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Acne: What Causes It and How to Treat It

picture of a woman with acne hiding her face under the covers
Afraid to show your face because of your acne?

Natural Treatment for Acne

What Causes Acne?

Pimples beyond puberty are usually caused by persistent hormone imbalances usually estrogen dominance or androgen (male hormone) excess.   High levels of male hormones often cause deeper, more painful, inflammatory, or cystic acne outbreaks.  Outbreaks that are caused by male hormone imbalance are often located along the jawline, in the same area that men would grow facial hair or beards.  Androgenic pimples are also found on the chest, shoulders, or back. High levels of male hormones increase oil production on the skin, which blocks pores, and causes an overgrowth of bacteria on your skin that leads to acne. This type is referred to as acne vulgaris. Some acne is also caused by fungal overgrowth on the skin. This type is referred to as fungal acne.

What are the other symptoms of Estrogen Dominance?

Symptoms of estrogen dominance can include:

  • very heavy and/or very painful periods
  • tender breasts
  • very clotty periods
  • weepiness or feeling highly emotional

What are the other symptoms of Androgen Excess?

Androgen excess symptoms include:

  • deeper, cystic type acne on the chest, back and/or jawline
  • cystic lesions can be itchy, painful, deep, red, and contain pus
  • thinning hair
  • irregular periods
  • infertility
  • anger, irritability, aggression
  • excessive hair growth in unwanted areas (face, body)
  • PCOS

Whiteheads, Blackheads, Comedones, Pustules, Papules – What is the Difference?

A whitehead is a type of pimple that happens when dead skin cells, oil, and bacteria are trapped in your pores.  As the name suggests, it makes a bump with a white head on it.  Whiteheads are also called closed comedones.

Pustules are similar to whiteheads but are larger.  The pore becomes overly full and the wall of the pore begins to break down.  Papules are like pustules but are not filled with pus.  They are more like a hard bump.

Blackheads are pores that are also filled with dead skin cells, oil, and bacteria, but the pore is still open.  Exposure to air oxidizes the material inside the pore causing a black appearance.

Should you Pop Pimples?

Picking or popping whiteheads or blackheads does not solve the underlying problem.  Picking at them increases the risk of redness, inflammation, infection, and possible scarring.  Exfoliating and using peels can also irritate already sensitive skin.

Natural Treatment for Acne that Works

As a naturopath, here is how I would approach your outbreaks to fix the underlying cause:

  1. Test for and then balance your hormones (estrogen, progesterone, testosterone, DHT, and DHEAs) through:
    • healthy, whole foods diet
    • regular exercise
    • stress reduction
    • liver detoxification (not through the kits from the health food store!)
    • vitamin and mineral support
  2. Increase healthy skin nutrients through diet and/or supplementation.
  3. Decrease excess oil production in your skin
  4. Improve your immune system function to prevent excessive bacterial growth on your skin
  5. Test for and eliminate food allergies or do an elimination/challenge diet

Seeing lasting improvement in your skin can take some time and effort.  Quick remedies aren’t addressing the underlying cause.  They are usually only temporary.

The Benefits to Seeing a Naturopath for Acne Treatment

Here’s why you should see a naturopathic doctor for your skin:

  1. Better hormone balance to prevent hormone-related conditions like infertility, endometriosis and PCOS in women and prostate or fertility problems in men
  2. Healthier looking skin without chemicals on your skin
  3. Clearer skin without the chronic antibiotic use
  4. Healthier looking skin without hormone treatments like birth control pills
  5. Healthier looking skin without skin irritation and harsh drugs like Accutane
  6. Lasting improvement versus recurrence every time you stop treatment
  7. Lower overall (systemic) levels of inflammation through natural anti-inflammatory treatment

Can Acne Heal on its Own?

It can with a little help to correct the underlying hormone imbalance through the measures I’ve listed above.  Inflammation goes down, your skin can heal, future outbreaks are less severe and less frequent and your scars can fade.

Does Acne Cause Hair Loss?

In general, no.  In very severe cases of pimples on the scalp, scarring can cause patches where hair falls out and doesn’t grow back.  However, the same hormonal imbalances that cause pimples, also cause hair loss.  If your hair is falling out and you have acne, fixing excess male hormones will help both problems.

Why Are Pimples Common in Teenagers?

At puberty, the reproductive glands are kicking in.  As a result, they are producing more hormones.  Initially, this hormone production can be erratic.  There is a period of adjustment while your body gets used to its newfound hormonal status.  Normally, as your hormones settle into their new adult levels, skin typically calms down.  If pimples persist past adolescence, then correcting ongoing hormone imbalances becomes necessary.

Teenage and college or university years are also times of high stress, and potentially unhealthy diet, lifestyle, and sleep habits.  All of these compromise immune function and foster hormone imbalance, allowing higher levels of acne-causing bacteria to grow on the skin.

Acne Vulgaris vs Acne Rosacea

Acne vulgaris is what people typically refer to as just acne, pimples, or zits.  Acne rosacea is a red, bumpy rash that occurs most commonly across the nose and cheeks.  The exact cause of rosacea is unknown, but certain foods aggravate the condition.  Inflammation is a key component of rosacea.  Anything that causes heat or flushing will make this condition worse. As a naturopath, I can treat hormonal Vulgaris, but also inflamed rosacea.

What About Apple Cider Vinegar, Aspirin or Face Masks for Acne?

Topical treatments will sometimes reduce the number and severity of pimples or zits.  These treatments are not addressing the root cause of the problem, though.  As a result, they only work temporarily while you are using them.   Sometimes these harsh chemicals will leave your skin dry and irritated.

I can help.  Book an appointment here or call the Toronto clinic for more information on naturopathic remedies for acne at 416-481-0222.

Authored by Dr. Pamela Frank, BSc(Hons), ND

Picture of Toronto Naturopath Doctor Dr. Pamela Frank, Best Naturopath in Toronto many times over
Dr. Pamela Frank, BSc(Hons), Naturopathic Doctor

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.

Research on the Best Natural Remedies for Problem Skin

Probiotics, Skin and Overall Health

Probiotics have been found to help irritable bowel-related diarrhea and pain, chemotherapy- and radiation-induced diarrhea, constipation, immunity, allergies, and acne.  Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

Fish oil

Fish oil supplementation improves overall acne severity in those with inflammatory acne. Source: Lipids Health Dis. 2012 Dec 3;11:165.


An Bras Dermatol. 2010 Jun;85(3):346-53.

There are lower incidences of acne in non-Western populations. Their diets do not contain processed foods, dairy, sugars, or refined oils. Instead, they eat mainly fresh food, fruit, vegetables, meat, chicken, and grilled seafood.

Journal of the Academy of Nutrition & Dietetics. 2018;118(10):1874-1885

IGF-1 concentrations decreased significantly among participants randomized to a low glycemic index and glycemic load diet. No change in body composition, glucose, insulin, or insulin resistance was seen after the 2-week trial.

Observational studies reported that cow’s milk intake increased acne prevalence and severity, and a positive association between a high-glycemic-load diet, hormonal mediators, and acne risk. Source: Skin Therapy Letter, Volume 15, Issue 3, pages 1-2, 5, March 2010.

Am J Clin Nutr. 2007; 86(1):107-15.
In this study, male patients (ages 15-25) were put on a low glycemic index diet for 12 weeks.  The diet contained 25% of energy from protein and 45% from low-glycemic-index carbohydrates. Total pimple counts decreased in the low-GI group compared to the control group.  The experimental diet also resulted in a greater reduction in weight and BMI and improved insulin sensitivity compared to control.


J Diet Suppl. 2012; 9(4):253-61.
After 4 weeks of treatment, the mean # of non-inflamed, inflamed, and total lesions, plus Michaelson’s acne severity score, decreased significantly in the barberry group (ages 12-17)

Aloe vera gel

J Dermatolog Treat. 2014; 25(2):123-9.
The combination of tretinoin and aloe vera gel (TR/AVG) was significantly more effective in reducing non-inflammatory, inflammatory, and total pimple scores compared to the control group.  At the end of the study, redness in the TR/AVG group was significantly less severe.

Tea Tree Oil and Adult Acne

Australas J Dermatol. 2017 Aug;58(3):205-210.

In a study looking at the effectiveness of tea tree oil, participants applied tea tree oil products to the face twice daily for 12 weeks.  They were assessed after 4, 8, and 12 weeks. The participants saw a significant decrease in pimples after 12 weeks of use. The use of the tea tree oil products significantly improved mild to moderate acne and the products were well tolerated.

Great summary of the research on acne and plants:

A review of phytotherapy of acne vulgaris: Perspective of new pharmacological treatments 



Acne medications include antibiotics such as clindamycin, doxycycline, minocycline, erythromycin, and tetracycline. Excess oil production on your skin, plus poor immune function leads to excessive bacteria growth on your skin.  Antibiotics will help kill off the bacteria but they also can disrupt the good bacteria in your digestive tract and weaken your immune system.

Killing off the bacteria on the skin isn’t really addressing the root of the problem. Because it is the hormone imbalance that leads to excessive oil and bacteria growth.  So, antibiotics are only a temporary solution.

Antibiotic side effects

Antibiotic side effects include nausea, vomiting, diarrhea, lightheadedness, dizziness, unsteadiness, drowsiness, mouth sores, cough, sunburn (sun sensitivity), muscle pain, difficult or painful swallowing, change in the amount of urine, pink urine, brown/gray tooth discoloration, blue/gray/brown discoloration of the skin/lips/tongue/gums, numbness/tingling of the hands/feet, unusual fatigue, stopping of menstrual periods, or new signs of infection (e.g., fever, chills, persistent sore throat, yeast infection).

Oral Contraceptives

Birth control pills will provide measured amounts of hormones.  This can help shut down excessive hormone production from your ovaries.  However, that doesn’t really fix the underlying problem.  It just masks it temporarily while you take the pill.  Balancing hormones means ensuring that your diet is clean, stress is managed, and you exercise regularly.  Also, your liver is efficiently managing hormones and chemicals that can be acting like hormones.

Birth control pill side effects

Common side effects of the birth control pill include acne, breast tenderness or enlargement, changes in appetite, changes in sexual interest, weight gain, dizziness, hair loss, headaches, nausea, stomach cramps or bloating, unusual spotting or bleeding, and vomiting.


Spironolactone is an anti-androgen medication.  It helps to block the male hormones.  This still doesn’t address the root of why the male hormones may be too high.  Therefore, it will only provide a temporary solution while you are taking the medication.

Side Effects of Spironolactone

Side effects of spironolactone include drowsiness, dizziness, lightheadedness, upset stomach, diarrhea, nausea, vomiting, or a headache, increased thirst, change in the amount of urine, mental/mood changes, unusual fatigue/weakness, muscle spasms, menstrual period changes, breast pain, breast enlargement (gynecomastia) in men, and sexual function problems.

Accutane (Isotretinoin)

Accutane is a powerful vitamin A derivative that blocks vitamin A receptors.  It dries your skin and shuts down normal oil production.

Accutane Side Effects

Accutane comes with many side effects. It can cause dry lips and mouth, swelling of your eyelids or lips, crusty skin, nosebleeds, upset stomach, or thinning of your hair, mental/mood changes (e.g., depression, aggressive or violent behavior, thoughts of suicide), tingling in your skin, sun sensitivity, back/joint/muscle pain, signs of infection (e.g., fever, persistent sore throat), painful swallowing, and peeling skin on your palms/soles.

DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested on this website.

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