The Root Causes of Acne & How to Treat It
Acne is not just a skin problem — it is driven by internal imbalances including hormones, blood sugar, gut health, and chronic inflammation. This page explains the different types of acne, their underlying causes, and the evidence-based strategies used to treat them effectively.
What Type of Acne Do You Have?
Comedonal acne consists of pimples that are dried, not red — you can see either whiteheads or blackheads. The comedones can be steamed and extracted using a metal extractor. They respond best to Retin A and Benzoyl Peroxide, which keep the pores clean and minimize the number of blackheads and whiteheads forming.
Usually red, painful, inflamed, and may contain pus — indicating a large amount of bacteria inside. When these heal they tend to leave behind PIH (post-inflammatory hyperpigmentation) as red or brown discoloration. Topical or oral antibiotics are effective at this stage. Blue light or laser therapy can also vaporize the bacteria and lighten pigmented scars.
Hormonal acne tends to appear or worsen before a menstrual period. As estrogen drops, stronger testosterone levels stimulate the oil glands — increasing sebum production and promoting pore inflammation. Spironolactone is an androgen blocker widely used by dermatologists to treat hormonal acne effectively.
Cystic acne forms nodules that burrow deep into the skin, resulting from an enclosure of infected acne beneath the surface. It tends to heal by eating away at the skin, often leaving lasting scars. This type typically requires more aggressive treatment under medical supervision.
Truncal acne affects the back or chest, usually appearing as small red and pus-filled bumps. They often leave large brown spots (scars) across the area. Treatment follows similar principles to facial acne but may require different delivery methods.
Functional Medicine Approach to Acne
A functional approach looks beyond the skin and asks: what internal imbalance is driving the acne? Instead of only treating pimples with creams or antibiotics, the goal is to correct the root causes that trigger inflammation, oil production, and clogged pores.
The 5 Root Causes of Acne
Hormonal Imbalance
Very common in both teens and adults. Main drivers: androgens (testosterone/DHT) increase oil production; high insulin increases androgen signaling; low progesterone in women leads to estrogen dominance; cortisol stress hormone.
Common signs: jawline acne, chin acne, cystic acne, worse before periods.
Insulin & Blood Sugar Dysregulation
High insulin increases androgen activity, sebum production, and inflammation.
Common triggers: refined carbohydrates, sugar, sweet drinks, frequent snacking.
Foods most linked with acne: sugary drinks, high glycemic foods, excessive dairy.
Gut–Skin Axis
Gut imbalance can drive systemic inflammation. Common contributors: dysbiosis, SIBO, candida, leaky gut.
Gut inflammation leads to immune activation, which leads to skin inflammation and acne. Many acne patients also experience bloating, constipation, or food sensitivities.
Chronic Inflammation
Acne is fundamentally an inflammatory condition. Drivers include processed foods, omega-6 heavy diets, poor sleep, chronic stress, and environmental toxins.
Poor Detox / Liver Function
Hormones must be cleared by the liver, gut, and bile. If detox pathways are sluggish, estrogen and androgen metabolites accumulate — leading to acne flares.
Functional Lab Testing (Optional)
For difficult acne cases, possible labs include:
- Hormones: testosterone, DHEA-S, estradiol, progesterone
- Metabolic markers: fasting insulin, HbA1c
- Inflammation: hsCRP
- Gut tests: microbiome testing, stool analysis
Functional Treatment Strategy
Nutrition
Best dietary pattern: low glycemic foods, high fiber, anti-inflammatory diet.
Helpful foods: leafy greens, omega-3 fats (fish), fermented foods, zinc-rich foods.
Reduce: sugar, dairy (especially whey), ultra-processed foods.
Key Supplements
Evidence-supported options:
- Zinc: Reduces inflammation and bacteria.
- Omega-3 fatty acids: Anti-inflammatory.
- Vitamin D: Many acne patients are deficient.
- Probiotics: Improve gut–skin axis.
- NAC: Supports detox and inflammation.
Hormone Balancing (Adults)
For adult acne in women, possible tools include: DIM, myo-inositol, spearmint tea, progesterone therapy, and anti-androgen treatments such as spironolactone.
Stress & Sleep
Stress increases cortisol, which increases androgen activity leading to acne.
Helpful strategies: regular sleep schedule, daily exercise, meditation or breathwork.
Advanced Skin Treatments (Adjunct)
Procedures that help acne: chemical peels, microneedling, PDRN (Rejuran), laser therapy, blue light therapy.
These treat the skin directly, while functional medicine addresses the internal cause — the combination achieves the best results.
The Simple Truth
Acne is not just a skin problem. It is usually driven by hormones, blood sugar, gut health, and inflammation. When we fix those internal issues, the skin improves naturally.
Our 4-Pillar Acne Program
A very effective way to structure acne care is a 4-pillar program — a medical and aesthetic hybrid model that most clinics do not offer.
Hormone Balance
Address the root hormonal drivers of oil production and chronic inflammation.
Gut Health
Repair the gut-skin axis to reduce immune activation and systemic inflammation.
Anti-Inflammatory Nutrition
Correct blood sugar, reduce inflammatory foods, and nourish skin from within.
Advanced Skin Treatments
Combine clinical procedures to clear active acne and fade post-inflammatory scarring.
Frequently Asked Questions
Key signs of hormonal acne include: excessive oil production, acne along the chin and jawline, new or worsening pimples around the time of your menstrual cycle (especially before the period), and acne that is resistant to basic topical treatments such as Retin A or Benzoyl Peroxide.
Continue your basics such as Retin A and Benzoyl Peroxide. Consider Spironolactone — an FDA-approved medication that dermatologists and endocrinologists have used for years to treat hormonal acne. It blocks receptors on the oil gland and decreases testosterone levels in the body, reducing both inflammation and pus. You typically need several weeks to see improvement.
Spironolactone clears hormonal acne by blocking oil gland receptors and decreasing testosterone. For resistant cases, specialists may add oral contraceptives with low androgenic effect. Topical regimens including prescription-grade Acne Control products available at our clinic help maintain clear skin long-term. Note: Spironolactone is not recommended for males due to its hormonal effects.
Over-stimulation of oil glands by testosterone is the primary driver. In women, the estrogen-to-testosterone ratio is normally about 10:1. Before menstruation, during menopause, and as women age, estrogen drops — causing the body to have relatively more testosterone. This stimulates the oil glands through acne-causing sebum overproduction and pore inflammation.
Do you want clear, beautiful skin? Our Acne Program can help.
Our comprehensive acne program is tailored to your skin type, lifestyle, and goals. Book a free consultation today.