Adult and Teen Acne

What's causing it, and what you can do about it

When it comes to acne that seems to be atypical and more severe than normal there is likely something wrong. There are a few common reasons that I will discuss in this article along with practical advice anyone can implement for their skin health.

First, many people find that a vitamin A deficiency will worsen or cause bad skin. When skin quality worsens with an increase in sun/light exposure then vitamin A deficiency is likely. Light increases our utilization of vitamin A, and if you already had relatively low vitamin A levels then an increase in light exposure will “use up” even more of the vitamin A leading to a more severe deficiency. This more severe deficiency in the vitamin can really worsen skin. Light also makes us use up riboflavin (vitamin B2) and folate (vitamin B9) at an increased rate. Light is very good for skin health, so don’t try to avoid light, but rather be mindful of your vitamin A (and B2+B9) needs.

Vitamin A is a strong anti-estrogen, especially for the skin. When there is too much estrogen production, especially at the skin level, then acne can form. Also, vitamin A is essential for gonadal function and gonadal steroid production (ovaries or testicles). When your gonads don’t work well your adrenals ramp up hormone production, the adrenals include the skin as the skin is a major adrenal hormone producer. The (inappropriate) increased production of hormones in the skin can lead to acne as well. So long story short, eat more vitamin A if your skin is bad, especially if you find it worsens in the sun.

Vitamin A deficiency also causes keratosis pilaris (KP) also known as “chicken skin” and sometimes called “fish skin”. Vitamin A deficiency leads to an overproduction of keratin, leading to the crusty bumps that appear on the skin.

“Vitamin A is necessary for the proper differentiation of cells in skin and other membranes. A deficiency tends to cause an increased rate of cell division, with the production of abnormal cells, and a substitution of keratinized cells for other types. Estrogen also promotes keratinization and speeds cell division.” -Ray Peat

The best sources of vitamin A are organ meats, especially beef liver. Other livers (like chicken, bison, and lamb) are also good sources, but typically they don’t have as much vitamin A as beef liver. If you can’t eat cooked liver, try liver sausage or liver pate. If you still can’t handle that, then maybe a desiccated liver product would help. You can also consume dairy and egg yolks for an appreciable amount of vitamin A. Some people may find they need to supplement some retinol palmitate in order to get enough vitamin A.

“If acne or dandruff occurs, a vitamin A deficiency is suggested. Vitamin B12 and vitamin E are both needed to make use of vitamin A efficiently. “ -Ray Peat

Part of the vitamin A discussion was on the hormonal causes of acne. Increased production of adrenal hormones and excess estrogen are causes of acne. This is why girls with PCOS typically suffer from acne (and hair loss, and abnormal facial hair growth), this is a situation of very high estrogen and very high adrenal output, with very low functioning of the thyroid, liver and gonads (ovaries in the case of PCOS). I wrote an article on PCOS that explains this in great detail. The gist of that article is essential that when your thyroid, liver and gonads are working well your pituitary and adrenals don’t need to work so hard. When your thyroid, liver and gonads are not working well, the adrenals and pituitary ramp up to make up for the lack of thyroid/liver/gonad performance.

This means that if you improve the function of the thyroid, liver and gonads you can “calm down” the excessive release of pituitary hormones (such as prolactin) and adrenal hormones (such as adrenaline, cortisol and DHEA). To reiterate, excessive adrenal and pituitary hormones can lead to poor skin and many other symptoms. Some ways to directly “calm down” excessive pituitary and adrenal hormone release are supplementing pregnenolone and progesterone. A common drug for adult female acne (and hair loss) is spironolactone, this drug has overlapping effects with progesterone. Like progesterone, spironolactone can calm down excess adrenal output and helps lower the release of hormones like aldosterone.

A more indirect way would be to do things to increase your own production of thyroid and gonadal hormones. When you improve thyroid and liver functions you should, as a result, increase the function of the gonads. As a result of that, you will produce a lesser quantity of the more harmful hormones. This is the main reason why thyroid and liver health are essential for improving your skin. If you are a teen with bad skin, this may be temporary. But if you are an adult with noticeably bad skin, you are likely suffering from poor thyroid and liver function, and as a result, you likely have insufficient gonadal (testicular or ovarian) function, and as a result, have high pituitary and adrenal hormones. This all worsens the skin.

Pituitary hormones like prolactin are very bad for the skin in excess. Part of the reason why zinc is so crucial for skin health is that it lowers prolactin. Eating enough zinc by consuming oysters and red meat (beef, lamb) can really help lower prolactin, and can increase skin health and reduce acne. Vitamin B6 and vitamin E also lower prolactin. Milk-included acne is likely at least partly related to the fact that typical dairy is “A1” dairy which has a certain inflammatory protein that can increase prolactin, similar to the effects of gluten. People find that taking “anti prolactin” substances like vitamin B6 or zinc protects against their milk-induced or gluten-induced acne. Go for A2 cow dairy, or goat dairy which doesn’t increase prolactin.

Excess estrogen is very involved in acne, and estrogen directly activates the adrenals and pituitary, worsening acne further. Vitamin E, the raw carrot salad and boiled white button mushrooms can be very helpful in reducing excess estrogen. The main direct way to improve estrogen dominance is to increase thyroid function and progesterone production. Optimal thyroid function is also necessary for the liver to be able to detoxify excess estrogen. One possible practical thing to do (more for a woman) would be to supplement progesterone dissolved in vitamin E, progesterone is very protective against excess estrogen. If you get acne flareups in conjunction with PMS then you may find this article interesting as well.

“We have used transdermal progesterone therapy in two hundred women suffering from the full range of perimenstrual symptoms, including migraine, acne, depression, mastalgia, edema, and lethargy, and we found that nearly all of the women, applying the lotion themselves, are able to find the appropriate dosage for controlling their symptoms.” -Ray Peat

Ray Peat successfully used progesterone dissolved in vitamin E oil for acne:

“The patients (except for one of the teenage boys, who reported no effect), consistently reported that the use of progesterone at the first sign of a pimple stopped the development at that stage, prevented the expected outbreak, and within a few days resulted in relatively clear skin. The improvement ranges from complete freedom from pimples in half of the group, to "improved, but still visible blemishes" in three women.” -Ray Peat

I mentioned the raw carrot salad for lowering estrogen, this is because detoxified estrogen gets into the intestine while it’s combined with bile. If you do not excrete this detoxed estrogen quickly enough, it is reabsorbed. The raw carrot salad acts like a broom scraping the intestine clean and it can bind to this estrogen and prevent it from being reabsorbed. Improving gut motility will also really help, and will help to avoid constipation. Aged Cascara Sagrada can be really helpful for this, or aloe vera, they both contain forms of emodin, a safe gut motility-improving substance.

Bile production and bile flow are very important for skin health, for a few reasons. One, bile is needed to absorb fat-soluble vitamins, such as skin-protective vitamin A. Bile is also necessary for estrogen removal. Estrogen itself really impairs bile flow, and gallbladder issues are often caused by excess estrogen. Taurine, glycine and choline are very useful nutrients to consume for bile production. Many people also supplement with TUDCA (a bile acid) and ox bile extract which can help people who have trouble making their own bile in sufficient quantities, or with bile flow issues. Tudca is also beneficial for liver health.

Improving bile is important for a clear small intestine, as it has an antimicrobial effect. Impaired fat digestion can also lead to acne, so bile is very important, as bile is needed to break down fats. Many people find their skin worsens when they eat a lot of fat, if this happens it is likely you have issues with bile production or bile flow. Coffee consumption also improves bile flow and liver health.

Furthermore, anything that irritates the intestines has the potential to worsen skin. Some people have too much bacteria in their intestines, and thus they have bacterial overgrowth. This is most commonly SIBO, small intestinal bacterial overgrowth, but the colon can have too much bacteria as well. If you have bacterial overgrowth, this can directly worsen skin. Cleaning the intestines with the raw carrot salad is a great idea. Some people find that “spore-based probiotics” really help with bacterial overgrowth, one good product is CoreBiotic. Antimicrobials things like monolaurin or antimicrobial herbs may be useful for bacterial overgrowth. Avoiding food that leads to bacterial overgrowth is also helpful, this means avoiding beans and raw vegetables for most people, along with most grains. It’s probably a good idea to avoid gluten, as gluten directly irritates the intestines, worsening skin health.

For severe acne, you may want to talk to your doctor about going on a low dose of minocycline. This isn’t for everyone of course, as some people really want to avoid antibiotics. The thing about tetracycline antibiotics (such as minocycline) is they are far more than antibiotics, and at low doses (less than 50mg a day) minocycline acts as a potent anti-inflammatory, more so than an antibiotic. Going on a low dose of minocycline massively improves skin in many people really suffering from bad acne. If acne is less severe, then this is probably not necessary. I must emphasize, a low dose is what you want, 50mg would be the highest you should go, and less may be better. This, of course, requires a prescription.

Furthermore, you may have a leaky gut, leading to worse skin. Everything previously mentioned should help with a leaky gut, but in addition, consuming more glycine will really help. Glycine is high in collagen, gelatin and some other gelatinous foods and cuts of meat like ox tail. Zinc carnosine and creatine are great for leaky gut and gut health in general.

Vitamin D and some other nutrients are also very helpful for skin health in general. Biotin is a very useful nutrient for skin health, and some people may want to supplement it. One reason biotin can help is it is necessary to prevent fungal infections, and this really helps protect the skin. I would also recommend consuming enough selenium in the diet, as this nutrient is very important for good thyroid health, among other things.

It seems that iron overload can also worsen skin health and can promote acne. Lactoferrin has been shown to improve skin health, and part of this effect may be its ability to normalize iron levels in the body. If acne is particularly bad, one may want to experiment with supplemental lactoferrin to see if it helps the skin improve. Look up Andra Sitoianu on Instagram who talks a lot about iron overload and lactoferrin use. I should mention that colostrum seems to be very beneficial for skin health, and it is also very high in lactoferrin.

This article was not specifically on eczema, but it seems like a lot of the information here can be useful for eczema as well. In addition to the information here (vitamin A, biotin, zinc carnosine, vitamin D etc) it seems that the probiotic “primal defence ultra” from Garden of Life can be very helpful for eczema.

When it comes to putting products on your skin, really make an effort to avoid excessive use of chemicals and other additives that can irritate and worsen the skin. I personally think the best face cream, body cream and face cleanser you can buy is from Saturee. The ingredients are fantastic and they contain things like niacinamide, eugenol, camphor, caprylic acid and many other useful ingredients. If you do purchase Saturee products, you can use discount code DEAN to save.

The last thing I want to mention is that if you have bad skin you should really consider avoiding bad foods. This may seem obvious to some, but it is still worth mentioning. Fried foods, chips, and packaged foods that contain vegetable oils like canola oil should all be avoided. Restaurant food is usually cooked in these harmful oils, so it’s best to cook your own food and avoid eating out.

In summary:

1. Consume enough vitamin A or supplement

   1. Getting enough sunlight is great for the skin, but if sunlight worsens the skin, you probably need more vitamin A

2. Increase thyroid, liver and gonadal health

   1. This should “calm down” excessive pituitary and adrenal hormones, which worsen skin.

   2. This should help you lessen estrogen excess

3. Possibly supplement progesterone dissolved in vitamin E

   1. Particularly helpful for controlling excess estrogen

4. Consume enough zinc or supplement

   1. Oysters, red meat

5. Consume enough glycine, taurine and choline, or supplement (for bile health)

   1. Can also supplement TUDCA or ox bile

6. Improve gut health

   1. Some quick advice is the raw carrot salad

   2. Boiled white button mushrooms, zinc carnosine, creatine

   3. Decrease bacterial overgrowth, spore-based probiotics (CoreBiotic), and antimicrobial herbs like oregano, Ceylon cinnamon, thyme, and cloves. Monolaurin.

7. Potentially supplement vitamin E, vitamin D, biotin, lactoferrin

8. Avoid gut irritants

   1. gluten, beans, raw vegetables, A1 dairy (A2 and goat dairy is good)

If you enjoyed this article, please consider checking out the other articles I’ve written. Also, please feel free to subscribe (it is free to do so) and share the articles with others. Thank you!

*None of this is medical advice. I am not a medical professional, always talk to your doctor*

BTW: I am a frequent guest on the podcast “Stuff Your Doctor Should Know”.

Discount code DEAN works at:

1. Ona’s Naturals (progesterone oil, topical progesterone and pregnenolone creams)

2. LifeBlud (Magnesium products, Taurine, Theanine, B vitamins, Methylene Blue)

3. Health Natura (oral pregnenolone, Methylene Blue)

4. Saturee (skin care products, desiccated liver, aged Cascara Sagrada)