Understanding how functional dermatology approaches acne starts with understanding what acne is—and what drives it beneath the surface.

What Causes Acne? (Pathophysiology)

Acne is a multifactorial skin condition involving several key processes:

1. Excess Sebum (Oil) Production
   Increased sebum production from sebaceous glands can create an environment prone to breakouts.
2. Abnormal Skin Cell Turnover
   Keratinocytes (skin cells) proliferate excessively and do not shed properly, contributing to build up within pores.
3. Clogged Hair Follicles
   The combination of excess oil and skin cells leads to blockage of hair follicles (comedone formation).
4. Microbial Overgrowth
   Blocked follicles create an environment where microbes such as Cutibacterium acnes (formerly Propionibacterium acnes) and, in some cases, yeast like Malassezia, can proliferate and trigger inflammation.

What Triggers Acne?

Trigger vs. Cause

A cause is part of the underlying mechanism of acne.
A trigger is something that worsens or initiates a flare—but removing it doesn’t necessarily eliminate the condition entirely.

Common Acne Triggers

• Dietary Patterns
  Diets high in refined carbohydrates and sugars may increase insulin and insulin-like growth factor 1 (IGF-1), which can նպromote oil production and skin cell growth.
  Some evidence suggests dairy may exacerbate acne in certain individuals, though responses vary.
• Hormonal Fluctuations
  Androgens (e.g., testosterone) can increase sebum production. Hormonal imbalances or shifts (puberty, menstrual cycles, certain medications) may contribute to breakouts.
• Mechanical Irritation
  Friction from masks, helmets, or tight clothing can irritate follicles and worsen acne (“acne mechanica”).
• Medications
  Certain medications (e.g., corticosteroids, some hormonal therapies) may contribute to acne in susceptible individuals.
• Stress
  Elevated cortisol levels can increase inflammation and sebum production, potentially worsening acne.
• Cosmetics & Skincare Products
  Comedogenic (pore-clogging) products may contribute to breakouts.
• Other Factors
  Some individuals report sensitivity to specific ingredients (e.g., certain surfactants or supplements), though evidence varies and is often individualized.

Acne and Gut Health

Emerging research suggests a connection between the gut microbiome and skin health, often referred to as the gut–skin axis. Imbalances in gut bacteria (dysbiosis) may influence inflammation and immune responses that can impact acne.

For example, some studies have found associations between Helicobacter pylori infection and increased acne severity. However, this relationship is still being studied, and it is not considered a primary or universal cause of acne.

How Functional Dermatology Approaches Acne

Functional dermatology takes a whole-person, systems-based approach. Instead of focusing only on topical symptoms, it considers:

• Hormonal balance
• Gut health and digestion
• Immune function
• Nutrition and lifestyle
• Environmental exposures
  

Because acne is highly individual, this approach aims to identify personal contributing factors rather than applying a one-size-fits-all treatment.

Testing and Evaluation

Some practitioners may recommend advanced testing to explore underlying contributors, such as:

• Stool analysis (gut microbiome assessment)
• Organic acids testing
• Hormone testing (e.g., dried urine testing)
• Bloodwork
  

It’s important to note that the clinical usefulness of some of these tests varies, and they should be interpreted carefully within the broader clinical picture.

What to Expect

Treatment plans are typically personalized and may include:

• Targeted skincare
• Nutrition and lifestyle modifications
• Stress management strategies
• Addressing hormonal or digestive imbalances when appropriate
  
  

Follow-up is often periodic (e.g., every 2–3 months), as skin improvement takes time and reflects internal changes.

Bottom Line

Acne is not caused by a single factor—it’s the result of interacting biological processes influenced by internal and external triggers. A functional approach aims to understand those layers, but it should be balanced with evidence-based care and realistic expectations.