# Acne

Category: Conditions

Also known as: acne vulgaris

Acne is fundamentally a sign of systemic hormonal imbalance, most often driven by low thyroid function and a corresponding deficiency of vitamin A, rather than a primary skin disorder. Ray Peat argued that the surge of sex steroids at puberty increases the body's demand for…

11 passages · 2 authors · 2013–2022 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/acne

## Synthesis

**Acne** is fundamentally a sign of systemic hormonal imbalance, most often driven by low thyroid function and a corresponding deficiency of **vitamin A**, rather than a primary skin disorder. [Source 2, 5, 11] Ray Peat argued that the surge of sex steroids at puberty increases the body's demand for vitamin A, which is crucial for skin cell differentiation, steroid production, and resistance to infection. [Source 5] He noted that thyroid hormone is essential for preventing an imbalance of these steroids and for maintaining immune function and sebum production in the skin. [Source 5] When thyroid function is low, the body relies on stress hormones, and the adrenals produce **DHEA**, which can be converted in the skin into potent androgens that drive the overproduction of sebum. [Source 10] This sebum then feeds bacteria, creating the localized inflammatory reaction recognized as a pimple. [Source 10]

The connection between the gut and the skin is a critical pathway in the development of acne. Peat consistently emphasized that intestinal irritation from poorly digested foods or allergens can contribute to skin inflammation and problems with the excretion of fats and sweat. [Source 2, 11] Georgi Dinkov has elaborated on this, explaining that chronic gut irritation is not mutually exclusive from the hormonal pathway, as it will increase **estrogen** and **cortisol** while suppressing protective hormones. [Source 4] Peat also observed that excess dietary fat, relative to sugar, can disturb the skin's energy production, suggesting that individuals who experience acne from drinking milk might benefit from consuming lower-fat varieties. [Source 6] This aligns with the broader principle that *polyunsaturated fatty acids (PUFAs)* interfere with thyroid function and are a foundational dietary problem. [Source 8]

Peat described a specific phenomenon where a surge of youth-associated hormones, triggered by improved thyroid function, can cause what he called a "rejuvenation" of the skin's oil and moisture glands, leading to acne even in older individuals. [Source 8] He personally experienced this when first supplementing DHEA, and noted that the process of converting cholesterol into progesterone and DHEA, which is stimulated by thyroid, dramatically increases the consumption of vitamin A. [Source 8] A resulting vitamin A deficiency can cause the immune system to fail, allowing bacteria to proliferate on the skin. [Source 8] Peat shared that he himself required 100,000 i.u. of vitamin A daily for several years to prevent acne and ingrown whiskers, and that the need for such high doses decreased only when his thyroid function improved, which he could track by the accumulation of carotene in his calluses. [Source 3]

For treatment, Peat recommended addressing the root causes by optimizing thyroid function and vitamin A status, while also employing topical agents to manage symptoms. [Source 2, 5] He found that a 10% sulfur soap leaves an antiseptic residue that can prevent infection, and that a solution of aspirin in water applied to the skin helps with inflammation and is mildly germicidal. [Source 1, 5] Dinkov has pointed to the efficacy of topical **niacinamide** as a desirable alternative to antibiotics for inflammatory acne, and noted that **caffeine** has progesterone-like and anti-estrogen effects that can be helpful against hormonally driven acne by opposing local tissue androgens. [Source 9] Peat also noted that internal antibiotics like minocycline can be used for their anti-inflammatory effect, and that changing the diet while using an antibiotic can make the improvement permanent. [Source 7] He cautioned that while estrogen-based contraceptives can clear acne by causing the oil glands to atrophy, this does not address the underlying metabolic problem. [Source 5]

## People also ask

### How does low thyroid function cause acne?

Peat argued that low thyroid function forces the body to rely on stress hormones, causing the adrenals to produce DHEA which is converted in the skin into potent androgens that drive sebum overproduction, feeding bacteria and creating pimples.

### Why might someone get acne when starting thyroid treatment?

Peat described a "rejuvenation" phenomenon where improved thyroid function triggers a surge of youth-associated hormones that reactivates the skin's oil glands, dramatically increasing vitamin A consumption and potentially causing a temporary deficiency that allows bacterial proliferation.

### What is the gut-skin connection in acne development?

The corpus describes how intestinal irritation from poorly digested foods or allergens increases estrogen and cortisol while suppressing protective hormones, contributing to skin inflammation and problems with fat and sweat excretion.

## Related concepts

- [Fish Oil](https://bioenergeticoracle.com/md/concepts/fish-oil/index.md)
- [Hashimoto's Thyroiditis](https://bioenergeticoracle.com/md/concepts/hashimoto-s-thyroiditis/index.md)
- [Uterine Fibroids](https://bioenergeticoracle.com/md/concepts/uterine-fibroids/index.md)
- [Cheese](https://bioenergeticoracle.com/md/concepts/cheese/index.md)
- [Diabetes](https://bioenergeticoracle.com/md/concepts/diabetes/index.md)
- [Eczema](https://bioenergeticoracle.com/md/concepts/eczema/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Ray Peat Email Advice Depository — Post 69

Ray Peat · Email · May 17, 2013

> **Question:** [Acne]
>
> **Ray Peat:** Have you tried anything topical, such as sulfur, or an antibiotic such as minocycline? 10% sulfur soap leaves an antiseptic residue on the skin that can prevent infection. I think it would be good to try the sulfur soap first. The simple ones are what I use; I haven't tried one with salicylic acid.
>
> **Question:** Is it okay to shower twice a day and use sulfur soap?
>
> **Ray Peat:** The sulfur lingers on the skin for at least a day. It can leave you fairly smelly.
>
> **Question:** Can flowers of sulfur taken internally help with acne? Would minocycline also help?
>
> **Ray Peat:** Either of them can help, but with prolonged use the intestine can develop sensitivity to the sulfur. causing irritation instead of stopping it.

### Source 2 — One Radio Network: Health & Diet

Ray Peat · Interview · Dec 4, 2013 · http://l-i-g-h-t.com/files/one-radio-network-patrick-timpone-dr-peat-answers-questions-regarding-health-diet-and-nutrition-part-1.mp4

> **Caller:** What happened to the book store and newsletter?
>
> **Ray Peat:** Yes, when they re reprinted. People can still sign up for the newsletter
>
> **Caller:** What is the ideal diet for Type 2 diabetes? I am taking 100mg of L Tryptophan at night for sleep, shall I discontinue.
>
> **Ray Peat:** There are articles on my site about Diabetes, explaining how the unsaturated fats are an essential problem in causing diabetes, and sugar is NOT a problem and has been used a s a cure, getting the right diet and making sure the Thyroid function is optimized are the basics. Aspirin is well-known to help to regulate blood sugar and help to lower inflammation, and the problems associated with diabetes.
>
> **Caller:** I keep getting Acne, how can I deal with it? I take chlorella, have saunas, make green smoothies, what can I do?
>
> **Ray Peat:** Thyroid and Vitamin A are the basic things, but the skin and intestine are very closely related, so you want to make sure you aren’t eating any foods that aren’t well-digested, or can irritate your intestine, because that can contribute to inflammation or problems with excretions of fats and sweat.

### Source 3 — Ray Peat Email Advice Depository — Post 1

Ray Peat · Email · Jan 14, 2013

> **Question:** Hello Mr. Peat, This inquiry concerns the use of vitamin A supplement, specifically NutrisorbA. For the past year, I have found that if I take less than 100,000 iu per day I get acne, and upon increasing my dose to 100,000 iu, the acne goes away within a day or two. I have tried, on various occasions, to reduce the supplement, and simultaneously increase liver, or decrease sun exposure, etc. I avoid PUFA, drink lots of milk and orange juice, eat eggs, cheese, and a carrot salad every day. I get quite a bit of sun (1 to 2 hours per day), and sit under the IR lights every day. I take between 25-50mcg of t3 per day, and my temperatures seem to be healthy - oral temperature in the morning is around 98.5, which increases to 99.5 - 99.7 by midmorning. My resting heart rate is between 80 - 90 bpm. I have also tried taking a b6 supplement, and while it made me feel very merry, it did not decrease the acne. My question: Is this dose of vitamin A safe, or is there some other factor that could be wasting vitamin A of which I am unaware? Thank you for reading, Anon
>
> **Ray Peat:** For several years, I had a similar need to take 100,000 i.u. daily to prevent acne and ingrown whiskers, so I read a lot about its effects. The toxic effects of extremely big doses, such as 500,000 to a million i.u., seem to be from either oxidative processes (rancidity) that are prevented by adequate vitamin E, or by antithyroid effects. I found that when my need for vitamin A began to decrease I tended to accumulate carotene in my calluses; that happens when the thyroid function is lower, reducing the need for vitamin A. Since you are eating foods with carotene, the calluses on your palms or soles should serve as an indicator of when your tissues are saturated with vitamin A. About 100 i.u. of vitamin E would help to keep the vitamin A from being wasted by oxidation, and possibly could reduce your requirement for it.

### Source 4 — #110 - Why your skin is a reflection of your internal health with Emma Sgourakis & Georgi Dinkov

Georgi Dinkov · Interview · Apr 25, 2022

> **Georgi Dinkov:** I can send you some links. I mean, some of them are very well-known symptoms, like having large brown spots on the skin, especially on the back, is a well-known clinically established sign of colon cancer, also known to be caused by estrogen. because estrogen is the hormone of pigmentation, increasing it, while progesterone is the opposite. So there are several of these signs slash symptoms on the skin, on the surface, that speak to a much deeper problem. And the Chinese knew this, you know, 10, 12 centuries ago, but now it's making itself into Western medicine as well. And a good dermatologist, basically, he or she was supposed to ask you how long you've the acne breaks out for, how long they last, right? Are they correlated with any kind of an event in your life, such as, you know, having your period or like, you know, basically a stressful period at work, at home, maybe somebody's going through a divorce or like having a new child, these kinds of things. And then a good dermatologist should be able to do a, you know, run even a basic hormonal profile. and try to correlate the two and see how things relate. They shouldn't automatically be prescribing this toxic vitamin A derivative and sending it off, right? I mean, that's just a pill pusher. You need probably to check with another doctor. And sometimes the primary care practitioner, the GP, will be able to notice these signs too. In the United States now, they've changed the guidelines, the screening guidelines, and the new guidelines do include basically a screening test, which the nurse or the general practitioner is supposed to check. If you show up with basically – if you're an adult and repeatedly show up with outbreaks on your face or elsewhere on the body, they will actually run the hormonal test without even you asking for them. I started to recognize that the acne, even though it is a cosmetic issue, it is itself just a sign slash symptom of something else going on. Usually hormonal.

### Source 5 — Email Exchanges — Acne

Ray Peat · Email · 2015

> # Acne
>
> Have you tried anything topical, such as sulfur, or an antibiotics such as minocycline? 10% sulfur soap leaves an antiseptic residue on the skin that can prevent infection.
>
> Vitamin A affects the differentiation of skin cells, the production of steroids, and resistance to infection and inflammation. The great increase in formation of the sex steroids at puberty increases the need for vitamin A, and makes its regulatory actions more important. Thyroid's important functions for the skin are the production of steroids and preventing their imbalance, and maintaining the immune function and production of sebum. Other nutritional deficiencies, especially the balance between vitamin E and unsaturated fats, affect the functions of vitamin A and thyroid, so it's important to include foods like liver, eggs, oysters, fruits, and milk in the diet. Sometimes it's easier just to use Benadryl or minocycline to reduce the inflammation and infection.
>
> A solution of aspirin in water on the skin helps with the inflammation, and is mildly germicidal.
>
> [Why do many women get rid of acne using CONTRACEPTIVES (estrogen)?] Estrogen causes the oil glands to atrophy, so the skin doesn't support bacterial growth so well. Topical sulfur's germicidal effect can help, and topical aspirin and caffeine are antiseptic as well as antiinflammatory. One function of vitamin A is to increase progesterone in the skin, and it has to be in balance with thyroid to do that. Another function is to differentiate the skin cells, reducing keratin plugging of the glands.

### Source 6 — #118 - The truth about estrogen replacement therapy, calcium and milk myths with Dr Ray Peat and Kate Deering

Ray Peat · Interview · May 23, 2022

> **Ray Peat:** Yeah.
>
> **Kate Deering:** Okay. So if someone has an issue, I've had people say that literally they've had cancer and so they won't drink milk. And I find that doesn't make a lot of sense, but I think it's the premise that they think that the hormones are going to affect them.
>
> **Ray Peat:** Yeah, I think it's one of the tricks of the anti-milk cultures.
>
> **Kate Deering:** Yes, they are out in full force these days. What about people who drink milk and they say milk is giving me acne? What would you say is going on there?
>
> **Ray Peat:** Milk does what?
>
> **Kate Deering:** Gives them acne. They start to get acne on their skin. Skin issues.
>
> **Ray Peat:** Yeah, maybe they're drinking too much fat with it. Any kind of fat in excess will disturb your skin energy production. And for any cell, its functions decrease under the influence of fat rather than sugar.
>
> **Kate Deering:** So if someone thinks that they're drinking milk and they're getting acne, then maybe consuming a lower fat milk would be to their benefit.
>
> **Ray Peat:** I think so.
>
> **Kate Deering:** Okay. Okay. And what about milks linked to increasing insulin growth factor? So that's a conversation as well. They think it is having an effect on this growth factor. What would you comment on that?

### Source 7 — Ray Peat Email Advice Depository — Post 200

Ray Peat · Email · Jan 14, 2016

> **Question:** Acne...
>
> **Ray Peat:** Antibiotics can be used topically, but the tetracycline type is usually taken internally, for their antiinflammatory effect. Changing the diet while using an antibiotic can make the effect permanent.

### Source 8 — One Radio Network: Thyroid, PUFAs, OJ, and Sugar

Ray Peat · Interview · Feb 19, 2019

> ## Acne, Hormones, and "Rejuvenation"
>
> **Patrick Timpone:** A listener writes that she is eating liver, eggs, and bone broth, and avoiding PUFAs. She feels better, but she is getting painful acne.
>
> **Ray Peat:** When I first supplemented DHEA, I got acne. One of the thyroid's most important functions is to increase your conversion of cholesterol to progesterone and DHEA. The surge of new, youth-related hormones can give a 50-year-old person teenage acne. It takes a good balance of nutrients. Too much protein relative to carbohydrate can dip your blood sugar and cause a stress reaction that activates cortisol. If your thyroid is good, the adrenals will make a surge of DHEA, which can make the skin oily. Acne is a sign that the skin is rejuvenating its oil and moisture glands. However, stimulating the conversion of cholesterol increases the consumption of Vitamin A. A Vitamin A deficiency can make the immune system fail and allow bacteria to grow on the skin.
>
> **Patrick Timpone:** Is that why people take cod liver oil?
>
> **Ray Peat:** Yes, but it comes with Vitamin D and fish oil. Young people do well with fish oil because when the thyroid is up, it can consume and excrete the fish oil fats. But when you are under stress, the fish oil tends to accumulate, break down, and produce inflammation and immune-suppressive products.

### Source 9 — IdeaLabs Forum Q&A — SolBan

Georgi Dinkov · Forum Q&A · Feb 6, 2015

> **Belsazar:** (2016-05-16) Why are not more people with acne trying this? „4% nicotinamide gel is of comparable efficacy to 1% clindamycin gel in the treatment of acne vulgaris. Because topical clindamycin, like other antimicrobials, is associated with emergence of resistant microorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.“ (Shalita AR1, Smith JG, Parish LC, Sofman MS, Chalker DK. (1995). Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol.) [references] It also seems to help againts PIH (post inflammatory hyperpigmentation) which are long lasting red marks that follow inflamed pimples: [references]
>
> **Georgi Dinkov:** (2016-05-16) Thanks for posting these. I fully agree, I think people benefit and it may be just due to not many people knowing about these effects until you pointed them out
>
> **Belsazar:** (2016-05-23) Why do you think so? There is actually no available data on topical caffeine and acne. I also couldnt find any anecdotal evidence from acne boards. It is added to a few so called "beauty products" but not in context of acne.

### Source 10 — #110 - Why your skin is a reflection of your internal health with Emma Sgourakis & Georgi Dinkov

Georgi Dinkov · Interview · Apr 25, 2022

> **Georgi Dinkov:** A couple of reasons. Perhaps the most common one is basically the overproduction of sebum in the skin. And that is usually driven by high levels of aromatizable androgens, specifically DHEA, the adrenal androgens. And what happens is that basically in some people, there is an overactive adrenal system. which is usually a result of suppressed thyroid function, because then the adrenals basically get reactivated to pick up the slack. So if your thyroid is not working well, then the only way for the body to keep you alive is to run you on stress hormones. And people that are younger, acne usually tends to present in people under the age of 40. People that are younger, when their adrenals get activated, they produce cortisol, but they also produce another steroid known as dehydroepiandrosterone, or DHEA, and it's released there by the adrenals in order to counterbalance or at least negate some of the catabolic effects that cortisol has. So basically, when DHEA is released in sufficient amounts, it circulates, and then in the skin, it gets metabolized into even more potent androgens, and that increases the production of sebum by the skin, which is a mixture, sebum is a mixture of lipids and waxes. And what happens is that there's a type of bacteria, I think called propionium bacterium or something, and it uses the sebum as a source, as a food. And then the presence of the bacteria in the pores creates an inflammatory, localized inflammatory reaction, which is what causes the pimples and the pus, you know, to accumulate. And it stays there for as long as you have this overproduction of sebum. So they discovered a long time ago that if you administer antiandrogens, you can decrease the local production of sebum in the skin, right? But unfortunately, some of those drugs, which is, as we mentioned, the synthetic vitamin A derivatives, such as isotretinoin, also known as Accutane, under the trade name Accutane, they are potent antiandrogens.

### Source 11 — One Radio Network: Patrick Timpone: Dr. Peat Answers Questions Regarding Health, Diet and Nutrition Part 2

Ray Peat · Interview · Jan 1, 2014 · http://www.l-i-g-h-t.com/files/one-radio-network-patrick-timpone-dr-peat-answers-questions-regarding-health-diet-and-nutrition-part-2.mp4

> ## Acne and Rosacea
>
> **Patrick Timpone:** Stella says: "I keep getting acne. I sweat in saunas and take chlorella, but still have issues."
>
> **Ray Peat:** Thyroid and Vitamin A are the basic things, but the skin and the intestine are very closely connected. You want to make sure you aren't eating any foods that aren't well digested or that irritate your intestine.
>
> **Patrick Timpone:** What about using the far infrared sauna and niacin together for rosacea?
>
> **Ray Peat:** Niacin sometimes refers to nicotinic acid. Nicotinic acid happens to increase your histamine, serotonin, and prostaglandins, all of which are inflammatory. I don't think it's good for anyone to take nicotinic acid other than as occurs in food. Niacinamide is a form of that same vitamin (B3) that is active in cells and doesn't release those inflammatory materials.

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