If you haven’t figured out by now, this blog is not about having perfect skin. It is mainly about preventing people from going down the traditional route of acne therapy which is ridiculously expensive and more importantly, can potentially have horrendous health consequences. Isotretinoin and long-term antibiotic use are amazingly still routinely used for acne, and both can have side effects that can ravage mental health under the right conditions. The intestinal microbiome is 3-5 pounds and humans have 10x more bacterial cells than human cells. Arbitrarily taking antibiotics, in the evolutionary sense, makes no sense.
I know someone who developed high levels of HPHPA, a clostridia bacteria that affects dopamine metabolism. They suffered this presumably from taking long-term antibiotics combined with a poor immune system and poor diet. This website is not here to make you look like Fabio, but to make sure that you don’t head down a much worse road. I would say mental health but that would be a misnomer. In the past I have received terrible advice from dermatologists. One doc said it would be fine if I loaded up on aspirin everyday to reduce acne inflammation. Aspirin is an interesting drug, but is there not an easier and more sustainable path to achieve the same outcome?
Life can be tough however, and use every tool available to you. Exercise and diet should be first-line therapy, not third-line. However there are some compounds that are of interest in regards to healing acne should correcting deficiencies fail.
Metformin: Acne is related to pre-insulin resistance. Metformin is an interesting drug with potential life-extension application. If acne is associated with elevated cumulative insulin levels, metformin may ease the burden. This could be particularly helpful if markers for diabetes are particularly high (fasting insulin, Hemoglobin A1C).
Anti-inflammatories: If acne is an inflammatory disease, then anti-inflammatory drugs should work. I wouldn’t recommend this, but it is an option. Adequate vitamin D levels would also be another route for potentially reducing inflammation. It is correlated with lower levels of inflammation.
Anti-anxiety/stress options: Adaptogenic herbs are interesting and typically not used clinically. They are understudied, can have side effects, but have a lot of potential as well. Acne is correlated with higher levels of cortisol, the stress hormone. One mechanism I can see causing a problem here is that elevated cortisol tends to break down collagen which is important for skin barrier function (not to mention muscle and connective tissue as well). Low dose anti-depressants could be beneficial in some perhaps. Glycine would be very beneficial as well, particularly in a gelatin mixture. This would hit both skin/joint health and stress. Vitamin C is important, particularly in those who have an increased demand due to elevated cortisol levels. Vitamin C is crucial for collagen and thus skin health. Current demand for vitamin C can be measured by urinary vitamin C (if low necessitates more vitamin C).
Novel compounds: Cocoa
Increased intake of carotenoids (spirulina springs to mind)
Reddit/foodnerds is an interesting study dump– I recommend subscribing.
Anyway those are just a few thoughts. Be pragmatic. I am not against pharmaceuticals in the least, but I do believe that most of the RX meds that dermatologists rely on are unnecessary 80% of the time. I also wanted to reiterate that this blog is not designed for the person who only has 2 or 3 pimples. It is designed for the person who has moderate to severe acne and is headed down a bad road ‘mentally’. I can relate to the latter and not the former. At the end of the day I think there are very few problems that education can’t solve. Acne and health are no exception.