A few days ago I invited everyone on social media to ask me their most pressing questions about acne.  The questions were great, and the Q&A goes something like this:

  1. What is the best way to test for hormonal acne?

In the past I used urine steroid hormone testing when women presented with hormonal acne, but since then I have stopped doing this as often.  See the next question to discover why!

  1. What is the best way to treat hormonal acne?

After practicing naturopathic medicine for over 12 years I have discovered that the best way to treat hormonal acne is by balancing the body from its foundation.  This means regulating insulin levels, supporting the liver and reducing inflammation in the body.  After 100 days of implementing this protocol in the body, the ovarian follicles will have had a chance to develop optimally and normal levels of estrogen and progesterone will be produced in the body.

  1. What is the best way to treat cystic acne?

Cystic acne is often hormonal and the result of inefficient detoxification in the body.  Following a program that balances insulin levels, reduces inflammation and supports the liver is the best way to prevent cystic acne.  If you do feel a cystic lesion forming, using ice to reduce inflammation can often prevent the cyst from fully developing.  If the cyst has already formed, alternating hot and cold compresses can sometimes help it resolve.  If not, your best bet is to leave the cyst alone and allow it to go away on its own.

  1. What are your thoughts about spironolactone?

Spironolactone is a drug that is often administered to treat acne because it acts as an androgen-blocker.  This means that it stops androgens, the hormones that ultimately cause acne, from binding to receptors and contributing to acne.  This does not solve the underlying imbalances within the body that are contributing to acne, so often acne will return (often even worse than before) once the drug is discontinued.  Spironolactone is also used to lower blood pressure and it is a mild diuretic.  There can be side effects from this medication, including GI distress, headaches and dizziness.

There are some excellent natural androgen-blocking substances out there that do not have the same side effects as spironolactone.  But the best way to solve acne for good is to balance the body from its foundation.

  1. Does the location of your acne indicate that there is something going on in your body?

Often if the acne is along the jawline it has a hormonal origin.  If acne is primarily on the chin it can be from stress, and acne on the cheeks and forehead often indicate dysbiosis and sluggish detoxification.  These are general guidelines only though.

  1. Is the redness on my skin rosacea or inflammation?

Rosacea is inflammation, and the redness is definitely due to an inflammatory process in the body.  Often red skin on the face is due to dilated blood vessels and inflammation.  This usually indicates that the gut needs to be healed so that the inflammation can be resolved.

  1. I don’t have active acne, but I have congested, blocked pores all along my jawline. What could be causing this?

If the congestion is just around your jawline, it could be due to a hormonal imbalance.  Your body is producing too much sebum (oil) in that area of the body and its production needs to be reduced.  This can be accomplished often by regulating your insulin levels, reducing inflammation and supporting your liver.

  1. Why does it take so long for hyper-pigmentation and scars to resolve?

Hyper-pigmentation is the result of melanin production in the skin in response to an inflammatory process.  Once the threat of further inflammation / damage has passed, it takes time for the body to break-up and degrade the melanin.  Often, the body needs support in order to fully accomplish this task.

Scar repair involves the production and re-organization of collagen fibers.  This is a process that takes time as well, and will likely need additional support.

  1. Does histamine intolerance contribute to acne?

Yes, histamine intolerance can contribute to acne.  To find out if this is a problem for you, removing all foods that histamine-triggers is suggested.  This includes foods such as alcohol, fermented foods, aged cheese, smoked/cured meats and fish, dried fruits and soured dairy.  The good news is that histamine intolerance can be resolved by healing the gut, reducing inflammation and supporting the liver!

Whew!  Great questions, people!  There are even more questions – the ones that have to do with topical skin care, which I will save for another post.  But if you are interested, watch the video below where I answer all those questions anyways.  I just couldn’t help myself.  I really love thinking and talking about acne too much!!

Have a great day – and if you need help balancing your body (ie. balancing your insulin levels, healing inflammation and supporting your liver), check out my 7-Week Clear Skin Program!  Because you read this post, I am offering it to you at an extra-special sale price.  Click here to learn more.


Dr. Stacey




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