heat’
The liver is the other organ worthy of some love in any skin disorder. It deals with all internal and external toxins, and in chronic skin disease the liver has been working overtime to attempt to detoxify an overburdened system. Dark leafy greens, adequate B vitamins, magnesium and omega-3 fatty acids, zinc, selenium and vitamin C are all required for optimum liver function.
In terms of herbs, dandelion root, barberry, rosemary, milk thistle, garlic, turmeric and liquorice all act on the liver in different ways and the chosen herbs should be matched to the constitution of the individual – dandelion, barberry and milk thistle for hot types; garlic, rosemary, turmeric and liquorice for cold types.
In more traditional medicine parlance, improperly digested food and toxins in the circulation can create ‘dampness’ in the system, and obstruct lymphatic clearance. The lymphatic system is what keeps our extracellular fluid clean – if it is not working optimally, tissues become congested, inflamed and infected. Hence the traditional rationale of giving ‘depuratives’ for skin conditions – ‘blood cleansing’ and lymph-moving herbs, such as cleavers, red clover, blue flag and burdock.
In Chinese medicine, acne is seen as a condition of heat – more specifically ‘damp heat’ when the lesions are infected, for which antiseptic and cooling herbs are required. Chinese skullcap or Scutellaria baicalensis is a specific herb for clearing damp heat, and clinically very useful in the treatment of acne and other skin conditions, reducing inflammation and providing antimicrobial activity. In Western terms, this would fit with our tendency to give herbs like goldenseal, echinacea and oregon grape root, both internally and externally, as a topical treatment for the infected spots. These can be applied in tincture form, mixed in with some rose water or chamomile tea.
1. Shuttle & Redgrove (1986) The Wise Wound: The Myths, Realities and Meanings of Menstruation. New York: Grove Press.
2. Thiboutot (2000) New treatments and therapeutic strategies for acne. Arch Fam Med. 9:179-187.
3. Speroff et al. (1999) Clinical Gynaecologic Endocrinology and Infertility. Baltimore; Lippincott Williams & Wilkins.
4. Lange JH. Endotoxin as a factor for joint pain and rheumatoid arthritis. Clin Rheumatol. 2004 Dec;23(6):566
By Poppy Burr
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Poppy is a UK-trained medical herbalist practising in Praia da Luz. She offers consultations and treatment in Western Herbal Medicine, incorporating Functional Medicine testing and nutritional strategies where appropriate. For more information, visit poppytheherbalist.com.