What actually causes acne?
Quick answer: Acne is an inflammatory condition with hormonal, metabolic, and gut-related drivers. Excess androgens stimulate sebum production, insulin resistance fuels hormonal imbalance, gut disruption increases systemic inflammation, and stress compounds all three. Lasting improvement requires identifying and addressing your specific combination of drivers.
Most of my acne clients come to me after years of topical treatments, antibiotics, or Roaccutane — and their skin has either persisted or relapsed the moment they stopped. That’s because these approaches target the symptom without addressing what’s driving the breakouts in the first place.
The skin is one of our major elimination organs. When internal systems are under strain — hormonal imbalance, gut disruption, metabolic stress — it’s often the skin that shows it first. What I see in clinic is that acne almost always has multiple interconnected drivers, and addressing them together is what produces lasting results.
What types of acne do you see most commonly?
Hormonal acne is the most common presentation in my clinic, particularly in women. It typically appears along the jawline, chin, and lower cheeks, flaring cyclically around menstruation. The mechanism is excess androgens — particularly testosterone and DHT — stimulating the sebaceous glands to overproduce sebum. I see this in PCOS, post-pill rebound, perimenopause, and in women with subclinical imbalances that don’t always appear on standard blood work.
Insulin-driven acne is frequently overlooked. High circulating insulin directly stimulates ovarian androgen production and increases IGF-1, which amplifies sebum production and skin cell proliferation. Many clients don’t realise their dietary patterns — particularly high refined carbohydrate intake — are directly fuelling their breakouts through this insulin-androgen pathway.
Gut-driven acne is something I assess in every acne client. Disruption to the gut microbiome increases systemic inflammation, impairs immune regulation, and compromises hormone metabolism. I frequently see acne worsen after courses of antibiotics — ironically, often prescribed for the acne itself.
Post-pill acne is common and frustrating. The pill suppresses your body’s own hormone production and artificially lowers androgens. When you stop, there’s often a rebound surge in androgen production — sometimes to levels higher than before — triggering acne that you may never have experienced previously.
Stress-related breakouts operate through the HPA axis. Chronic stress elevates cortisol, which disrupts sex hormones, increases inflammation, impairs gut integrity, and directly stimulates sebaceous gland activity.
What does your assessment involve?
In your initial 90-minute consultation, I take a detailed history covering your skin timeline, menstrual cycle, digestive health, stress, sleep, diet, medication history — particularly oral contraceptives and antibiotics — and any previous treatments you’ve tried.
The location, type, and timing of your breakouts tell me a lot. Jawline acne points toward androgens. Forehead congestion may suggest gut involvement. Widespread inflammation often indicates a systemic driver like insulin resistance or chronic stress.
I typically recommend blood work to establish baseline markers — testosterone, free androgen index, fasting glucose, insulin, iron and ferritin, vitamin D, and sometimes a comprehensive thyroid panel. This gives us objective data to track progress and refine the plan.
How do you approach acne naturally?
My approach works across several pillars simultaneously, tailored to your specific drivers:
Metabolic foundation: If insulin resistance is present, dietary modification is the single most impactful change — low-GI eating, protein at every meal, and fibre-first meal composition to stabilise blood sugar.
Hormonal balance: Targeted nutrients including zinc for androgen regulation and skin integrity, inositol for insulin sensitivity and androgen reduction, and vitamin A for healthy skin cell turnover.
Gut restoration: Probiotics to re-establish beneficial flora, dietary fibre to support the microbiome, and removal of any identified food triggers.
Stress and nervous system: Magnesium supplementation, adaptogenic herbs, sleep hygiene, and stress management strategies to calm the HPA axis.
Most clients see meaningful improvement within eight to twelve weeks, with continued progress over four to six months. Skin healing takes time — the skin cell turnover cycle is approximately 28 days — but the changes are lasting because we’re addressing the cause, not suppressing the symptom.
References: Melnik, B.C. (2018). Acne vulgaris: the metabolic syndrome of the pilosebaceous follicle. Clinics in Dermatology, 36(1), 29–40. Salem, I., et al. (2018). The gut microbiome as a major regulator of the gut-skin axis. Frontiers in Microbiology, 9, 1459.