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Adult acne (acne that persists after age 25) is one of the most frustrating conditions a woman can experience. Triggers for acne are multi-factorial, and often include a combination of excess sebum (oil) production, hyperkeratinization (blockage of the pores by dead skin cells), bacterial colonization with propionibacterium acnes, and inflammation. Stress, androgens (male hormones), vitamin D and insulin can all regulate the production of sebum. One of my first steps in treating women with adult acne is to run lab work to better understand the influence of these factors. Initial tests often include assessing for hormonal imbalances, nutrient status, and screening for insulin resistance.

Hormone Testing

Many women with adult acne have a relative excess of androgens (male hormones such as testosterone, DHEAS, and DHT), which further stimulate sebum production. The role of hormone testing is to screen for conditions that can cause excess androgen production. The most common hormonal condition causing hyperandrogenism is polycystic ovarian syndrome (aka PCOS). Oftentimes women with PCOS experience acne as a teen that is difficult to treat, and continue to experience acne into adulthood.

Nutrient Status

There are two nutrients I often screen for in adult women: vitamin D and vitamin B12. Vitamin D plays a role in normalizing the sebaceous gland and regulating sebum production. High levels of vitamin B12 can actually propagate p.acnes production and worsen acne. Many women with acne notice an improvement in their skin when we optimize the levels of these two nutrients.

Insulin Resistance

Insulin resistance is a condition where the body overproduces insulin to keep blood sugar levels balanced. It is screened for with a blood test that checks a patient’s glucose (sugar) and insulin levels. High levels of insulin is a trigger for acne by increasing androgen production and by stimulating the growth and maturation of sebaceous glands, which leads to excess sebum production. Insulin resistance can be corrected by diet, exercise and supplementation.

Once we understand the underlying factors triggering a woman’s acne, we can lay out an individualized plan to address her unique physiology. Treatment often also involves addressing stress, reducing inflammation through the diet, and prescribing topical agents to reduce p.acnes colonization. Most women can expect to see benefit within 12-16 weeks of treatment.

Are you looking to better understand the underlying triggers for your acne? Click here to book a complimentary “meet and greet” consultation with Dr. Gri, Naturopathic doctor.