Integrative Skin Series: Finding the Right Approach to Treat Acne

The Integrative Skin Series is an educational series created by practitioners to discuss how different perspectives can be integrated for skin care and health.  

Acne is a chronic condition that is common among teenagers and can persist into a person’s thirties and forties.^[1] The psychological effects are intense, ranging from slight embarrassment to social anxiety and depression.^[2] When visiting a practitioner for treatment, here are some of the things that a practitioner will look at when thinking about how to treat acne. Everyone’s acne is slightly different and highlighted by the unique approaches that are taken here: 

What Type of Acne Do You Have? 

A dermatologist or integrative medicine specialist will look closely at your skin and consider several factors when thinking about how to treat your acne:

1. Type of bumps
2. Arrangement of the bumps on the face and body
3. Scarring

Type of bumps 

There are several different types of bumps in acne. They are split into those that have a lot of inflammation and those that do not appear to have much inflammation. A good rule of thumb is that acne bumps that are redder have more inflammation.

Inflammatory bumps are typically treated with medications that have anti-inflammatory actions. Dermatologists frequently use antibiotics because of their anti-inflammatory effects. Acne dominated by inflammatory bumps is known as inflammatory acne.

Non-inflammatory bumps are typically treated with medication that can reduce the skin’s pores from clogging and reduce the oils that are being produced in the skin. Some examples include retinoids and medications that can change how the hormones activate the skin. Acne dominated by non-inflammatory bumps is known as comedonal acne.

Arrangement of the bumps

The arrangement of the bumps is important in developing the right treatment. Here are two examples:

• Bumps along the jawline in women are typically driven by a hormonal influence
• Bumps that include the chest, shoulders, and back are not as easily treated with topical treatments and may require medications through the bloodstream such as oral antibiotics and isotretinoin (previously known as Accutane)

Scarring 

Scarring is something that dermatologists watch closely. The best way to treat scars is to prevent or reduce their chances of forming. When dermatologists see scarring start to take place or if there is already a lot of scarring present, they tend to become more aggressive with their treatments to get the acne under control more quickly. 

Ayurvedic Medical Approach to Acne 

In Ayurveda, the practitioner examines the balance of the three physiological energies: vata, pitta, and kapha. Acne comes in multiple different forms based on the exact imbalance that is present and treatments are tailored to the specific imbalance.

There are several types of acne that are seen from the Ayurvedic perspective. Pitta-type acne is more inflammatory with bumps such as red “pimples” and red/painful nodules. Kapha-type acne develops from excessive oil production and clogged pores and is dominated by non-inflammatory bumps known as comedones. In many cases, there is a mix of both inflammatory and non-inflammatory bumps, and this is known as Pitta-Kapha-type acne. When there is significant scarring present, this is due to an imbalance of the vata dosha.

When approaching treatment, an Ayurvedic practitioner will look to correct imbalances through the use of a variety of treatments. For example, if pitta is imbalanced, the strategy is to reduce the imbalance by using pitta-balancing herbs and procedures. This includes the use of Sunder Vati formulation that has been shown to decrease inflammatory and non-inflammatory bumps, indicating that it balances kapha and pitta.^[3] The herbs that composed the Sunder Vati formulation in this study were Kutaj, Amalaki, and Vidanga with ginger used as a carrier herb in a low concentration. As Table 3 shows, the components of the formulation reduced the effects of both pitta and kapha, and it is not surprising that this formulation was able to improve both inflammatory and non-inflammatory bumps in acne.

By combining different herbs together in a logical way, an Ayurvedic approach can be tailored to different variations in acne. However, Ayurveda goes beyond herbal approaches and incorporates lifestyle practices and dietary changes to help reduce imbalances.  

Traditional Chinese Medical Approach to Acne 

Traditional Chinese Medicine (TCM) has a long history of helping those with skin conditions. It is important to know that in TCM different types of acne are caused by different imbalances, and the therapies are tailored according to one's unique symptoms.^[4] TCM practitioners aim to find the root cause of the acne in order to bring balance to the body.

To determine the type of acne, a TCM practitioner will consider the type and location of acne, degree of inflammation, the overall look of the skin, and the whole body health. 

For example, if you have more whiteheads and blackheads on your forehead without particularly oily skin, you may have heat in the lungs. But if you have more redness and painful and inflamed acne, your acne may be more related to heat toxicity. Oily skin, in particular, is a reflection of dampness. And for women, if acne appears along the jawline and gets worse around her menstrual cycles, it is usually an imbalance in the flow of the body’s energy and circulation of blood. Also, a person's tongue and pulse reflect the nature of the imbalance causing his/her acne. A red tongue body with a thick yellow coating is reflective of heat, but a pale tongue with a thick white coat indicates dampness.

TCM treatments will combine various therapies including acupuncture, herbal remedies, and topical washes, as well as cupping.^[5-7] The therapies are customized to each person’s type of acne. For example, if there is heat in the lungs, herbal formulas such as Pi Pa Qing Fei Yin may be used to remove heat from the lungs. But in the case of more dampness, herbs such as yi yi ren and bai zhi can be added to the formula to address that concern. Cupping is when glass or plastic cups are depressurized and placed upon muscles and pressure points. This therapy has been studied to treat acne, particularly inflammatory and cystic acne.^[8] The type of acne will inform the practitioner on which acupuncture points and herbs to use for that particular type of acne. 

Integrative Approaches to Acne

Acne is best addressed by finding approaches that work together. Treatment for acne, across the integrative spectrum, will look at the type of acne and will tailor remedies for that specifically. Western dermatological approaches may offer both topical and oral medication depending on the severity and chances of acne scarring. Many people are seeking integrative therapies that take a broader approach to acne beyond what is offered through any one approach. Traditional Chinese medicine and Ayurveda are ancient traditions with approaches that focus on balance to the body and the skin. Additionally, integrative approaches may emphasize supplements, holistic therapies such as acupuncture, diet, and lifestyle choices that may not have been emphasized in the conventional Western approach that can be better tailored to each person.