Acne is the most common skin condition in the United States. It occurs due to clogged hair follicles caused by oil, skin cells, and bacteria, which can present as blackheads, whiteheads, and pimples anywhere on the body.
Though it is often perceived as a teenage problem, acne can affect people of any age. Approximately 50% of women in their 20s, 33% in their 30s, and 25% in their 40s suffer from acne.
Breakouts around the mouth and chin are common, especially with hormonal acne. Hormonal acne is due to fluctuations in reproductive hormones seen in puberty, menstruation, pregnancy, menopause, and polycystic ovarian syndrome (PCOS). However, hormonal imbalances are not the only cause of perioral acne.
Root causes of acne around the mouth can be addressed through a functional medicine approach. A provider may evaluate potential causes of perioral acne and identify underlying imbalances and triggers, including hormones, diet and nutrition, gut health, stress and adrenal health, environmental and lifestyle factors, and detoxification pathways.
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What Is Acne Around the Mouth?
Perioral acne typically occurs around the mouth but may extend to the chin and jawline. It can include open comedones (blackheads), closed comedones (whiteheads), pustules, papules, or cysts. Perioral acne differs from perioral dermatitis, rosacea, and dry skin. However, these conditions may have overlapping features.
Perioral dermatitis presents as small, inflammatory papules, pustules, or pink scaly patches typically around the mouth. Despite its name, it can also affect other face areas, including around the eyes, nose, or chin. In perioral dermatitis, there is typically a clear area of unaffected skin immediately around the lips.
Acne that worsens during menstrual cycles may be due to hormonal triggers. Because skin conditions may have overlapping characteristics, seeking expert advice from a healthcare provider is essential.
Root Causes of Acne Around the Mouth
Several potential triggers, or combinations of triggers, may cause perioral acne. Determining the root causes of these triggers is essential to long-lasting effects.
Hormonal Fluctuations
Hormonal skin changes may occur during puberty, menstruation, pregnancy, menopause, or in polycystic ovarian syndrome (PCOS). The cause of PCOS is not entirely understood. However, hormone imbalances, specifically excess testosterone (hyperandrogenism) and insulin resistance, are common signs.
Testosterone, dehydroepiandrosterone sulfate (DHEA-S), and dihydrotestosterone (DHT) stimulate sebaceous gland growth and sebum production, leading to clogged pores and acne.
On the contrary, estrogens have the opposite effect, inhibiting these male androgen hormones. Estrogen inhibits the growth and function of sebaceous glands; therefore, the function of these glands depends on the estrogen/androgen ratio.
Diet
Studies reveal the impact of nutrition and diet on acne and skin health. Consuming high-glycemic foods and dairy products increases insulin and insulin-like growth factor-1 (IGF1) levels. Elevated insulin levels can stimulate oil gland formation and production and raise androgen levels, which may lead to increased breakouts.
Refined sugars and carbohydrates are high-glycemic foods. Those who have sensitivities to certain foods, such as dairy, soy, or gluten, may experience acne as a manifestation.
Stress
Stress triggers the release of pro-inflammatory cytokines and cortical-releasing hormones, leading to increased cortisol levels. Cortisol is a stress hormone that prompts inflammation and increases sebum production. Studies show an association between emotional stress and acne.
Poor Sleep
Poor sleep also increases cortisol levels. One study suggests a correlation between sleep quality, stress, and acne severity through various physiological and psychological mechanisms.
Environmental Factors
Frequent touching of facial areas can transfer bacteria and microbes from hands to hair follicles and pores, risking inflammation and infection.
Additionally, certain cosmetic products containing irritative or occlusive ingredients can clog pores, including skincare products and lip cosmetics. Similarly, fragrances may cause irritation and allergic reactions, leading to acne.
Oral hygiene products may also have irritative ingredients like alcohol in mouthwashes or fluorides and sodium lauryl sulfate in toothpaste.
Medications
Certain medications and topical products have been found to worsen or trigger acne, including corticosteroids, testosterone, halogens, isoniazid, lithium, serotonin reuptake inhibitors, and progestin contraceptives.
When To See A Doctor For Lab Testing
Functional medicine focuses on identifying the root cause of health conditions and potential triggers. Providers can provide personalized guidance and treatment plans tailored to patients' needs.
Patients should consider consulting a healthcare professional to obtain a proper diagnosis if they have tried multiple over-the-counter modalities that have been ineffective or if acne breakouts are severe or causing emotional distress.
Hormonal Testing
A provider may consider ordering a hormone test to evaluate androgen levels and other hormones, including:
Hormone tests can provide valuable insights into the underlying causes of acne, leading to more effective treatment plans.
Tests for Underlying Conditions
Tests for identifying signs of insulin resistance and high blood glucose include:
Labs to further investigate other underlying issues like thyroid dysfunction may include:
- Thyroid-stimulating hormone (TSH)
- Free T3 and Total T3
- Free T4 and Total T4
- Thyroid Peroxidase Antibodies
Comprehensive metabolic panels, inflammatory markers, nutrient panels, and food sensitivity panels may also be considered.
A healthcare provider can determine which tests to conduct. This is especially important if a patient is experiencing persistent or systemic symptoms.
Approaches to Resolving Acne Around the Mouth
Lifestyle Modifications
Lifestyle changes are a great place to start for treating acne around the mouth. Depending on the patient, this may involve:
- Stress management techniques
- Supporting high-quality sleep
- Increasing intake of anti-inflammatory foods
- Appropriate dietary modifications like limiting dairy, soy, or gluten
- Practicing good oral hygiene
- Staying hydrated
- Avoiding facial touching
Natural Treatments
Using natural remedies and treatments reinforces the principles of functional medicine. These may include:
- Tea Tree Oil: Tea tree oil has well-established antibacterial, antioxidant, and anti-inflammatory properties. It is a natural alternative to consider, specifically targeting Propionibacterium acnes, the bacteria involved in the formation of acne.
- Aloe Vera: One study showed improvements in moderate to severe acne using aloe vera and ultrasound combination therapy to improve penetration into the skin.
- Green Tea Extract: Applying green tea extract may help reduce inflammation and bacterial overgrowth on the skin. One review demonstrated these benefits in acne treatment without significant adverse side effects.
- Honey: Honey has been used topically in skin conditions for its natural antibacterial properties.
- Zinc: Topical or oral zinc supplementation may help decrease inflammatory papules.
Over-the-Counter Solutions
Over-the-counter solutions are almost always essential in the treatment of acne and have been found to be very effective, with increased efficacy when used in combination with other modalities.
- Benzoyl Peroxide: Benzoyl peroxide is an over-the-counter topical and an FDA-approved prescription for acne. It is effective against Cutibacterium acnes because of its bactericidal properties.
- Salicylic Acid: Salicylic acid is a beta-hydroxy acid (BHA) that functions as a chemical exfoliant by promoting the elimination of dead skin cells. Benzoyl peroxide and salicylic acid are commonly found in facial cleansers, exfoliators, and other skin care products.
- Retinol: Topical retinoids are foundational for acne treatment, effective for unclogging blocked pores and increasing cellular turnover.
Pharmaceutical Treatments
Pharmaceutical treatments may be necessary in certain patients. The following may be considered if initial treatments fail or in severe acne cases:
- Oral Antibiotics: Patients may require oral antibiotics. Tetracyclines, such as doxycycline, minocycline, and sarecycline, are the preferred first-line treatment option.
- Hormonal Therapy: Hormonal therapy is mandatory for severe and resistant cases. Androgen receptor blockers, oral corticosteroids, oral contraceptives, or insulin-sensitizing agents may be considered.
- Isotretinoin: Isotretinoin, also known as Accutane, is in a group of retinoids used for severe acne vulgaris that has not responded to other treatments.
- Tretinoin: Tretinoin is a retinoid that may be used long-term to increase cell turnover.
- Adapalene: Adapalene is another topical retinoid that is effective in treating acne.
Combining these treatments for acne may target multiple causes and triggers, increase efficacy, and lead to improved outcomes.
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Key Takeaways
- Perioral acne triggers may vary among individuals, and there is more systemic involvement than one may think. Seeing a functional healthcare provider provides a root-cause approach and diagnosis to perioral acne.
- The presentation of acne may be multifactorial and complex. Therefore, combination therapies with natural remedies, topicals, and prescriptions should be considered to provide a more efficacious treatment outcome than monotherapy.
- Lab testing may include hormones, micronutrients, food sensitivities, blood sugar levels, metabolic markers, thyroid function, and inflammatory markers. Lab evaluation can guide a more effective treatment plan, leading to healthier and clearer skin.
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