Acne Is Never “Just” Acne. Why Taking A Holistic Approach to Healing Is Vital For True, Lasting Results
One of my greatest concerns with being hypervigilant in trying to find a specific diagnosis for acne is that all of these diagnoses fail to meaningfully describe who the client is and what exactly they are suffering from.
Trying to identify with a diagnosis of “fungal acne” or “hormonal acne” is still missing the entire point of the diagnosis of “acne vulgaris”. Even the actual diagnosis itself fails to fully embody the impacts such a condition has on a client.
Here’s what I’m trying to get at:
Suffering from acne is not simply a physical phenomenon.
The diagnosis of acne vulgaris is defined as “a common inflammatory pilosebaceous disease characterized by comedones; papules; pustules; inflamed nodules; superficial pus-filled cysts; and (in extreme cases) canalizing and deep, inflamed, sometimes purulent sacs.”
Nowhere in this definition does it mention anything about the mental, emotional or psychosocial impacts that acne is also characterized by. Nor does it mention anything about common physical comorbidities that oftentimes go along with acne like gut dysbiosis, systemic inflammation or hormonal dysregulation for example.
A diagnosis helps to give us something to work off of in how to manage the condition physically (or superficially). But in my opinion, it also heavily undermines the stuff that no one ever talks about, that in my opinion IS characteristic of chronic acne - the mental/emotional aspects of this condition.
Here’s a short list of comorbid disorders associated with acne:
Sinopulmonary disease (sinus infection, sore throat, asthma and non asthmatic lung disease)
Upper GI comorbidities (heartburn, abdominal pain, nausea/vomiting, food/digestive allergy
Psychological comorbidities (depression, anxiety, attention deficit disorder/attention deficit hyperactivity disorder, insomnia)
This list, in my opinion and experience is very limited, but at least there’s a study out there opening the gateway for us to talk about comorbidities with acne, particularly the psychological comorbidities.
Taking a more energetic perspective to the diagnosis of acne, here are some further insights to the “core” (or pathophysiology) of acne:
Not accepting the self
Dislike of the self or lack of self love
Feeling unsafe in one’s own “skin”
Lack of confidence
Fear of being seen
The skin is a major sensory organ, meaning that it expresses our felt (or unfelt) emotions like paleness, coolness, sweating, “goose bumps”, etc. So really, it’s not that far-fetched to be able to grasp the concept that our “inner world”, our feelings about ourselves, can manifest physically as acne. Not to mention, when we refer to the gut/brain/skin axis (the approach I use with clients to heal acne with a whole-body, functional medicine perspective), it’s also relevant how we feel about ourselves and how these thoughts can manifest dysfunction in other areas of the body, which then can lead to acne.
A major mainstay of the approach I take with clients is encouraging clients to work on this “inner stuff”, either by taking courses or finding resources that can help them or seeking therapy. Assessing limiting beliefs, reflecting on childhood “trauma” or conditioning from childhood and evaluating interpersonal dynamics is not something that we think about when we think about clearing acne. But healing acne isn’t JUST about reducing the number of breakouts, it’s so much more than that. I like to see clients approach clearing their acne as a healing journey, where we’re not just switching out topicals, popping a couple supplements and changing how we’re eating, but also improving our lifestyles, work on our relationship with ourselves and overall creating a better life.
And after 8 years of experience working with clients, as well as my own personal experience of working through my own health issues (including struggling with acne), more often than not I’ve witnessed that the ones that give up or have recurrences are the ones that have either refused to truly look at this aspect and how important it is in their healing journey, or simply aren’t ready to do so.
Like I keep saying, you can have the most perfect diet in the world and be doing all the right things product-wise but it’s like putting lipstick on a pig if you’re not willing to do this deeper work. As painful as struggling with acne is, the whole point of this condition being put on your life path is for you to learn something from it and trust me, the lesson isn’t something as simple as learning how many grams of carbs you should be having per meal.
References:
Silverberg JI, Silverberg NB. Epidemiology and extracutaneous comorbidities of severe acne in adolescence: a U.S. population-based study. Br J Dermatol. 2014 May;170(5):1136-42. doi: 10.1111/bjd.12912. PMID: 24641612.
Shenefelt, P. D., & Shenefelt, D. A. (2014). Spiritual and religious aspects of skin and skin disorders. Psychology research and behavior management, 7, 201–212. https://doi.org/10.2147/PRBM.S65578
