Acne affects between 40 million and 50 million individuals in the United States. Epidemiological evidence suggests that acne incidence rates are considerably lower in non westernized societies suggesting our current inflammatory lifestyle and environment could contribute to our high number of acne sufferers. A functional medicine approach can help you narrow down which inflammatory factors could be contributing to your acne flare-ups.

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CC: Acne (Face, Chest), Constipation

Ashley* was a 33 yo female complaining of acne, mainly on her face and chest. She had given birth to her second child one year ago and reported her acne had started during her pregnancy. She had no history of acne when she was younger. Since giving birth, the acne had worsened and was now painful at times. She also had constipation on and off over the past 12-18 months, which was “not normal” for her. The constipation, which was also predominant during pregnancy, continued despite being prescribed Miralax and stool softeners by her primary care doctor.

Additionally, Ashley reported that she hadn’t yet had her menstrual cycle return post-pregnancy, despite stopping breastfeeding six months ago.  

Additional History

Adjusting to her new schedule had come with several life changes for Ashley, including moving from an apartment into a new home that required renovations. She had not yet returned to any of the supplements she had taken before getting pregnant, and her diet had changed as well. Ashley had started eating more packaged/pre-cooked foods for convenience and found herself eating more bread and sugar than she was used to. She reported she had gotten into the habit of eating more refined carbohydrates when she had morning sickness for most of her pregnancy and now felt like she “had” to have them. Since her pregnancy, she had sugar cravings most afternoons and evenings, which led her to opt for fruit or baked goods.

Regarding her skincare, she had not changed any personal care products and avoided fragrances, opting for non-toxic skincare as much as possible.

Lab Work

Comprehensive Stool Test Results

• Pancreatic Elastase Low
• Fecal Fat High
• SCFA Low
• Candida albicans 4+
• Bifidobacterium spp., Lactobacillus spp. 0+ (none detected)

Other Labs Results

Lab Analysis

Ashley’s lab work points to a few core issues that are contributing to her acne and constipation:

Dysbiosis and Malabsorption

Ashley’s stool test showed low pancreatic elastase and high fecal fat, indicating low digestive enzyme function and likely malabsorption. This can lead to difficulty absorbing nutrients from food and can contribute to bloating and digestive issues such as constipation. Additionally, she showed a high growth (4+) of candida albicans, with no growth of beneficial microbes such as the Lactobacillus spp. and Bifidobacterium spp, indicating dysbiosis in her microbiome. An imbalanced microbiome can lead to constipation, hormone dysfunction, inflammation, and a slower detoxification ability (1, 2, 3).

High Testosterone

Her testosterone levels are elevated. When paired with low progesterone and borderline-low estradiol, elevated androgens can contribute to acne and menstrual cycle irregularities in women.

Elevated blood sugar and HgBA1c

Elevated blood sugar can lead to sugar cravings and inflammation. When paired with high androgens, this is a common laboratory profile seen as an underlying cause of adult acne in women.

Multiple Food Sensitivities

Many of the things Ashely had reported eating during and after her pregnancy, including gluten-containing baked goods, sugar, potatoes, and certain fruits (blueberries), all came back with high antibody levels on her food sensitivity panel. Continuing to eat these foods could be contributing to inflammation as well as her digestive complaints.

Interventions

• Remove foods with 3+ on the food sensitivity test and begin a whole foods-based diet focusing on quality protein, healthy fats, and fiber in the form of vegetables, low-glycemic fruit, and limiting starchy vegetables.
• Start comprehensive digestive enzyme to help support food breakdown and nutrient absorption (Apex Energetics Enzymix-Pro)
• Started fish oil supplement at 2g combined DHA/EPA per day
• Started Inositol (Ovasitol), 2g per day, to help support healthy hormone levels and insulin sensitivity
• Started Magnesium Glycinate, 400mg at night
• Started Vitamin D3, 2000IU once/day (Apex Energetics Liqua-D)
• Added in a greens powder (Organifi Green Juice) to increase nutrient intake and support healthy detoxification function, one scoop per day in water
• Encouraged her to increase exercise to the point of breaking a sweat 3x a week, plus daily walking (especially after dinner). Ashley decided on weight training with a personal trainer.
• Started red light therapy 3-4x/week (with eye protection) to areas affected with acne (4)
• For three weeks, supplemented with Solaray Yeast-Cleanse (oregano-oil and other antifungals) once/day, along with one capsule of BIND (Systemic Formulas binder, charcoal-based) in the evening to help address yeast overgrowth and elimination.
• Started probiotic (Metagenics Ultra-Flora), two capsules per day.
• Encouraged Ashley to take up journaling and breathwork to help manage stress.

Follow Up Labs 3-4 Months Later

Over the course of three months, Ashley implemented her nutritional, supplemental, and lifestyle changes with weekly coaching and support. At our in-depth follow-up visit three months later, Ashley’s acne had markedly improved, and she was now having daily bowel movements.

She had her first menstrual period since pregnancy just before our 3-month visit and noticed her acne flares up the week leading up to her period, albeit temporarily.

Her sugar cravings were no longer there, and she felt she had more energy to work out and cook. Her blood sugar markers had started to fall as well.

Her Omega-3 index showed she still wasn’t in the optimal range, but things were trending in the right direction.

Now that her period had returned, we continued to work on supporting her menstrual cycle to reduce the PMS-related flare-ups she had experienced just prior to our 3-month check-in.

A few weeks later (in the luteal phase), we did a repeat hormone test to get follow-up markers for her hormones, which all came back within the normal range.

Summary

This case demonstrates how powerful it can be to look internally at potential root causes of acne. It highlights the importance of gut health and a healthy microbiome balance for bowel regularity and skin health. In Ashley’s case, her experience also serves as a reminder that women can experience a wide variety of changes in their physiology postpartum. These can involve reproductive hormones, blood sugar regulation, gut health, detoxification, and more.