Acne is a common skin condition in the United States. It occurs when hair follicles become clogged with oil, skin cells, and bacteria, which can appear as blackheads, whiteheads, and pimples anywhere on the body.
Though often seen as a teenage issue, acne can affect people of any age. Approximately 50% of women in their 20s, 33% in their 30s, and 25% in their 40s experience acne.
Breakouts around the mouth and chin are common, especially with hormonal acne. Hormonal acne may be related to changes in reproductive hormones seen in puberty, menstruation, pregnancy, menopause, and polycystic ovarian syndrome (PCOS). However, hormonal imbalances are not the only potential cause of perioral acne.
Potential causes of acne around the mouth can be explored through a functional medicine approach. A provider may evaluate possible 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 influenced by hormonal changes. Because skin conditions may have overlapping characteristics, seeking advice from a healthcare provider is important.
Root Causes of Acne Around the Mouth
Several potential triggers, or combinations of triggers, may contribute to perioral acne. Understanding these triggers is important for 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) may support sebaceous gland growth and sebum production, which can lead to clogged pores and acne.
On the contrary, estrogens may have the opposite effect, potentially inhibiting these male androgen hormones. Estrogen may inhibit the growth and function of sebaceous glands; therefore, the function of these glands may depend on the estrogen/androgen ratio.
Diet
Studies suggest that nutrition and diet can impact acne and skin health. Consuming high-glycemic foods and dairy products may increase 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 contribute 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 may trigger the release of pro-inflammatory cytokines and cortical-releasing hormones, leading to increased cortisol levels. Cortisol is a stress hormone that can prompt inflammation and increase sebum production. Studies show an association between emotional stress and acne.
Poor Sleep
Poor sleep may also increase 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, increasing the risk of 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, which could lead 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 potentially 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 offer personalized guidance and 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 options 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 factors of acne, which may lead to more effective 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 function 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 Managing Acne Around the Mouth
Lifestyle Modifications
Lifestyle changes can be a helpful starting point for managing 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 Options
Using natural options aligns with the principles of functional medicine. These may include:
- Tea Tree Oil: Tea tree oil is known for its 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 management 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 Options
Over-the-counter options are often essential in the management of acne and may be effective, especially when used in combination with other approaches.
- 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 management, effective for unclogging blocked pores and increasing cellular turnover.
Pharmaceutical Options
Pharmaceutical options may be necessary in certain patients. The following may be considered if initial approaches are not effective or in severe acne cases:
- Oral Antibiotics: Patients may require oral antibiotics. Tetracyclines, such as doxycycline, minocycline, and sarecycline, are the preferred first-line option.
- Hormonal Therapy: Hormonal therapy may be considered for severe and resistant cases. Androgen receptor blockers, oral corticosteroids, oral contraceptives, or insulin-sensitizing agents may be options.
- 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 managing acne.
Combining these options for acne may address multiple factors and triggers, potentially increasing efficacy and leading 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 evaluation to perioral acne.
- The presentation of acne may be multifactorial and complex. Therefore, combination approaches with natural options, topicals, and prescriptions should be considered to provide a more effective 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 plan, potentially leading to healthier and clearer skin.
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