Acne Treatment

The Stress-Skin Relationship

September 7, 2021 by Dr. Nicole Cain Leave a Comment

We see it every day – the models in the media with gorgeous skin, smooth as can be, and zero imperfections. We are constantly absorbing unrealistic beauty standards of skin, which can lead to chronic stress about living up to those standards. What can we do if this stress and anxiety build into a cascade where it causes more skin outbreaks?

It is a vicious cycle that occurs repeatedly, and in the end, you are left with the question, “WHY?” Typically, when we think about anxiety, we think about heart palpitations, tremors, and that deep sense of panic. It seems like acne would be the last symptom that would be expressed as a result of anxiety – but it can be a cause of unexplained repeat breakouts. Let’s dive into the interconnected relationship between stress and skin.

Getting To the Root Cause
What Is the Relationship Between Acne, Stress, and Hormones?

It is fairly common knowledge that anxiety has an effect on our hormones, but it’s not often considered that this can result in dermatoses, or “disease of the skin.”

Cutaneous hyperandrogenism (CHA) is a skin condition where hormones cause skin changes such as acne, hirsutism, seborrhea, and androgenetic alopecia. One of the most common hormonal culprits of acne is androgens like testosterone and DHEA. What’s even more interesting is that your androgens may be responsible for your acne, even if your hormone testing is normal.

There are two reasons this may happen: The first relates to how your skin processes androgen enzymes. If you experience an “over-expression of the androgenic enzymes” in your skin, you will be at an increased risk of hormone-related acne. The second variable is the sensitivity of your skin’s androgen hormone receptors. If your receptors are overly responsive to the presence of androgens, you will be at a higher risk of hormone-related acne (Shrivastava, et al., 2018).

Your hair follicles and the sebaceous glands within are equipped with the necessary enzymes and receptors to make and metabolize androgens on their own. This process is essential for natural hair growth. Because of this ability, an associated misfortune is acne. We typically see the expression of androgen-mediated acne being most common in the 12-24 years old age group due to the vast hormonal changes that are happening in that season of life. However, this acne-causing process can affect anyone and everyone, and can especially be worsened by stress.

This mechanism by which this happens begins with the hypothalamic-pituitary axis (HPA) (See image). This axis plays an incredibly crucial role in moderating the fight or flight response. When the brain senses stress, it triggers the hypothalamus to respond by secreting corticotropin-releasing hormone (CRH). There are two things that occur as a result of this hormone secretion.

First, CRH binds to the anterior pituitary gland, causing the release of adrenocorticotropic hormone (ACTH). ACTH then calls on the adrenal glands to respond and secrete two key hormones: androgens and cortisol.

Let’s start with the androgens: the skin receives androgen hormone signals at a type of receptor, called Androgen Receptors (ARs). These are located in every cell of your body, including the sebocytes (oil cells) in your face. The increased activity of these receptors triggers an overproduction of sebum within the pilosebaceous unit, a hair follicle and its oil gland.

The second thing that is secreted from the adrenal gland is cortisol, otherwise known as “the stress hormone.” Cortisol is trying to get the body back to its normal state and works to provide negative feedback to both the hypothalamus and the anterior pituitary gland to stop them from secreting their respective hormones (Allen, Sharma, 2020). Cortisol will release for hours after the initial stress trigger, but if the stress stimulus is chronic, cortisol can never catch up.

The other notable thing that happens with the release of CRH is that it directly binds to sebaceous glands, resulting in more oil production.

“Expression of the complete CRH system is abundant in acne-involved skin, especially in the sebaceous glands, possibly activating pathways which affect immune and inflammatory processes leading to the development and stress-induced exacerbation of acne” (Ganceviciene, et al., 2009).

The excess oil that is produced on two different pathways as a result of CRH, causes the pores in your face to get clogged with dead skin cells and oil. This environment becomes a feeding ground for the bacteria which live on your skin called “cutibacterium acne.” As the bacteria multiply, the pore becomes inflamed, and acne emerges.

Then when we notice the imperfections on our skin, it triggers more stress and the cycle repeats itself.

Quick Solutions for Right Now

Now that we have reviewed the mechanism in which cutaneous hyperandrogenism occurs, let’s consider some options to combat these unwanted outbreaks. To do this, we have to figure out a way to slow down the response at the androgen receptors and balance the dysregulation of the hormone microenvironment. We can achieve this topically with plant medicine!

Topical Herbs

One plant that I love for its antiandrogenic effects is saw palmetto (Serenoa repens). It is a fruity-smelling oil full of greatness for your pores. The fat-soluble extract from the berry contains between 85 and 95 percent of free fatty acids and sterols. These compounds help to keep the skin nourished and reduce irritation. They act by blocking the 5-alpha reductase pathway, slowing down the conversion of testosterone into dihydrotestosterone (DHT). DHT is a hormone that can contribute to acne. Saw palmetto also has an abundance of antioxidants, which makes it protective against oxidative stress, supporting the health and appearance of your skin (Reddy, et al., 2017).

Another herb that is beneficial for cutaneous hyperandrogenism is green tea (Camellia sinensis). Its main active antiandrogenic component is epigallocatechin gallate (EGCG). Just like saw palmetto, it is an antagonist of androgen action via the 5-alpha reductase pathway. Not only is green tea antiandrogenic, but it is also full of vitamins B2 and E. These vitamins are very important ingredients in many cosmetic products for a few reasons. Vitamin B2 makes your skin more radiant and helps balance your skin’s natural oils; something that can be helpful to CHA caused by stress. Additionally, vitamin E has antioxidant properties, and it promotes wound healing. This is a great herb to keep your skin looking youthful, as well as slow down androgen receptor activity (Pazyar, et al., 2012).

Finally, the last herb I recommend for antiandrogenic effects is Chinese peony root (Paeonia lactiflora). This herb is useful in a few ways for CHA because of its main constituent, paeoniflorin. Paeoniflorin is useful for androgen-related acne due to its inhibition of the conversion of testosterone to DHT, as well as its ability to increase the activity of aromatase, the enzyme that turns testosterone into estrogen. This leads to less availability of androgens and less activity at the ARs.

The second skin benefit to paeoniflorin is that it is known to heal and reduce post-inflammatory hyperpigmentation in the skin. You know those dark spots that sometimes linger after a pimple heals? It can be daunting thinking about permanent acne damage. Fear not; Chinese peony root is an amazing rescue remedy for this (Qiu, et al., 2016) (Grant, Ramasamy, 2012)!

Now let’s formulate a personalized mixture designed to reduce stress-induced acne.

Facial Toner

When caring for acne, a very important aspect is your skin care routine. First and foremost, do not over-cleanse. When it comes to skin care, less is usually more. If you over-cleanse, it might dry out your skin and encourage oil production which is not ideal for acne.

When you are gearing up to begin your facial cleansing routine, gently wash your face with the cleanser you find to be most effective for your skin. Then pat your face dry, and end your routine with a spritz or two of this at-home botanical facial toning spray.

This spray is light, moisturizing, and is formulated to help with androgen receptor activity.

How to make your at-home facial toner:

50% Aloe Water (1 tablespoon aloe gel, 4 oz of water, blend until smooth)
16.6% Saw Palmetto Liquid Extract
16.6% Green Tea Liquid Extract
16.6% Peony Root Liquid Extract

If you were to make a three-ounce bottle, this might look like 1.5 ounces of aloe water, and a half-ounce of each herbal extract respectively. Give it a good shake before each application to make sure you’re getting the most out of the amazing herbs within!

If you are wondering where to even begin getting your hands on these herbal extracts, each of them can be found online through a simple search!

You Are Your Own Best Advocate

If there is one thing that you take away from reading this, I hope you know that you are your own best advocate. Each provider that you seek out for help truly desires to get the best results, but that outcome doesn’t always come to fruition. If that does happen, you have to remind yourself that you know your body best, and you are the only one who has the capabilities to keep the healing hope alive. Whether your advocacy looks like making an at-home facial toner, doing some meditation for stress relief, or giving an entirely new option a try, my favorite way to manage stress and anxiety is outlined step-by-step in the Anxiety Breakthrough Program, which you can access here. Keep fighting for that part of you who wants to get to the bottom of their health concerns.

Sometimes, the answer is not always as simple as “you have acne.” Whether it’s stress, hormones, food allergies, cosmetic products, or another potential root cause, it is of the utmost importance to explore all possible avenues and look at the body as a unit working together to get to the answer.

How To Enhance Your Skin Microbiome

December 29, 2020 by Dr. Trevor Cates Leave a Comment

Skin Microbiome

Our skin is home to a vast array of microbes, and together they make up our skin microbiome.

Many people typically only think of their skin as it relates to beauty — but our skin’s health is essential to our overall health. After all, it serves as the interface with the outside world. Our skin is our frontline of defense against injury or potential pathogens, and our skin microbiome is the cavalry protecting the frontline.

What’s A Microbiome?

The skin microbiome, or skin flora, is the term used for the trillions of bacteria, fungi, protozoa, and viruses – that live on our skin. There are 1,000 different bacteria species and almost 80 different types of fungi species. Some of these species even reside in your gut flora.

The microbiome changes depending on the location on your body or “eco-niche.” Each species has a preference for the amount of light they can be exposed to and whether the skin is dry, oily, moist, or hairy – so every “eco-niche” has distinct communities of microbes. Also, depending on if you are older or younger, and depending on your gender, certain microbiome species may prefer to live on your skin. For example, a sweaty adolescent male verse an older postmenopausal female will have very different microbiomes.

How does skin microbiome play a role in our health?

The human digestive tract contains a delicate balance of microorganisms called the gut microbiome. The balance of gut microbiomes includes friendly bacteria that help regulate harmful bacteria, parasites, or an overgrowth of candida.

Besides the obvious health implications, body microbiome health matters. This is because a healthy and balanced microbiome will directly impact how your skin looks. Simply put, “as we age, toxins, stress, infections, poor dietary choices, and certain medications can negatively affect the gut microbiome.”

1. Influence Immune System

Skin microbiome was once thought to only exist on the skin’s surface and not deep into the dermal layers. Later, it was discovered that these microbes could move into the dermis and into subcutaneous fat. Meaning, the skin microbiome can influence and impact our immune systems through contact in these dermal layers. Depending on good microbes’ health, it will affect (negatively or positively) your immune system’s response to pathogens.

2. Protect Against Infection

Healthy good skin microbiomes and gut microbiomes can protect you against infection. This is because when good microbes flourish, they can crowd out the pathogenic (bad) species.

Prebiotics are one way to promote the growth and activity of beneficial microbes. Prebiotics are ‘good’ bacteria promoters – like foods, fiber, and herbs. Examples of prebiotics include chicory root, Konjac root, dandelion greens, garlic, leeks, onions, oats, barley, and apples. In case of skin or digestive infections, a prebiotic and probiotic combination is a beneficial addition to your physician’s prescribed treatment plan.

Another way to protect against infection is by balancing the skin’s pH. Our skin prefers a relatively acidic environment – a pH around 5.0. This slightly acidic environment provides the perfect environment to inhibit pathogenic (harmful) species. Using skin care products that offer an ideal pH balance can help fortify a healthy microbiome to protect against infections and skin breakouts.

3. Reduce Inflammation

When the body’s microbiome is not balanced, the immune system will respond by releasing agents to balance the system. Unfortunately, the antimicrobial peptide agents the immune system releases cause inflammation and may weaken the skin microbiome and the barrier protection it provides the skin. Also, many other health issues are associated with inflammation.

On the other hand, good gut and skin microbiome have the opposite effect. A good microbiome inhibits the release of inflammatory compounds from the immune system. Increasing your intake of both prebiotic and probiotic foods can support a healthy immune system to decrease the inflammatory response.

4. Protection From The Environmental

The microbiome can protect our body from the outside environment. Both these organ systems are responsible for creating a protective barrier against the external environment. Each has its unique mechanisms for interacting with the immune system and working to protect against outside pathogens. In their way, both the skin and gut microbiome can minimize oxidative damage and exposure to allergens and aid in wound healing to repair damaged barrier functions. If we lose beneficial microbes, then we lose their protection.

HOW TO ENHANCE YOUR MICROBIOME

Eat prebiotic foods such as flaxseed, chicory root, Konjac root, dandelion greens, garlic, apples, leeks, onions, oats, and barley.
Eat probiotic foods like kimchi, sauerkraut, pickled produce, yogurt, and kefir.
Take a high-quality probiotic supplement daily
Cut back on excess carbohydrates and sugars
Balance your skin’s pH with natural skincare products formulated with an ideal pH.
Use pure, natural Argan oil to regulate the skin’s acid mantle and impart luminosity, softness, and moisture to your skin.

“There is no magic bullet when it comes to restoring and maintaining a healthy gut and skin microbiome. The good news is that with a few simple changes to your lifestyle you can change you can achieve better health and gorgeous, glowing skin.”

Would you like to learn more about the importance of gut and skin microbiomes? Then take a moment to watch three of my favorite, very insightful microbiome interviews on The Spa Dr. podcast:

The Microbiome Solution with Naveen Jain
Healthy Skin and The Skin Microbiome with Dr. Trevor Cates
Addressing the Gut Biome with Christa Orecchio

Potential Problems with Common Dermatology Prescriptions

February 15, 2018 by Dr. Trevor Cates Leave a Comment

Dermatologists and primary care doctors are terrific at diagnosing skin conditions. Unfortunately, they typically focus on treating the symptoms of common skin problems rather than the underlying cause. The result is a propensity to rely on prescriptions such as antibiotics and corticosteroids.

This is a byproduct of conventional medicine’s reliance on medicating patients in lieu of focusing on whole body health. Many chronic conditions could be avoided altogether simply by implementing healthy lifestyle changes. This holistic focus is the goal of naturopathic doctors.

As the title of my book, “Clean Skin from Within,” makes clear, I believe that healthy, glowing skin begins within.

The Dangers of Treating Skin Conditions with Antibiotics

Antibiotics are often the go-to solution for dermatologists when treating skin conditions such as acne and eczema. There are a number of reasons that relying on these prescriptions poses a problem.

First, over-reliance on antibiotics has created resistance to these medications – even some pimples are antibiotic-resistant. There is also the issue that antibiotics eliminate all bacteria, even the good kind that protect your skin and enhance digestion.

Another potential issue is that antibiotics are intended only to treat bacterial infections. Of course, not all skin problems stem from infections. If your issue is not bacterial in nature and you take antibiotics to treat it, you’re definitely doing more harm than good. For example, Clostridium difficile bacteria, an infection caused by antibiotics, kill around 14,000 Americans every year. Even non-fatal cases suffer from intense diarrhea.

Taking antibiotics when you don’t have an infection raises your risk of a number of side effects, including vaginal yeast infections, diarrhea, vomiting, and upset stomach. These unnecessary prescriptions are responsible for nearly 20 percent of all emergency room visits.

Finally, overusing antibiotics makes them less effective when you actually need them. And yes, there are skin conditions that do call for an antibiotic response.

The signs of a skin infection that may require antibiotics include:

A high white blood cell count
Fever or chills
Painful, swollen, or red wounds
Pus-filled bumps
Red or warm skin accompanied by other signs of infection
Sores or cracks that ooze pus
Wounds with crusts that are yellow or honey-colored

If you have any of these symptoms, see your doctor to determine if an antibiotic is necessary. In certain circumstances and when indicated, antibiotics can save lives, but let’s save them for when we really need them.

The Dangers of Corticosteroids

Dermatologists often prescribe topical steroids to treat psoriasis, eczema, and rashes. These ointments help reduce inflammation and itching by suppressing the patient’s immune system.

Potential side effects include thinning skin, hyperpigmentation, irritation, and infection. The potential side effects of oral corticosteroids are even more serious and include Cushing disease and hypothalamus-pituitary-adrenal suppression (HPA).

While topical steroids can help relieve itchy and inflamed skin, it can come at a cost when used long term. The real issue with steroids is that they suppress your symptoms while doing nothing to address the underlying problem that caused your skin condition to begin with. If you have a severely inflamed skin, topical steroids can give you some temporary relief. But, with chronic skin issues, it’s important to find out what is triggering the skin eruption and support the body’s innate ability to health with a more integrative approach.

The Dangers of Common Oral Acne Treatments

Millions of women use birth control pills as contraception, but some doctors prescribe The Pill to treat acne as well. Hormonal contraceptives, while effective at preventing unintended pregnancy, may cause health issues. After all, by their very nature, they throw off the hormones cortisol and testosterone. What’s more, they may cause nutritional deficiencies.

Before being discontinued in 2009 for its dangerous side effects, doctors issued millions of Accutane prescriptions. The goal was acne treatment but side effects that included psychosis, suicidal behavior, birth defects, and miscarriages were deemed too high a price to pay for clear skin.

Unfortunately, Accutane was just a brand name. The drug is still prescribed under its generic name, isotretinoin, as well as the alternative brand names Absorica, Amnesteem, Claravis, Myorisan, and Zenatane. These drugs remain on the market due to their effectiveness in treating severe acne. However, before people turn to medications with so many severe side effects, I want them to understand their natural options.

Discovering Healthier Skin Solutions

Prescription medications are enticing because they promise a quick solution. It’s much easier to take a pill or use an ointment than it is to make the lifestyle changes necessary to heal your skin from the inside. While prescription and OTC medications have their place and can provide relief, they come with a number of possible side effects and are only meant to be a short-term solution. Ultimately, what leads you to optimal health and the absence of disease is to address the root cause and use a natural approach that supports your body.

The two-week program outlined in my book is proven effective at improving chronic skin conditions such as acne, eczema, and psoriasis.

The Four Steps of My Two-Week Program

The lifestyle changes I outline for patients get results. They fall into four main categories:

Clean Plate: Eat a diet rich in anti-inflammatory foods that support liver and kidney function and aid digestion. Also, avoid foods that trigger skin inflammation.
Clean Slate: Reduce your exposure to toxins in your skincare products as well as the air you breathe, the water you drink, and the food you eat.
Clean Body: Support your body’s detoxification with supplements that boost liver and kidney function and enhance toxin removal.
Clean Mind: This emotional cleansing helps you identify the psychological triggers that negatively affect your skin. This program will push you out of your comfort zone, so this final step is important.

These four steps help improve overall health and give you glowing, healthy skin at any age.

The Stress-Skin Relationship

Getting To the Root Cause
What Is the Relationship Between Acne, Stress, and Hormones?