Acne is one of the most common skin conditions, affecting nearly 85 percent of people between the ages of 12 and 24.¹ Not only does acne leave physical marks such as blackheads, whiteheads, inflammation and scars, but it can also create psychological wounds in the form of anxiety, depression and low self-image. As one woman — Emily Goldberg, editorial fellow at The Atlantic — afflicted with chronic acne explains:²

“Over the years I struggled with acne, I had begun to think of it as a personal failure. Something was wrong with my skin, but I also felt like something was wrong with me because I couldn’t fix it. Worst of all, there was no hiding this failure. I was convinced it was the first thing people saw when they looked at me, because I knew it was the first thing I saw when I looked at myself.”

I have personal experience with acne and can relate to both the physical and psychological pain that accompanies it. From my teens into my late 20s, I struggled with cystic acne, a severe form characterized by large, painful lesions.

Most teens get a type of acne called acne vulgaris, which can appear on your face, back, chest, neck and shoulders. The most common belief about acne is that it begins when the pores in your skin get clogged with oil (sebum) and dead skin cells, causing the growth of bacteria that trigger inflammation.³

Contrary to what you may have been told, acne is more than an aesthetic problem. It is a sign of imbalance in your body, very specifically in your gut. Many physicians miss the acne-gut connection and focus instead on topical treatments and powerful prescription drugs. These approaches are time-consuming, expensive and offer few lasting effects. Because there are no “quick fixes” to address acne, it’s worth your time to uncover the hidden aspects of your diet and lifestyle that are very likely contributing to it.

Treating Acne Is Big Business

Acne is one of the most common skin problems for which people seek the advice of a dermatologist, and one of the most frequently misunderstood and mistreated conditions. A focus on external solutions has fueled the growth of the acne-treatment industry, which is now estimated at $3 billion in the U.S.⁴

If you have a mild case of acne, the first line of conventional treatment is often topical. Topical treatments claim to reduce oil production, unclog pores, speed cell turnover and kill off bacteria, thereby reducing inflammation. Your physician will likely recommend creams, gels and lotions, such as benzoyl peroxide or salicylic acid, or topical retinoid medicines, such tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).

If you have moderate to severe acne, it’s unlikely topical treatments will be effective. This may result in your physician suggesting oral antibiotics. Some of the most common antibiotics prescribed for acne include doxycycline, erythromycin, minocycline and tetracycline.⁵Remember that while taking antibiotics may kill some of the bacteria that are feeding your acne, it will also destroy your beneficial gut bacteria. Loss of healthy gut bacteria can result in yeast infections, as well as resistant bacterial strains, among other problems.

Antibiotic resistance continues to be a serious and growing problem today. Take erythromycin, a commonly used acne antibiotic. As more strains of bacteria adapt to erythromycin, it is becoming less effective. Because of antibiotic resistance, some physicians have begun to limit the duration antibiotics are used to treat acne, while others have pulled back from prescribing them altogether.

Toxic Medications May Be Offered as the ‘Gold Standard’ of Acne Treatment

If you have severe acne, the gold standard for drug treatment was previously a powerful and potentially harmful medication called Accutane (isotretinoin). A number of studies linked Accutane to numerous damaging side effects, including birth defects, Crohn’s disease and suicide.⁶ When its patent ended in 2009, Swiss drug maker Roche Pharmaceuticals stopped manufacturing Accutane.

Although Accutane is off the market, several generic equivalents of isotretinoin remain available today, among them Amnesteem, Claravis, Myorisan and Sotret.⁷ Isotretinoin is extremely unsafe for pregnant women, and it is administered with great care for that reason.

One additional method that has been used to control acne for premenstrual flare-ups and moderate cases of acne in women involves prescribing low-dose birth control pills that contain estrogen, such as Estrostep, Ortho Tri-Cyclen or Yaz.⁸ While many acne sufferers go through some or all of the treatments mentioned above, it is often to no avail, as affirmed by Goldberg:⁹

“For years, the cabinet underneath my bathroom sink was a graveyard of skin-care products, filled with the ghosts of face soaps, washes, toners and scrubs past. Bottles of Neutrogena, Cetaphil, Proactiv and Clean & Clear products were all laid to rest after my hopes that they would cure my blemished face were dashed, raised and dashed again. Nothing I tried worked.

A couple years and a handful of dermatologists later, piles of prescription products were also thrown into the landfill of acne medications in my bathroom. Tubes of Retin-A, Tazorac and Epiduo cream, and antibiotics like doxycycline and tetracycline had all been prescribed to no avail.”

While your physician may try to win you over to one of the treatment options I’ve just discussed, I hope you will not be content with any of those proposed solutions, which seek to treat only your skin. You can make better use of your time by learning about and beginning to treat your acne from the inside out.