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Everything you need to know about acne in 3000 words

Posted by on Jan 16, 2014 in acne, Blog, Hormones | 24 comments

Everything you need to know about acne in 3000 words

 

Contrary to the popular dermatology mantra that lotions solve everything and food solves nothing, there is nothing more powerful for skin health than improving the quality of your diet. If you eat garbage, your cells will swim in it, and they are not going to be able to help it if they get red and sick. If you eat nutrient-dense foods and support healthy hormone function with an anti-inflammatory diet, your skin will heal, glow, and radiate.

 

How skin works

 

The skin is the largest organ in the body. It is also one of the key players in keeping you toxin free, as it is the primary barrier between you and the outside world. If you have skin disturbances, it is completely understandable, and you are definitely not alone. The skin does a lot of heavy lifting, and in this toxic, inflamed world, it’s no wonder that this incredibly multi-faceted and important organ often struggles to keep up.

The skin is composed of three layers: the epidermis, which is the thinnest of the three layers and sits on the very top; the dermis, which sits in the middle; and the hypodermis, which connects skin to bone and muscle. Contrary to logic, the epidermis—the layer everyone gets to see—is not all that important. It is composed of dead skin cells that are in a constant state of being replenished and sloughed off. This process takes approximately 35 days.

The real action takes place in the middle layer, the dermis. This is where collagen provides firmness to the skin and is where hair follicles, sweat glands, nerve endings, and blood vessels reside. Most important for acne sufferers, inside the dermis sit the sebaceous glands, which secrete oil onto the surface of the skin. This oil normally performs a good, protective function. In excess, however, it can create oily skin and acne. When inflamed, it exacerbates acne and leads to skin disorders such as eczema and rosacea.

Topical elements can affect your skin, too. You can abrade your skin with harsh chemicals, for example. But far and away the most important thing you can do is to correct the problems of hormone imbalance and inflammation from the inside out.

 

Acne in three steps:

hormones, inflammation, and infection

 

Conventional dermatological wisdom is that bacteria are the primary cause of acne. This has a grain of truth to it, since bacteria do play a role, but it is minimal compared to the internal conditions that start acne in the first place. Acne in reality develops in three steps. First, male sex hormones can cause excess oil production in the dermis layer of the skin, which clogs pores (though surface debris can also clog pores, rendering hormones less important in this case). Second, inflammation attacks the clogged pores. Third, bacteria infect the clogged pores and cause low level inflammation to increase to large, painful, irritated pustules. The two primary causes of acne are hormone balance and inflammation, and bacteria are only a tertiary concern.

Male sex hormones can dominate female sex hormones in the blood a number of different ways. Insulin resistance, blood sugar spikes stress, starvation diets, or the menstrual cycle are all potential culprits, many of which often occur simultaneously. It is also possible for progesterone (albeit, while a female sex hormone) to cause acne, and this occurs as a result of the menstrual cycle and birth control pills.

 

Insulin resistance and hormone imbalance

Insulin resistance gives millions of women hormonal acne every year. It occurs by a simple mechanism: insulin stimulates testosterone production in the ovaries. Chronically elevated insulin levels lead to chronically elevated testosterone. Testosterone is a male sex hormone that directly stimulates oil production in pores. If you are insulin resistant and experience acne, testosterone is likely a primary contributor to your acne woes. This explains why so many women with polycystic ovarian syndrome experience acne. A high testosterone level is one of the primary characteristics of PCOS.

 

Blood sugar and hormone imbalance

Blood sugar spikes contribute to acne largely because they elicit an insulin response, which in turn spikes testosterone production (in addition to causing inflammation). This phenomenon is not confined to women—it occurs in men as well. It is so common, in fact, that it partly explains why many people break out around the holidays—large quantities of sugary foods lead to blood sugar disasters. It is also part of the reason why many people have skin reactions to dairy, particularly milk: dairy is highly insulinogenic.

 

Stress and hormone imbalance

Stress is a major player in skin health, and for a wide variety of reasons.

First, the skin contains stress-hormone receptors. When you are stressed out, your skin knows it. It has the ability to panic under stress just as much as your brain does.

Stress is also inflammatory. It inflames the gut, incites the immune system, and makes the skin leap into overdrive. This point is brief, but it is a big deal and needs to be taken seriously. Both psychological and physiological stress contributes to inflammation in a big way.

Finally, stress performs a function in the body known as pregnenolone steal. In this process, the stress glands steal the hormonal resource pregnenolone that would otherwise be devoted to making estrogen and other female hormones and instead directs its use to stress hormones such as DHEA-S. This is problematic not only because estrogen has a balancing effect against testosterone and is great for your skin, but also because DHEA-S acts similarly to testosterone with respect to the skin and stimulates oil production.

 

Starvation and hormone imbalance

The reproductive system does not like being toyed with, so denying it nourishment does not go well. Restricting calories, exercising too much, and radically depleting fat stores are three surefire ways to signal starvation.

The female sex hormones estrogen and progesterone are hit particularly hard by these starvation signals, which is unfortunate, because estrogen is one of the most powerful molecules for healthy skin. If estrogen levels decrease far enough relative to testosterone or DHEA-S, acne often results. It is also worth noting that estrogen is produced in fat cells. If your fat stores fall below a healthy level, your estrogen levels may end being up too low for healthy skin.

 

The menstrual cycle and hormone imbalance

Many women experience breakouts in connection with their monthly cycles. Unfortunately, hormone balance functions differently in different women, so I can’t make any overarching statements about the precise events occurring in your body. However, there are some clues I can point to.

The first two weeks of the menstrual cycle, which include the week of bleeding and the following week, are generally quite calm for women and entail great skin health. At the two-week mark, however, or during ovulation, testosterone levels spike. For women for whom oil production is a problem, or for whom testosterone levels are already out of balance from insulin resistance and the like, ovulation can cause acne outbreaks.

The second half of the menstrual cycle can be problematic, too. Estrogen and progesterone levels both fall and rise periodically throughout this time in delicate balance. If one leaps out ahead of the other or drops through the basement, skin changes can occur. Estrogen is generally regarded as a balm for the skin. In contrast, unnaturally elevated progesterone causes acne. What is the best thing you can do to reduce monthly breakouts? Achieve better hormone balance between testosterone, estrogen, and progesterone by eating an anti-inflammatory, hormone-balancing diet like the Sexy by Nature diet.

 

Birth control pills and hormone imbalance

Because all these hormone irregularities can lead to acne, many women begin taking hormonal birth control in the hope of clearing their skin. Sometimes it works. But sometimes it doesn’t, and instead makes it much worse. For this reason, some women go through several different pills before finding one with the “right” combination of estrogen and progesterone that enables them to have clear skin. Others never achieve clear skin on birth control, but accept acne as a necessary component of their birth control regimen. This is unnecessary. Not only do several dozen birth control options exist, but a few of them require no hormonal interference at all. The vast diversity of birth control options are explored in depth on page XX.

 

Inflammation

Acne is perhaps the most visible symptom of systemic inflammation. If an individual has significant acne, there is inevitably at least some amount of inflammation in her blood. Without inflammation, the pores that hormones clog would never become the nasty lumps they are, or at least not quite so big.

For this reason, healing your gut and cooling inflammation is perhaps the most powerful step you can take to overcome acne. Focusing on antioxidants, which fight inflammation, in your diet (such as those found in fruits and vegetables) and in your skincare routine will also go a long way toward soothing your acne. Both supplemental and topical antioxidant use has been shown to reduce breakouts by as much as 50 percent.

 

Bacteria’s role in acne: not guilty!

Bacteria live in and around the layers of everybody’s skin. Many dermatologists insist that the key to clear skin is killing off these bacteria, so most topical acne treatments do just that. The thing is, however, that not only do bacteria exist naturally all over the surface of everybody’s skin, but they can even promote healthy skin.

Sure, it is the case that bacteria infect clogged pores. But this is only the case if the bacteria on your skin are in an unhealthy state. The role bacteria play in acne is much like the role it plays in the gut: there are both “good” and “bad” bacteria on your skin. You can develop acne only if you have a significant imbalance between good and bad, which occurs as a result of both topical and internal stressors.

Many strains of harmful bacteria are present almost exclusively on the skin of people who have acne relative to those who don’t, which demonstrates that bad bacteria are the ones responsible for infecting pores. Yet even more remarkably, some healthy strains of bacteria are only present on the skin of people who do not have acne. This indicates that good bacteria can actually fight acne. Topical probiotics may soon become an important component of skin care regimens, and some of them are already on the market.

 

External influences:

the role of touching, picking, cleansers

and lotions

 

Counterintuitive as it might sound, one of the best things you can do for your skin is to stop washing it.

Much like with food, today’s culture has this idea that skincare products designed in a laboratory are better for us than natural methods. The chemical barrage to which we subject our skin on a daily basis is unnecessary and often harmful. First, consider the fact that benzoyl peroxide, one of the most popular topical acne treatments available over the counter, reduces antioxidant activity in the skin. Antioxidants are crucial for reducing inflammation. Consider too that the skin has natural oils and cleaning and healing processes that work delightfully well on their own. Washing the skin removes those natural oils, so the skin often dries out in response. With dry skin, women often turn to lotion. However, the skin also tries to rectify the dryness on its own by increasing oil production. At this point, both you and your skin are engaged in efforts to increase lubrication. Too much lubrication clogs pores, so your washing and moisturizing routine is counterproductive.

The act of washing your face can make it either too dry or too oily, depending on how your skin reacts. Rarely does washing leave it in tip-top shape. And moisturizers that contain unnatural chemicals often don’t heal the skin; they just cover it up. Many natural alternatives to washing and moisturizing, such as apple cider vinegar, baking soda, coconut oil, lard, cod liver oil, and vitamin blends provide real healing to the skin and can be protective in times of dryness or oiliness.

In all fairness, there are probably some manufactured toiletries that do not aggravate your skin. It is not absolutely necessary to “go all natural” and expressly forbid cosmetics. It is only important to note that they can be problematic, and to do your best to find a product—natural or not—that works for you.

In my experience, the only way to know if a lotion, if you choose to use one, is a good match for your skin is to try it for a few days and see. A different, more specific test is to apply lotion to one side of your face and not the other in order to witness its effects, or to apply it to the sensitive skin on your wrist or neck before using it on your face. I do not forbid using any manufactured cosmetic products—in fact, I use a lotion I buy at a mall. But it took me a long time to find one that did not irritate my skin. I opted to use it because it has white tea extract in it, and white tea is a powerful antioxidant. Applying antioxidants such as white tea, green tea, vitamin C, and B vitamins to your skin can help reduce inflammation in your skin as long as you are certain that you have found a lotion that does not aggravate your skin.

Another way to aggravate your skin is to pick at it. Just as with scabs and wounds, the skin does best when it heals on its own. Have you ever noticed that breakouts often occur near each other? This is because wounds act as beacons for inflammatory molecules. The more aggravated a wound is, the stronger the inflammatory response becomes, so pimples become bigger and nastier the more you touch them. Even worse is the fact that picking causes new pimples to crop up around old ones. Keeping your hands off your face is one of the harder habits to practice, but the less you touch your zits, the more your skin will thank you.

Even the simple act of touching clear skin can lead to the development of acne. Fingers carry all kinds of bacteria, dirt, and oils. When you touch your face, you put these dirty oils directly in contact with your pores. When I was in high school and college, I always had acne around my mouth, particularly on the right side of my face. It took me years to realize that I was breaking out because I rested my chin on my hand while I studied. Once I broke that habit, the acne faded away.

 

What to do for radiant skin

 

Eliminate sugar and insulinogenic foods and focus on reducing inflammation.

Eliminate gut-irritating foods such as grains, legumes, and dairy.

Include gut healing foods such as fermented foods or consider probiotic supplements.

If you eat a lot of fiber, consider reducing the amount of fiber in your diet, particularly insoluble fiber. Lots of fiber can irritate your gut lining if you are already dealing with inflammation or a sensitive gut.

Keep protein intake on the lower end of the spectrum—at 50 to 75 grams per day. Excess protein is a key player in oil production and oxidation.

Eliminate (or experiment with) hormonal influences on your skin. The most important hormonal foods are dairy, particularly milk, and phytoestrogens, especially flax and soy.

Eat to meet the needs of your metabolism: estrogen levels are at their best when you assure your body that it is being properly fed.

Consume plenty of fat to assure adequate collagen stores.

Consume at least three servings of fatty fish such as salmon every week. Alternatively, consider supplementing with cod liver oil, which delivers vitamins A and D—crucial vitamins for healthy skin—as well as anti-inflammatory omega-3 fatty acids.

Consume liver on a regular basis. Liver is the densest source of vitamin A available in the human diet.

Consume homemade bone broth—that is, a broth made from simmering bones in water—which is rich in collagen, calcium, magnesium, and other nutrients necessary for skin health.

Consume a diet rich in antioxidants, such as leafy greens and other vegetables and fruits.

Exercise.

Manage your specific health issue: PCOS and hypothyroidism are particularly problematic when it comes to skin health. PCOS because of its hormonal effects; hypothyroidism simply because cells lack the energy they need to heal.

Discontinue the use of soaps and abrasive cleansers, consider natural alternatives to conventional products, or make your own remedies from natural ingredients such as baking soda, coconut oil, and olive oil. Store-bought alternatives may work fine. The trick is to find one that works for you.

Consider using a topical probiotic spray on your skin. Topical probiotics add “good” bacteria to your skin that have the ability to offset the “bad” bacteria that inflame pores.

Consider applying an antioxidant lotion that includes green tea, white tea, vitamin C, or B vitamins to your skin.

Exfoliate with a clean washcloth once a week.

Do not pick at your skin.

Use a clean pillowcase.

Keep sunburns and harsh sun exposure to a minimum.

Consider supplementing with zinc, an antioxidant that has been shown to be particularly helpful for clear skin. N-acetylcysteine, milk thistle extract, and selenium have also been shown to have powerful effects on skin.

Consider supplementing or focusing on other nutrients that are crucial for the skin, such as vitamin A, vitamin C, vitamin E, omega-3 fatty acids, sulfur, B vitamins (particularly niacin), and vitamin K.

 

———

 

Fullscreen capture 2012-10-29 PM 080617.bmp

The above text is an excerpt from my book on women’s health, hormones, and love, Sexy by Nature, which is available on Amazon here.  

 

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24 Comments

  1. I like it! Especially the part about liver& fish- I like seafood and organs more than any other meat. Maybe my body just needs it .

  2. btw. I have one qestion – do I have to limit myself with the amount of fish? I like it that much that I can eat it every day (sardines/herring/salmon/ cod liver etc.)

    • Nope! Go wild, Olga.

  3. Wow what a wealth of information…I actually started Paleo with the hopes of clearing up my skin from hormonal acne, it’s only been a month but I have seen great results so far, your information is very helpful and I am going to go through it step by step. One thing I do wish I could rid myself of is Melasma, after taking birth control since my late teen years and sun exposure I had bad melasma…it has faded somewhat with stopping the BC and also going Paleo. Hoping some of these other tips will renew my face so I’m not so embarrassed anymore. Thank you

  4. I’m confused – you say reduce fiber, then say to eat fruits and vegetables, many of which are high in fiber, aren’t they?

    • I recommend peeling them. Insoluble fiber is rougher on the gut (lots of the skins) than soluble fiber (The insides)

  5. I’ve been fighting acne since I was 16 (I am now 27) and found antibiotics to be helpful until I realized how damaging they are to my overall system. I switched to spironolactone just over two years ago, which was also successful at eliminating my acne, but I am hoping to get pregnant in the near future, so I stopped taking it and my hormonal birth control. My dermatologist recently prescribed Nicazel (two capsules a day) and I’ve been taking it for almost 3 months now and so far, so good. I have a few cysts pop up here and there, but it’s by no means taking over my face like in the past. Do you know if Nicazel is safe to take while pregnant/trying to get pregnant? I asked my pharmacist, and he said that he couldn’t find any evidence suggesting it might be harmful. I plan on speaking to my gynecologist at an upcoming appointment, but I wondered if you had any information on the drug’s safety. It’s also really freaking expensive! I’ve been slowly altering my diet and face-washing regimen over the last year or so, but still have a long way to go (sugar is so addictive!), so balancing my hormones feels like an uphill battle that I may never win. Any thoughts for me on Nicazel as an intervention?

    Thanks!

    • I just did a bit of reading in nicazel – I can’t tell if it has doxycyline in it or tetracycline or not. If so, then it is a pregnancy hazard. If not, it seems to fine. No board has listed it as a pregnancy no-no so far as I can tell, anyway.

      If you are having a hard time getting off sugar, some amino acids might be tremendously helpful. Have you heard of Julia Ross and her book The Mood Cure? It’s beyond excellent for helping with cravings.

    • I also HIGHLY recommend a topical probiotic. I found mine with the company Probiotic Action.

      • I’m thinking of trying Probiotic Action spray. What has your experience been with it?

  6. These were the most helpful 3000 words I have ever read on acne! I have a question about the weight gain part: any recommendations for easiest/fastest way to put ON weight while maintaining paleo? I have always been on the small side 105-110 lbs, 5 1″, I think my metabolism is rather high as I have a similar build to my mom. When I started working as a nurse after college, I actually lost 10 pounds: working nights + high stress and physical job was not a good combination for me. And my acne went from a pimple here and there around my period to full on cystic on my chin/jaw/back. My cycle became somewhat irregular during this time with longer and shorter cycles, though thankfully I never stopped menstruating. Since changing to a more normal 9 a – 5 p work schedule 6 months ago and trying to incorporate paleo 3 months ago, I’ve noticed an improvement and am feeling sooo much better, but still with breakouts on my chin and jaw. I note that you mentioned that gaining weight for you was the “nail in the coffin” for your acne and overall health and have been working on gaining weight to aid in hormone balance (plus my husband and I have been trying to conceive since married two years ago without success thus far–doctors tell us everything in working order but recommend I gain some weight/decrease stress which led to the job change etc.) but find that it’s rather two steps forward one step back when going paleo: I gain a couple lbs and then lose it. Any recommendations/tips for a bit faster weight gain? I do eat a lot of eggs/nuts/sweet potatoes/avocados/coconut oil, multiple servings/day. I related to your own story very much (I am from Boston too!!) and am very happy to have discovered your blog. Thank you! P.S. – One other thing. When I started paleo three months ago, I noticed a marked improvement in my acne right away but, more recently, things seem to have worsened again. I know that could be for any number of reasons but is that typical: a sort of initial improvement then adjustment period? A vague question but thought I’d throw it out there.

    • I’m not sure. Sometimes I think when women suffer hormone imbalances, paleo can hurt rather than help – with acne at least – because hormones are made out of saturated fat. So if your saturated fat intake is high (as it should be!) it can help you make things that’ll make your hormones act up. It’s also possible that you consume more fiber than your gut really wants, which can be a problem on paleo. Too high of protein intake on paleo is also often a problem. Thinking about reducing insoluble fiber and protein could really help.

      More than anything I think its the stress and very often the change in carbohydrate content that does it. I also highly recommend supplementing with magneisum, which isn’t a direct acne-influencer, but its easy to be magnesium deficient on a paleo diet (since our soils are so depleted) and you need magnesium in order to keep stress hormone levels in check.

      As for fat gains – looks like you’re doing the right stuff. Pair your carbohydrates and your fat together, and make sure you eat a liberal amount of carbohydrates. Always eat until you are FULL. Get lots of calories wherever you can find them. Fruits and starches are great places, and all your fatty products are excellent, too.

      • Thank you so much! Noted on the magnesium, someone recommended maca powder and cacao for magnesium benefit.

  7. Excellent information, thank you!

    I have noticed that my skin problems are worse at the end of (the European) winter, around February / March, until the sun starts shining again. I mostly eat non processed foods, seasonal veggies and fruits and haven’t found any foods that really seem to trigger problems by experimenting. Any ideas why this seasonal effect exists? I have hermit tendencies in winter, could it be vitamin D related?

    Since I stopped using soaps and lotions on my face (which I didn’t use that much in the first place) and started using natural oil cleansing 2-3 times a week, my facial skin has gotten much better. I use a combination of jojoba and castor oil. When I have a break out, I treat that area a bit more with castor oil, it seems to help.

    The next thing for me to tackle is stress levels. I have a hunch that would improve life bunches.

  8. Excellent article, Stefani! I can’t wait to read your book. Do you have a particular antioxidant cream that you recommend? Thank you!

    • I cannot say I do, though Seppo recommends several himself in his ebook Clear for Life – and all of them can be found by searching ‘vitamin C’ or ‘green tea’ or ‘antioxidants’ on iherb.com

  9. Thank you for the tips and I strongly agree with what you said because I believe that “You are what you eat”. I’m just confused with what you said that it is also possible for progesterone to cause acne, and this occurs as a result of birth control pills. I have read a blog earlier stating that when you take birth control pills it will inhibit the production of progesterone. Enlighten me please. Thank you in advance.

    -Jane

    • Hello Jane, saw your comment and decided to reply, as I recently had this question myself. A nurse told me that some birth controls, such as Ortho Tri-Cyclen, have higher levels of progesterone in them. The article above states somewhere that progesterone is a female sex hormone, so I’m assuming it is something that is consistently present, but just needs to stay balanced, much like estrogen and testosterone. That said, progesterone is still an androgen, and if levels get too high in correlation with estrogen levels etc, it can cause breakouts.

      Correct me if I’m wrong of course, but I think this is correct!

  10. Hi !
    Thanks for this incredibly helpful article ! I’m already doing most of the things you advice, but I have a little question : fats are a big part of the paleo diet, so naturally when I lowered my carb intake (because of insulin resistance) I increased my fat intake (I use olive oil, coconut oil and eat fatty fishes). But my skin remains really dry and I noticed that I have a lot of digestive issues when eating a high fat meal (so yeah it’s 70% of my meals…) !
    On the hypothesis that the fats I consume aren’t well-metabolized (perhaps that’s why my skin remains dry despite a good healthy fat intake) and the digestive issues I have, I thought about a bad fat digestion… I tried jojoba and hemp seed oil, but I break out from them. What can I do ? :(

    • You still need carbs for smooth skin! Vitamin C is crucial.

      • Oh I’m already taking Vitamin C and my carb intake is about 100gr/day so I’m not low-carbing (I misspoke, but when I said that my meals consisted of 70% fat, it’s not about the macronutrient level : I meant that I always have a source of fats with my meals).

  11. Thank you so much for this article! After searching the web for something actually helpful for my adult acne, I finally found this. I plan on looking into your book as well. I think it would be really helpful for women like me to hear your personal routine (diet, skincare) for getting rid of your acne. I understand the theory, but find it hard to put it into practice. Especially the carb to protein and fat ratio. Thanks again!

  12. I just wanted to thank you for this article. I have been dealing with pretty severe and embarrassing acne around my mouth and on my chin for several months. I have tried so many things, nothing seemed to help at all. After reading your article, I took some plain yogurt and mixed the contents of a b vitamin capsule with it. I applied this to the area and left it on a few minutes. Then I wiped it off and applied cod liver oil which I left on all night. This morning, I got up and did the same thing. The boils under my skin literally shrank to almost nothing within a matter of hours. I think the condition was broyght on by stress from a move and irregular sleep patterns which I am trying to correct. Prior to a few months ago, I simply used coconut oill for skin cleansing, and my complexion was great. Hopefully, I will be able to get my hormones in balance soon!

  13. Thank you so much for this information. I am so frustrated at this point because I have tried so many different things over the past 6 years. I am almost 35 and I never had any problems with acne until I got pregnant with my first child at the age of 25. I am still struggling with it now, even though I have birth to my 2nd child 6 years ago. I had a complete hysterectomy 2 years ago because of large cysts and endometriomas and for a few months, my acne cleared, but then it came back again. Since my hysterectomy, I have been using a hormone patch. I have tried prescription oral pills, prescription creams and almost every skin care product you can think of. The most recent thing I have tried is an essential oil blend by DoTerra called Clear Skin. I thought it was the cure for me because my skin cleared up within a few days and has been clear for almost 6 months. About a month ago the acne started coming back around my chin. Most of the time they are large and cystic, but I also have small pimples as well. They are all on my chin. I am very careful to not touch my face with my hands. I wash my face with Cetafil and I don’t use any moisturizers. I have completely quit eating chocolate because I heard that might help, but I haven’t noticed any change. PLEASE help me. I don’t know what to do. I have another appointment with my dermatologist next week, but I want to know your suggestions before I meet with him. Thank you SO much!

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  1. Everything you need to know about acne in 3000 words | Paleo Digest - […] for Women / Posted on: January 01, 1970Paleo for Women – Contrary to the popular dermatology mantra that lotions …
  2. Paleo for Women | Hormonal Acne: Where It’s Coming From, and What to Do about It - […] January 2014 Update: For an even more thorough blogpost on the causes of acne and overcoming it, see the new …

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