Acne. While almost all humans experience acne during adolescence, some of us will see intermittent or even chronic skin breakouts well into adulthood. Some people may dismiss acne as a purely cosmetic concern, usually those who have been blessed with radiant skin their whole lives. However, the presence of acne can indicate an underlying health issue such as hormonal imbalances, nutritional deficiencies, food sensitivities, elevated inflammation, or infection.

Most cases of acne have three things in common:

1. Increased oil, or sebum, production, often the result of elevated hormone levels

2. Pathogens, usually bacteria like P. acnes or staphylococcus, but sometimes fungi

3. Inflammation

Oil Production

Healthy skin needs a certain amount of oil to maintain a strong barrier, prevent dryness, and protect against environmental pollutants. When oil production goes into overdrive, it can clog hair follicles, trapping bacteria or other pathogens along with dead skin cells. This creates a comedone, either a whitehead or blackhead, which may remain under the skin or break through the surface.

Common causes of increased oil production include androgen hormones such as testosterone, DHT, and DHEA, stress hormones like cortisol, and progesterone, which peaks the week before the menstrual cycle. Hormone testing can help identify whether a specific hormone is contributing to acne.

Other contributors include genetics, hot or humid weather, heavy or comedogenic moisturizers, over cleansing or over exfoliating, which can stimulate even more oil production, and certain medications such as steroids, testosterone, progestins, and lithium. Some supplements may also worsen acne, particularly high doses of vitamin B12, vitamin B6, biotin, and iodine.

Deep moisturizing hair conditioners can also be problematic if residue comes into contact with the skin on the face or body. Natural compounds that help lower androgen levels, such as inositol and saw palmetto, may reduce oil production. Stress management and proper progesterone and estrogen balance can also help. Higher doses of vitamin B5, vitamin A, and zinc have been shown to reduce excess oil as well.

Pathogenic Microbes and Why Treating Acne With Antibiotics Can Be a Problem

Skin is a complex ecosystem and home to trillions of bacteria, fungi, and microscopic organisms. Some of these microbes are known to contribute to skin conditions like acne vulgaris, which is why dermatologists often prescribe oral antibiotics such as doxycycline for persistent acne.

However, using antibiotics for weeks or months can lead to significant side effects, including digestive issues like diarrhea, constipation, bloating, and nausea, increased risk of yeast infections, light sensitivity, and skin changes such as dryness or burning. Long term antibiotic use can also promote antibiotic resistance, making bacteria in the body harder to treat in the future.

Antibiotics do not discriminate between harmful and beneficial bacteria. By disrupting the healthy bacteria in the digestive tract, they increase the likelihood of pathogenic bacteria or yeast overgrowing.

Many patients treated with antibiotics for acne as teenagers later develop chronic gastrointestinal issues or recurrent yeast infections. Antibiotic use can also increase the risk of fungal acne, which is not true acne but a type of folliculitis caused by yeast, most commonly Malassezia. It tends to appear in warm, sweaty, and oily areas like the chest, back, shoulders, and forehead. These bumps are often small and itchy and do not respond to conventional acne treatments. In many cases, they worsen with prolonged antibiotic use.

Topical agents such as benzoyl peroxide, salicylic acid, adapalene, and azelaic acid are often effective because of their antimicrobial properties. Natural options like tea tree oil, manuka honey, witch hazel, and apple cider vinegar also have antimicrobial effects. When oral antimicrobials are appropriate, natural options that target both bacteria and fungi may help prevent overgrowth of one organism while preserving beneficial bacteria.

Inflammation

The third major factor in acne development is inflammation. When a pimple becomes red, swollen, and painful, this reflects inflammation of the sebaceous gland. Inflammation may be a direct response to infection, or it may signal deeper, systemic inflammation.

Systemic inflammation can cause oils within the sebaceous glands to oxidize, creating an environment where bacteria multiply more rapidly. Common sources of inflammation include chronic infections, food sensitivities, especially to processed carbohydrates, sugar, and dairy, environmental toxins, heavy metals, cigarette smoke, alcohol, genetic factors, and hormonal imbalances.

Testing hormone levels, inflammatory markers, nutritional deficiencies, and pathogenic microbes can help create a highly individualized acne treatment plan. Addressing acne from the inside out avoids many long term side effects and supports true healing. When the body is healthy internally, that balance is reflected in clear, radiant skin.