A common question from patients is what causes acne and how do I get rid of it?

The answer is: there are many different causes. Hormonal effects are the most common cause of acne.  Androgens like progesterone and testosterone cause your body to produce more sebum (dirty/sticky oil) and the dead skin cells on top of the skin block the sebum causing inflammation and infection. This is why we see acne develop during puberty, during menstrual cycles, pregnancy, perimenopause, during the use of medical hormones, and any other hormonal shifts. Overgrowth of acne causing bacteria can also trigger inflammation, leading to the type of red pus filled acne lesions on the face and body. Inadequate cleansing, over cleansing, and genetics can also play a significant role. It is important to understand what is causing each individuals acne in order to choose the most effective treatment.

Now we know what causes acne, we can find solutions on how to treat it. We have multiple options for modifying the effects of acne causing androgens, as well as many ways to reduce the production of sebum. We also focus on safely exfoliating the skin so the oil doesn’t get trapped in the follicle. Great success has been seen with monthly salicylic acid peels. The acid exfoliates the surface of the skin in an even and controlled waywhile simultaneously decreasing production of oil.

Vitamin A derived medications are also commonly used to decrease sebum production, decrease inflammation, and make your skin cells less “sticky” so they are less likely to clog pores and lead to acne. The tropical form of this is commonly known as Retin-A, but there are several forms that can be used in more sensitive skin or in stronger forms, depending on a person’s individual needs. This topical is also an excellent anti-aging cream, so don’t throw it once the acne is gone!

Accutane (Isotretinoin) is an oral medication for acne, which is a much safer form of high dose vitamin A. Taking high doses of pure vitamin A can cause significant toxicity so we use this safer and more effective form in individuals with genetic, severe, scarring or stubborn acne. It is extremely safe when managed byan experienced physician.

We also use certain antibiotics to reduce the bacterial overgrowth, or in lower dose to decide the inflammation. Doxycycline is a commonly used antibiotic as it has both the antibacterial feature and an anti-inflammatory feature. Many new forms of this medication are formulated to reduce the possible side effects of nausea and sun sensitivity. There are also topical medications to reduce the bacterial overgrowth and lower inflammation.This can be especially helpful for use after the gym or sports practice or after a long day of work in a hot environment.

Ask Armstrong Advanced Skincare Patient Questions: 

Question 1: Does dairy consumption worsen acne? 

A: All dairy products contain proteins that act as androgens in the body, which can worsen acne in sensitive people. Dairy that has had fat removed is also more acnegenic than unprocessed whole milk products. Additionally, non-organic dairy products often contain added hormones by the dairy farmers. If eliminating dairy is not an option, we recommend consuming full fat organic dairy products to help reduce added hormones and maintain a natural hormonal balance in the food. A special note: Whey protein is the purified form of milk protein which is especially bad for acne and found in nearly all protein supplements and meal replacement bars/shakes.


Q2: What is the best way to prevent acne scars? 

A2: Get treated early and DO NOT PICK! Although there are treatments for acne scars, they can be difficult, painful, and expensive to get rid of. The best way to treat scars are to prevent them. Get treated early and prevent acne scarring from the beginning.


Q3: What is the best medical treatment for acne? 

A3: The best medical treatment for acne depends on the type and severity of the acne. One of my favorite in-office treatmentsfor acne is extractions combined with monthly salicylic acidpeels. When done monthly patients see a 57% improvement in six months. I like this treatment because it can eliminate the need for systemic treatments.


Q4: What foods trigger acne? 

  1. Caffeine
    Excess caffeine increase stress hormones that can play a role in acne, especially acne of the chin and jawline.
  2. Added sugar
    Added sugar should be limited to no more than 25 grams per day for women and 38 grams per day for men. Less is always better, but going above this limit may aggravate skin issues.
  3. Refined/processed foods
    Consuming foods that are high in carbohydrates – think: white food like pasta, white rice, and potato chips. Like added sugar these foods often cause spikes in blood sugar which can impact hormones linked to acne breakouts.
  4. Dairy and whey protein isolates
    As mentioned before, the hormones naturally found in dairy foods make them a common acne culprit.


Q5: What foods help acne? 

1. Probiotics

Research continues to demonstrate a link between gut health and everything from weight loss to immunity, so it’s not surprising that a healthy gut has been found to help support clearer skin. It’s important to maintain healthy levels of “good bacteria” – while keeping “bad bacteria” (which may be linked to increased acne) at bay – to promote gut health. Consuming probiotic-rich foods is one way to do this. Dr. Armstrong who also has a degree in alternative medicine can help find the right probiotic supplement for you.

2. Antioxidants

Research suggests that antioxidants play a role in reducing inflammation in the body and thereby they may help promote the health of our skin.

Fill your plate with color! produce including red, yellow and orange peppers, blueberries and dark leafy greens. My favorite antioxidant shake is: one pack washed blueberries, one pack washed strawberries, one pack washed raspberries, large handful of spinach, Stevia, ice, water, and optional vanilla plant basedprotein powder. This can also help with weight loss.

3. Unsaturated fat

Unsaturated fat helps with absorption of vitamins A, D, E and K. We already talked about the importance of Vitamin A. Vitamins A, D, E, and K also provide anti-inflammatory benefits, that can improve acne.

Fill your plate with salmon, nuts and avocado.

4. Zinc

Zinc is responsible for regulating oil production in the skin and helps control some of the hormones related to acne.  It can also help boost your immune system.

Fill your plate with lentils, mushrooms, and chickpeas. If that’s not possible because you’re a teenager LOL then taking a zincsupplement is fine as well


Do you have a medical question? Ask us!

Happy New Year and Blessings from our family to yours, 

Dr. Armstrong