Updated: Jul 17
Treating Spots, Blackheads and Acne Naturally - What is really going on and why are antibiotics not the answer?
Part 1 = introducing the basics.
Part 2 = the small print – how skin survives and works for us; what happens in acne.
Part 3 = the best way forward.
Part 4 = parts 2 and 3 put simply in bullet points.
(If you’ve already read the problem skincare page on the website you can skip part 1.) To understand what happens with problem skin, the first step is to look at the skin itself and how it all works, so just a couple of paragraphs with some technical details and interesting facts!
The skin is actually the largest organ in the body. It is dynamic and capable of adapting rapidly – to temperature and light etc. It measures 2 square meters in the average adult. Being the outermost structure we - more often than not - view it superficially, in a purely cosmetic way. We cover ourselves in makeup in order to try to look healthy and vibrant; we inject inky tattoos to decorate ourselves; we shave; we wax; we pluck and we plump; we have surgery to stretch out the wrinkles and make ourselves look younger; we sunbathe or get air-brushed to deepen our colour; we do everything we can think of in
order to appear healthier and younger than we really are. Yet the most attractive-looking skin is that of a make-up-free, healthy, dynamic and vibrant person. We know this; we envy those people; and... we do very little to try to achieve this for ourselves. It’s quicker and easier to buy and apply makeup. Instead of taking our skin for granted maybe we should find out a little about how it works and how we can take better care of it?
Skin consists of layer upon layer. Some people consider the skin to have two layers, other people think in terms of three. It rather depends on what you consider to be skin! The outer, soft covering of our body is divided into the epidermis, the dermis and the hypodermis. Each section has its own layers.
The epidermis is the outermost layer and the thinnest. Its own top layer is comprised of dead keratinocytes – dead skin cells that protect us from damage by heat, light, pathogens and minor scrapes. Melanin is synthesised in the epidermis (another protective function) and fats are contained here, which help to regulate hydration and water loss. The epidermis is nourished by the dermis, the next layer in.
The dermis contains blood vessels, sweat glands, hair follicles, lymphatics, nerves, fat cells and cells that fight bacteria. Collagen and elastin fibres are found here. Sebaceous glands around the hair follicles secrete sebum, an oily/waxy substance that lubricates the hair and skin.
The hypodermis connects our dermis to our muscles and bones. This is the subcutaneous layer, which actually means “below the skin”, which tells us that the first two layers are actually what we think of when we talk about the skin, and this third layer is what lies below. It is mainly comprised of fat, connective tissue, nerves and blood vessels. It insulates, helping to regulate body temperature. It stores fat and it acts as padding, protecting our inner organs from impact.
Like every other part of the body, skin is self-regulating. It secretes oil when it needs, it releases or takes in water when it needs, it nourishes itself as and when it needs and it cleanses, detoxes and repairs itself when it needs. It appreciates a bit of help with soap and water or an Elastoplast (not to mention delicious natural skin care products), but generally speaking it carries on fairly well when left up to its own devices.
And like every other part of the body the skin can lose its balance. Although this can be caused by topical applications and environmental factors it is very commonly kicked off by internal imbalance such as poor diet or hormonal fluctuation. When this happens we may develop problems such as acne.
Hormonal fluctuation happens all the time. It is only an issue when the ebb and flow is happening to excess. The main culprits that upset the skin are testosterone, oestrogen and progesterone - male and female hormones, all three of which are produced by both males and females.
Typical times in our lives when the sea can get a bit choppy for these hormones are: adolescence, pregnancy, peri-menopause and menopause. There are various medical conditions that influence hormones too, but these are too complex for the purposes of this post. Hormone production is regulated in the brain, so if you have a skin condition that is hormone related this is really a signal that there are deeper issues going on. Although your skin can be helped by a wise choice of skincare products, you may need to look at nutrition, life-style and stress factors in order to tackle the root cause of the imbalance.
Puberty is a time when boys start to produce large amounts of testosterone. Testosterone stimulates the sebaceous glands to produce sebum. Adolescent girls, too, start producing more testosterone and it is actually an extremely important hormone for women’s health. There are testosterone receptors in almost all tissues of the body. Females produce smaller amounts of male hormones than males do, and males produce smaller amounts of female hormones than females, but we all need a good balance of all of these hormones. Too much male hormone (androgens) in a female can cause (or be the result of) polycystic ovary syndrome, which can upset the skin as it often causes excess hair growth and acne. Methods of removing excess facial hair can aggravate already sensitive skin. Too much testosterone can result in acne in both sexes.
Acne is a condition involving three main factors: inflammation, clogged pores, and bacteria. It’s a bit of a vicious circle in that inflammation causes a build-up of sebum and skin cells which creates the perfect environment for acne-related bacteria such as Cutibacterium acnes [C. acnes] – not cute at all!) Bacteria benefit from the conditions, multiplying freely and causing further inflammation. For a long time it was thought that excess oil and skin cell production caused the blocked pores, leading to colonisation of C. acnes. More recently though, science has started seeing it differently. Instead of inflammation being the end result it is now being considered to be a causative factor that gets exacerbated as the bacteria multiply. So why does the inflammation happen in the first place?
To answer this question we have to look at the skin microbiota.
The Cutaneous Microbiota
C. acnes is just one bacteria found on the skin. There are actually hundreds of species of bacteria and other organisms including viruses, fungi, and mites that inhabit the healthy skin, forming its microbiota (flora). The main ones are Staphylococcus, Cutibacterium, and Corynebacterium. Just like the microbiome of the digestive sphere, these organisms help maintain skin health and prevent infections, by feeding on potentially dangerous microorganisms.
Put simply: just like good gut bacteria keep bad gut bacteria in check, good skin bacteria keep bad skin bacteria in check too.
The skin microbiota also breaks down sebum, making it usable, freeing up the fatty acids which help in the battle for health as they are toxic to many pathogenic bacteria. The balance of microorganisms on the skin is determined by how well it is moisturised and lubricated – its level of water and oil. Disruption of the delicate balance between host and microorganisms can result in skin disorders or infection. The healthy skin depends upon this symbiotic relationship between resident microbial communities and host tissue. Too much male hormone can trigger an over-production of sebum, too much for the microbiota to handle, and this leads to the scenario outlined above. As the outermost layer, microbial communities are “first responders” to negative changes in the skin environment. They transmit signals to the immune system, triggering an immune response. The immune response is how the body recognizes and defends itself against bacteria, viruses, and substances that it considers to be foreign and harmful. One part of the immune response is inflammation. This occurs when tissues are injured by bacteria, trauma or toxins etc. The damaged cells release chemicals including histamine, bradykinin, and prostaglandins. These chemicals cause blood vessels to leak fluid into the tissues, causing swelling. This helps to isolate the foreign substance and prevent it from causing deeper damage. This process attracts white blood cells (phagocytes) that "eat" germs and dead or damaged cells. When there’s nothing left to feed on the white blood cells die off. Pus is formed from a collection of dead tissue, dead bacteria, and live and dead phagocytes. This process can go on anywhere in the body, and where the skin is concerned, that is what is happening in acne. So, for instance, during adolescence when there is a surge of testosterone and the skin becomes oily because it has produced excess sebum, its whole environment changes. There is a shift in the balance of microorganisms, allowing some to thrive and causing others to decrease. The excess bacteria are deemed potentially dangerous by the skin’s immune cells which pretty soon dial 999 and call in the paramedics who trigger the protective response of an inflammatory reaction. The inflamed follicles, because they are swollen, restrict the release of the sebum which then builds up, and dead skin cells which are not being flushed away become trapped in the pores along with the trapped sebum. As mentioned above, bacteria such as C. acnes are able to take advantage of these environmental factors and they multiply, further triggering the immune response.
What usually happens at this stage is the adolescent becomes painfully embarrassed about their skin and invests time and money in products that are antibacterial, anti-inflammatory, oil-stripping and opaquely masking. All of these products are imposing specific actions on the skin. What needs to happen is for the microorganisms to return to their normal ecological balance but they can’t achieve this when substances are being applied which knock out many strains of bacteria and interfere with the natural rebalancing mechanism of the skin. As well as the bacterial imbalance, fungi such as candida can proliferate because the bacteria which normally keep it in check have been eradicated by these skin treatments. The teenager finds that they now have some patches that are dry and other patches that are oily, patches with spots and patches that are clear, sore acne spots in some places, blackheads in other places, etc etc etc. Everything feels out of control and their morale dips because teenage is a time when appearances are crucial.
With lowered morale the emotions become less stable which can affect behaviour such as comfort eating. Turbulent hormones can cause sugar craving, which feeds any excess skin fungi, making the situation worse. High blood sugar levels can lead to insulin resistance, which is another contributing factor in excess androgen production - the last thing that is needed at this point! The young person may cover up the imperfections with concealers, which not only run the risk of causing more clogging, but also reduce the amount of sunlight that reaches the skin. Of course we all know that excess sun can be damaging and it causes skin to age, but sunlight also triggers the availability of Vitamin D, which is another essential component for healthy skin. So… when the plate-spinning process of hormonal balancing really needs help, the typical reaction is to view its end results superficially and march in with a bleach equivalent in an effort to deep clean the skin and strip it back down to a clean slate. This would be fine if the skin were inanimate like a kitchen worktop, but that is simply not the case.
So how do we address this situation in an alternative, more natural, gentler and more helpful way? The truth is we can’t simply provide the correct microorganisms in the correct balance. We don’t even know what proportions of bacteria, fungi, mites etc each individual skin needs. It’s not possible to walk into the chemists and buy a pot of skin microbiota to apply as a healing salve. It’s time to start trusting in our body’s ability to heal itself. All we have to do is two simple things: provide the components that feed, nourish and support, and avoid the items that contribute to further imbalance. As stated above:
The balance of microorganisms on the skin is determined by how well it is moisturised and lubricated – its level of water and oil.
Disruption of the delicate balance between host and microorganisms can result in skin disorders or infection.
The healthy skin depends upon this symbiotic relationship between resident microbial communities and host tissue.
So, choose skincare products that contain a good helping of nutrition in the form of oils and botanicals (see my post Why Choose Natural Skincare Products? ), and that encourage moisture retention. Avoid products that advertise themselves as being chemically anti-bacterial and oil-reducing, and READ THE LABELS. Synthetic fragrances, petroleum ingredients and pearlising chemicals are foreign to the natural skin microbiota. Although your skin may not be allergic to these ingredients, they do not contribute to your skin’s health in any way and may add to a toxic overload. All preservatives are able to preserve the product because they are anti-microbial. Products created by factory mass-production are intended to have a long shelf life. These need strong anti-microbial preservatives. The anti-microbial chemicals in the product will also kill organisms on the skin, and the problem here is that they won’t differentiate. Just like antibiotics wipe out healthy gut flora, anti-microbials in skincare products will wipe out healthy skin flora. Choose natural products whose active components are essential oils. Essential oils contain phyto-chemicals which do address excess bacteria and fungus and can kill mites, but they work in a different way to man-made antibiotics. They are life-affirming components of plants that don’t only clear excess unwanted organisms but also encourage healing and rebalancing. It seems to be the case that bacteria don’t build up resistance to essential oils, whereas they do become resistant to antibiotics.
When considering natural skin care for acne and other skin problems it is also important to consider diet. Not only to avoid excesses but also to eat organically produced food as much as possible. Non-organic animal-derived foods such as meat and dairy will all contain antibiotics, vaccine components and often hormones. If you eat these foods you are also eating these medications and chemicals which may contribute to a toxic overload. My Problem Skin Care page gives more information about the skin being an organ of detoxification and how to support blood cleansing. See my Problem Skin Care page also for the New Leaf Naturals treatment routine for acne, using Crème Fresh, SpotTEA and Maskapone Magic.
Finally, trust in nature. Nature will always rebalance itself, given the right components. The only thing we need to add is patience.
The skin is designed to be self-regulatory
Internal and external factors can derail its balance
A common culprit is fluctuating hormones, which can happen at classic times of development such as adolescence
The three main factors in acne are inflamed skin, clogged pores and bacteria
The skin is covered in good bacteria and other good organisms that help to keep it healthy, this is called the 'microbiota'
The microbiota depends on adequate water and oil
Healthy skin depends upon this symbiotic relationship between resident microbial communities and host tissue.
Ruthless acne treatments that strip oils and wipe out bacteria disrupt the microbiota and make it harder for the skin to recover its balance
You need to provide the components that feed, nourish and support the skin, and avoid the items that contribute to further imbalance
Choose simple skincare products that are truly nourishing
Avoid skincare products that contain a lot of chemicals
Consider your diet and choose organic food as much as possible
Avoid sugary and refined foods
Good company, fresh air, exercise, sleep and simple eating - the things that create a healthy body-mind also create healthy skin
Give your skin what it needs and then be patient, give it time to find its way back to health
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