Recent studies and deeper understandings on skin microbiome and inflammatory induced acne have resulted in the change in acne treatment strategies from trying to kill all bacteria on skin to
- rebalancing the natural skin microbiome
- eliminating external causes of skin inflammation
- restoring the natural skin barrier
- rebalancing the oil gland in skin
Guidelines to achieve the above conditions are as follow:
Foods: Minimise sugar, high fat foods | Increase high vitamin high fiber foods such as fruit and vegetables, and include various mushrooms into your diet | Do not take antibiotics without consulting doctor
No acne has been found in populations living under dietary conditions with low hyperglycemic carbohydrates, low fat and no dairy product.1
Fast transition of the Eskimos from a hunting culture to urban lifestyle has witnessed a rapid increase in acne problem.2 The change from traditional dietary habits of Okinawans and Chinese to more westernized diets has also been associated with increased acne problem.3 Recent epidemiologic data indicate an increase in acne risk from developing to developed countries.4 In short, acne is closely related to Western diet.1-4
Foods with high fat, high sugar and high glycemic index, and dairy can aggravate acne by raising the levels of insulin-like growth factor-1 and insulin. The rising level of these biochemicals increases oil (sebum) production in skin.5-8 Such changes trigger many consequences that lead to acne.
In fact, acne is one of the six chronic diseases namely insulin resistance, diabetes, obesity, cancer, increase body mass index, and acne, that are associated with an over-activation of the regulator of nutrient/energy/redox sensor and protein synthesis in human body (the mTORC1 protein complex). This over-activation is associated with Western diet and high stress lifestyle.9
Accumulated data from researches in the last 10 years have shed the light on the importance of microbiome to human health. With the number of microbial organism living in human body 10 times the number of human cells, these microorganism play an important role to human health.10,11
Research has shown the relationship between gut microbiome and acne! In fact, one way that stress aggravates acne is likely through the altering of gut microbiome and increasing intestinal permeability, resulting in immune reactions towards various permeated entities, and potentially contributing to skin inflammation.12 Evidences have suggested that consuming a low fiber-high fat foods can change intestinal microbiome and the change can contributes to metabolic and inflammatory skin diseases.7 As such, maintaining healthy gut system is recommended for the fight against acne.
Consuming a more varieties of foods help cultivating a greater diversity of bacteria into your gut. Natural dietary fibers are food source of the gut bacteria.
Natural fibers from foods such as fruits, vegetables, nuts, legumes and whole grains help nourishing gut microbiome. In return, upon digesting fiber, bacteria produce short chain fatty acids that nourish the gut barrier. Healthy and stronger gut barrier improves your immune system and prevent inflammation, which reduces the risk of various diseases including acne.
Fermented foods are rich sources of good bacteria.
Fresh raw foods contain more diverse microorganism than cooked and processed foods.
Edible mushrooms contain prebiotics to stimulate the growth of gut microbiota.13
High sugar and high fat diet harms the diversity of your microbiome.
Sleep and Live under low stress environment: Enough high quality sleep | Know how to destress yourself
Sleep is vital to restore brain function, immune response and metabolism, and can also reduce stress. Lack of sleep or poor sleep quality is another cause in acne.14 Not having enough high quality sleep can induce immune imbalance and increase secretion of stress hormones, all of which can trigger acne cycle. Sleep deprivation is related to increased inflammation (through increased pro-inflammatory cytokines).15
The destressing and enough sleep lifestyle is one of the three guidelines for acne treatment used by the Japanese. Their three guidelines for treating acne include 1) trying to stop inflammation 2) trying to heal skin barrier and 3) attaining less stress and enough sleep in daily life.16
Facial care products: Facial products should never disrupt skin pH and skin barrier | Do not use antibiotics without consulting doctor | Avoid things that irritate or cause inflammation | Do not use product with too many preservatives
The new understanding of acne has identified acne as an inflammatory disease, with micro‐inflammation being the root cause that starts the acne cycle.17,18 This indicates that products that irritate skin can start acne cycle. It is difficult for consumers to understand all ingredients in cosmetics, therefore, consumers should pay close attention to their skin reactions on new products for at least 2-3 weeks. Over advertisement can lead to misunderstanding. There is no medical guideline stating that treating acne needs down time of acne flare. Such skin reaction indicates that the product is not right for you.
Alteration of skin pH has been shown as one of the cause of acne. The natural pH of skin is 5.5 for male and 5.4–6.0 for female. Washing skin with cleanser of neutral to basic pH can alter skin pH which can increase acne risk.19 A lot of researches have shown that washing skin with normal facial cleanser that is pH neutral or slightly basic induces skin pH to increase up to +3.0 units and skin pH recovery to its normal acidic condition requires several hours. This disruption in skin pH damages skin barrier function and can induce acne cycle. For healthy skin condition and intact skin barrier, using products with acidic pH of 4 – 5.5 has been recommended by experts.20 Cosmetic formulations with strong acid (peeling agents, pH lower than 4) can easily cause skin barrier damage and inflammation.
Diversity of your skin microbiome is very important. Washing your face too often or using too strong cleanser or washing with too strong rubbing action can all result in losing a big part of your microbial diversity. Maintaining diverse microbiota on your skin is essential for healthy skin.
Good skin cares contribute greatly to the natural skin health. Here are considerations one should keep in mind when selecting skin care products:
- Maintaining balance of natural microbiome on the skin: Look for product with pH of 4 – 5.5 | Avoid products with too many preservatives in the formulations | Avoid products that act by killing all microbes on skin | Avoiding too strong cleanser | Wash your face gently | Do not wash your face too frequently | Use oil to remove makeup instead of directly rubbing your face with cleanser containing strong surfactant
- Eliminating external causes of skin inflammation: Look for product with mildness | Avoid product that produces redness or dryness or burning feeling
- Restoring the natural skin barrier: Use only product with pH of 4 – 5.5 | Avoid products with strong surfactants—those end with sulfate | Do not wash your face too frequently | Wash your face gently
- Cordain, L.; Lindeberg, S.; Hurtado, M.; Hill, K.; Eaton, S. B.; Brand-Miller, J., Acne vulgaris: A disease of western civilization. Archives of Dermatology 2002, 138 (12), 1584-1590.
- Schaefer, O., When the eskimo comes to town. Nutrition Today 1971, 6 (6), 8-16.
- Shen, Y.; Wang, T.; Zhou, C. et al. Necropsies on Okinawans: Anatomic and pathologic observations (1946) Arch Pathol, 42, 359-380.
- Lynn, D. D.; Umari, T.; Dunnick, C. A.; Dellavalle, R. P., The epidemiology of acne vulgaris in late adolescence. Adolesc Health Med Ther 2016, 7, 13-25.
- 5. Adebamowo C.A., Spiegelman D., Berkey C.S., Danby F.W., Rockett H.H., Colditz G.A., Willett W.C., Holmes M.D. Milk consumption and acne in teenaged boys. J. Am. Acad. Dermatol. 2008;58:787–793.
- 6. Adebamowo C.A., Spiegelman D., Berkey C.S., Danby F.W., Rockett H.H., Colditz G.A., Willett W.C., Holmes M.D. Milk consumption and acne in adolescent girls. Dermatol. Online J. 2006;12:1.
- 7. Agamia N.F., Abdallah D.M., Sorour O., Mourad B., Younan D.N. Skin expression of mammalian target of rapamycin and forkhead box transcription factor O1, and serum insulin-like growth factor-1 in patients with acne vulgaris and their relationship with diet. Br. J. Dermatol. 2016;174:1299–1307.
- 8. Kim H., Moon S.Y., Sohn M.Y., Lee W.J. Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes. Ann. Dermatol. 2017;29:20–25.
- Melnik, B. C., Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle. Clinics in Dermatology 2018, 36 (1), 29-40.
- Salvucci E. Microbiome, holobiont and the net of life. Crit. Rev. Microbiol. 2016;42:485–494.
- Hooper L.V., Littman D.R., Macpherson A.J. Interactions between the microbiota and the immune system. Science. 2012;336:1268–1273.
- Bowe W., Patel N.B., Logan A.C. Acne vulgaris, probiotics and the gut-brain-skin axis: From anecdote to translational medicine. Benef. Microbes. 2014;5:185–199.
- Jayachandran M, Xiao J, Xu B. A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota. Int J Mol Sci. 2017;18(9):1934.
- McEwen, B. S.; Karatsoreos, I. N., Sleep deprivation and circadian disruption: Stress, allostasis, and allostatic load. Sleep Medicine Clinics 2015, 10 (1), 1-10.
- Dreno, B.; Bagatin, E.; Blume-Peytavi, U.; Rocha, M.; Gollnick, H., Female type of adult acne: Physiological and psychological considerations and management. JDDG: Journal der Deutschen Dermatologischen Gesellschaft 2018, 16 (10), 1185-1194.
- Katoh, N.; Ohya, Y.; Ikeda, M.; Ebihara, T.; Katayama, I.; Saeki, H.; Shimojo, N.; Tanaka, A.; Nakahara, T.; Nagao, M.; Hide, M.; Fujita, Y.; Fujisawa, T.; Futamura, M.; Masuda, K.; Murota, H.; Yamamoto-Hanada, K., Japanese guidelines for atopic dermatitis 2020. Allergology International 2020, 69 (3), 356-369.
- Dréno, B., What is new in the pathophysiology of acne, an overview. J Eur Acad Dermatol Venereol 2017, 31 Suppl 5, 8-12.
- Dreno, B.; Pecastaings, S.; Corvec, S.; Veraldi, S.; Khammari, A.; Roques, C., Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. Journal of the European Academy of Dermatology and Venereology 2018, 32, 5-14.
- Pluetrattanabha, N.; Kulthanan, K.; Nuchkull, P.; Varothai, S. The pH of skin cleansers for acne. Indian J Dermatol Venereol Leprol 2015, 81, 181-185.
- Blaak, J.; Staib, P., The Relation of pH and Skin Cleansing. In Current Problems in Dermatology (Switzerland), 2018; Vol. 54, pp 132-142.
Sciences of Acne