Hormonal Acne

A teenage girl with pimples in front of a white and navy floral patterned background

Traditional Chinese Medicine (TCM), has a great advantage when it comes to treating inflammatory and cyclical conditions such as hormonal acne. In TCM, the root cause of acne can vary and it’s important to look at other co-existing symptoms such as irregularities in the mood, digestion, sleep, stress, energy, and reproduction.

All acne has a hormonal component, but the acne we are addressing here today, specifically becomes worse in the pre-menstrual phase. It may come and go completely, or it may linger continuously but vary in intensity depending on the phase of the menstrual cycle.

TCM Acne Patterns

Liver Qi Stagnation

Liver qi stagnation does not cause acne by itself, but it rarely exists by itself and tends to co-exist with other pathogenic factors. This pattern accompanies just about every menstrual issue. Typical premenstrual symptoms such as irritability, breast tenderness, cramping, and bowel changes can be attributed in part to liver qi stagnation.

Blood Heat

Heat in the blood is a common culprit in inflammatory skin conditions. With this pattern, the skin is reddened (erythematous), dry/flakey, and lesions often bleed when popped or scratched. These pimples can be superficial or deep.

Blood Stasis

Blood stasis is a factor when more painful symptoms are present, such as painful cramps, blood clots, and even acne that is tender to the touch. There is a purple-ish hue to the lesions, which are often centered around the jaw-line. These pimples tend to be deeper, becoming cystic, leaving the skin scarred and hyper-pigmented.

Damp-Heat Obstructing the Skin

When damp-heat obstructs the skin, we see excess sebum production, often presenting as greasy and inflamed looking skin. Pimples present with larger whiteheads, swollen at the base (edematous), and gets worse with poor dietary choices including drinking too much alcohol and consuming greasy food as well as dairy. Often this pattern is accompanied by digestive irregularities such as loose stools and bloating.

Toxic-Heat

Toxic-heat may present in a variety of ways, including widespread deep, cystic acne, nodules, scarring, and fistulas. Toxic heat may imply an infection so lesions may be contain pus, and be red and swollen. These lesions are slow to form and slow to resolve. Acne is probably present all of the time, but can be aggravated premenstrually.

Managing Hormonal Acne

What to put on your acne-prone skin

Let’s keep it simple.

Wash with a gentle cleanser that includes salicylic acid, such as CeraVe’s SA wash.

The right chemical exfoliant can make the biggest difference than any other topical. These breakdown gunk clogging the pores, which makes the skin look more vibrant and refined. My favorite place to start with with Paula’s Choice 2% BHA/AHA liquid exfoliant. Be careful not to over-exfoliate as the skin barrier will become damaged and the skin will appear red, bumpy and inflamed. Begin using a new exfoliant only 2 x week and very gradually, over the course of several months, increase it to up to 4 x week.

Don’t be afraid to consult a professional on which chemical exfoliants are best for you. If you tend to be very rosey or get hyperpigmentation, there are better options for balancing your skin’s personal needs.

A light SPF moisturizer is essential for everyone’s AM skin-care routine, particularly if you have acne that tends to leave scars. I like Paula’s Choice and La Roche Posay’s SPF moisturizers. Remember to reapply every 2 hours! These brands also carry get PM moisturizers that are suitable for acne-prone skin without the SPF.

Benzoyle peroxide patches can be very helpful in a pinch, but the safest spot treatments are Dermatology-M’s herbal spot treatments, fei zi shui (for day time), and dian dou shui (for night time). While benzoyle peroxide can be so helpful in a last minute emergency (like you’re getting married in 4 hours), it can damage the skin barrier and destroy its healthy microbiota so it’s best to use it as emergency medicine only, and rely on these safer alternatives regularly.

Nutrtion for Skin Health

  • Aim for 8 servings of plants per day to get enough phytonutrients

  • Bump up the omega 3's by adding 3 servings per week of flax, salmon, anchovies, sardines or mackerel. Alternatively, you can supplement with a fish-based or algae-based omega-3 supplement

  • Avoid excess inflammatory foods, particularly dairy, refined sugars and carbs

  • Ditch the hydrogenated vegetable oils that are high in pro-inflammatory omega 6's

  • Limit alcohol intake to 3 drinks/week. Yes, really.

  • Supplementing vitamin D (up to 4000 IU has been proven to help mitigate inflammatory acne as many acne-sufferers are low in vitamin D

Support Healthy Detoxification

  • Eat dark leafy greens daily

  • Add a tincture or tea of bitter herbs such as burdock root, dandelion root and milk thistle

  • Supplements such as NAC, glutathione, DIM, or methyl-folate

Herbal Medicine for Acne

Plant medicine is indispensable when treating acne. While no two acne formulas are alike, here are some superstars that make an appearance in almost all of my acne formulas:

  • Chaste Tree Berry, vitex

  • Dan Shen, salviae miltiorrhizae radix

  • Bai Hua She She Cao, Hedyotis diffusae herba

  • Zhi Zhi, gardeniae fructus

  • Huang Qin, scutellariae radix

  • Lian Qiao, forsythiae fructus

To get your custom herbal blend as well as personalized nutrtional supplement, diet, and lifestyle recs, book a dermatology consult. Now seeing clients in person and via tele-health visit.

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