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Updated: May 26, 2023


Acne vulgaris is primarily a hormonal and immune condition (36) : skin cells respond in a noticeable fashion to androgens (37) and the correlation between hyperandrogenemia (excessive male sex hormones in the blood) and severe acne vulgaris is now well established (13). The disruption of hormonal and immune balance leading to acne is often associated to:

Cosmetic products ingredients:

Well-known hormone disruptors contained in make-ups, deodorants, body creams, toothpastes etc. include Parabens, Triclosan, PFAS, fragrances (Phthalates) , nanoparticles (zinc and titanium dioxide) and petroleum distillates (23)

Pesticides, herbicides and other chemicals:

A fairly long list of pesticides and herbicides have direct action on the human endocrine and immune system (22). Other disruptive chemical compounds that are unfortunately found often in our environment include PCBs (4) and BPA (16)


There is no wonder in stating that processed foods are at the root of a plethora of immune and endocrine conditions. Refined sugars can severely damage insulin and immune system regulation (3, 7) ; Trans-fats and vegetable oils and trans fats are highly inflammatory (14, 25) and dairy products may contain remarkable concentration of sex hormones (19) In addition, abnormal gut permeability can abnormally activate immunity and lead to inflammatory conditions and autoimmunity (5).

Drugs and medications:

Corticosteroids, lithium, DHEA, barbiturates, anticonvulsants, androgenic steroids, drugs containing bromides and iodides, interferon-beta some antibiotics and antimycotics have shown eruptions of acne vulgaris as an adverse side effect (26)

In addition, there have been identified internal factors which might contribute to the development of acne vulgaris including:

Psycho-emotional stress (35)

Gut dysbiosis (imbalanced gut flora). (17)

Metabolic conditions (diabetes, obesity, insulin resistance) (21)


The point of view on acne of Traditional Chinese Medicine (TCM) can provide further useful insights on the aetiology and treatment of this condition. TCM considers acne the result of damp heat accumulating in the organ systems of the Lung, Stomach, Spleen and Intestines and erupting through the skin (8). According to TCM expert Giovanni Maciocia, damp heat can be the result of the over-consumption of sweet and greasy foods, exposure to damp weather conditions, inability of the Spleen and Stomach to digest foods appropriately and excessive physical exercise; damp heat is a slow-resolving syndrome and tends to slow down the whole physiological processes (18)


Simple and organic skincare

Anti-inflammatory diet:

Foods and spices that have remarkable anti-inflammatory properties include wild caught oily fish (rich in omega-3) (31), turmeric (12) and fermented plant foods (Sauerkraut, kimchi, tempeh etc.) (28). It is also important to choose organic where possible to prevent the intake of endocrine-disrupting pesticides. In addition, nutritional supplements that can accompany well an anti-inflammatory dietary regimen include high strength fish oil (31) probiotics (6), Vitamin D (34) and Vitamin C (9)

Clear damp/heat:

Following an anti-inflammatory diet will largely support the clearance of the damp heat syndrome from the body (18). Herbal medicine can be extremely useful to clear excessive dampness and heat from the Lung and Intestines. The first herb to cool and dry the whole body is Burdock (Arctium lappa), which has an affinity for the blood and the liver and exerts diuretic, cleansing and tonifying properties (29). Another extremely useful herb is red clover (Trifolium pratense), which is not only a blood cleanser but it is used to balance female hormones (29). Other useful herbs with drying and cooling properties that act as lymphatic and blood cleanser include Nettle leaf (Urtica dioica) and Cleavers (Galium aparine) (29).

Stress management:

Finally, supporting the individual in becoming more resilient to stressors can have a positive effect on the psycho-neuro-endocrine system. Adaptogenic herbs that can support the individual’s ability to better endure stress and calm the nervous system include Korean ginseng (Panax ginseng), Siberian ginseng (Eleuterococcus senticosus) (30), ashwagandha (Withania somnifera), Gotu Kola (Centella asiatica) and Licorice root (Glycyrrhiza glabra) (33)


Acne vulgaris is a remarkably common skin condition affecting a large portion of the teenage and young adult population in most Western countries. Conventional treatment, although effective at relieving symptoms, unfortunately often fails to address the underlying causes leading to the eruption of acne. The holistic approach to acne takes on the other hand in consideration various aspects of the person’s life and aims at restoring balance within the whole organism; there is evidence in fact that excellent results can be achieved by eliminating endocrine disruptors, regulating inflammation, clearing excessive damp heat and supporting stress management.


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