Good bye spotty face.

Developing acne during puberty is fairly normal due to undergoing physiological changes of the body affecting 85% of teenagers but it's not normal to develop acne in our late twenties, thirties or even forties. I have seen several young women affected by late onset acne myself including. Luckily our skin on the outside is only manifesting imbalances happening inside our body. This article will highlight the most common causes of late onset acne and how it can be helped with herbal medicine.

Acne vulgaris is a common name for acne which manifests by formation of comedones, nodules, papules, pustules or cysts, caused by obstruction and inflammation of hair follicles and adjacent sebaceous glands. Acne is typically divided into inflammatory and non-inflammatory, and may be localised to the parts of face, neck, upper chest or back. There are various forms and severity of acne starting from mild, moderate to severe. The most common triggers and causes of late onset acne include:

1. Hormonal imbalance either due to stress, menstrual cycle, pregnancy, metabolic syndrome, PMS, PCOS, hypothyroidism, Cushing syndrome, etc. In most cases, androgen surge (predominantly testosterone) is causing increased sebum production, which clogs the pores, causing fatty acid oxidation, bacterial overgrowth of Propionibacterium acnes and inflammation.

2. Diet high in carbohydrates and sugar, salt, alcohol or dairy products causing excessive insulin and insulin-like growth factor 1 production stimulating androgen production, therefore affecting sebaceous glands.

3. Drug induced such as excess B2, B6 or B12 vitamins, certain corticosteroids, antibiotics or other medication.

4. Occlusive due to inappropriate use of topical cosmetics or clothing clogging the pores.

5. Environmental such as pollution, high humidity or heat causing excessive sweating, pore obstruction and bacterial overgrowth.

Diet is very much linked to hormone production, which comes hand in hand when treating hormonal imbalance. Depending what hormones are affected, it all links to adrenal gland and gonadal production of sex hormones. Acne treatment with herbs usually consists of internal and topical prescription and its management focuses on overall support.

Oregon grape

Internal support - balance, cleansing and elimination

Skin acts as eliminatory organ and if affected, other channels of elimination needs to be supported - primarily liver, gut and blood systems. A lot happens in the gut and if the function is compromised such as constipation or sluggish liver function, already excessive hormone production circulates back into the blood stream instead of properly eliminating out of the body. Herbal actions then very much include lymphatics, depuratives, bitters, hormone normalisers, immunostimulants, anti-inflammatories or demulcents.

WHITE PEONY (Paeonia lactiflora), used to modulate oestrogen and excess androgen production dominating in PCOS, often used with LICORICE root (Glycorrhyza glara) to down-regulate testosterone levels.

OREGON GRAPE/MAHONIA (Berberis aquifolium), used as bitter and depurative meaning 'blood purifier', improves liver and gut detoxification and elimination (as from excess androgen production), is antibacterial, antimicrobial and anti-inflammatory to GIT system. Not to be used in pregnancy.

DANDELION ROOT (Taraxacum officinalis), used to improve digestive health and its microflora, and reduce high blood sugar levels. Rich in vitamin A, silicone and zinc facilitating tissue healing.

POKE ROOT (Phytolacca decandra), used to improve lymphatic drainage and eliminate waste products, to reduce inflammation in severe inflamed nodular acne. Restricted herb.

Topical treatment - assisting healing and repair

Topical application of herbs is very useful remedy and can include aromatic waters (sprays/toners), creams, oils, gels or facial steams. I have been lucky to be working for a skincare brand making personalised face oil serums, and I have seen real improvement in skin appearance. However, there is this general misunderstanding for oils to be used on acne prone, oily or combination skin. This is not true. Simply because the role of the sebaceous glands is to produce sebum to protect and moisturise the skin. Sebum is composed of lipids, and oils are naturally semi-permeable to the skin enhancing its protection, moisture and elasticity. In fact, suitable oil application will reduce inflammation, bacterial overgrowth and normalise sebum production as opposed to excessive cleansing products to reduce oiliness of the skin, which only exacerbates sebum production.

BLACK SEED (Nigella sativa), effective in skincare for its anti-inflammatory, antibacterial and anti fungal properties.

BURDOCK SEED (Arctium lappa) - stimulates microcirculation, rich in vitamin A, E and zinc facilitating tissue healing.

CALENDULA (Calendula officinalis) is antiseptic, lymphatic and anti-inflammatory used to aid wound healing and tissue repair.

LAVENDER (Lavandula angustifolia), often used in form of essential oil for its antibacterial properties, can be used directly on the skin for local antiseptic treatment.

It is important to seek a professional advice to differentiate which hormonal imbalance may affect you in case you suffer from acne. Qualified herbalist will then asses and treat the skin at the root cause.


Bone, K and Mills, S (2013). Principles and Practice of Phytotherapy. 2nd ed. London: Elsevier Ltd.

Kuhn M. A. and Winston D. (2008). Herbal Therapy & Supplements: A scientific and traditional approach. 2ed. Philadelphia: Lippincott Williams & Wilkins.

Several, A. (2017). Perfect skin: unlocking the secrets. London: Vermilion.

Tomsen, M. and Genant, H (2009). Phytotherapy desk reference. 4th ed. Global Natural Medicine Pty Ltd.