When one of my patients presents with skin concerns, a component of my plan is always testing, particularly when it comes to acne. Acne is a concern that can arise for a variety of reasons and bloodwork is a helpful tool in understanding its root cause. Without understanding the cause of breakouts, it is very hard to manage, treat and ideally cure this condition.
Here are some of the blood markers I typically look at for a patient with acne:
Blood Sugar Markers
Fasting glucose and fasting insulin provide a deeper look into metabolism and how well a person’s body works with sugar. Fasting glucose looks specifically at the sugar level in your blood after fasting for at least 8 hours. Glucose in the blood comes from sugars or carbohydrates digested from the foods we eat. Fasting insulin assesses the hormone insulin after fasting for at least 8 hours; insulin is the hormone that helps cells use the sugars or carbohydrates that we eat. Unused sugar will be left circulating in the blood, wreaking havoc over time.
It is not these numbers in isolation that must be looked at (often these numbers will come back within normal range), but how they interact together. A calculation called the HOMA-IR (homeostatic model assessment for insulin resistance) is done with these two numbers to provide a more intimate look into how a body secretes insulin to assist in the metabolism of glucose (sugar, or any carbohydrate).
The reason this is important for acne is because the skin has a complex relationship with blood sugar. Breakouts can occur with a condition called Insulin Resistance. If the HOMA-IR is above two, typically this is considered “insulin resistance” and can be corrected with diet + lifestyle changes, supplements and, sometimes, medication. This correction can be very impactful for hormones overall and the health of the skin.
Androgens are a group of sex hormones that are found in both men and women. They are more masculinizing hormones and are more dominant in men, although healthy women will also make these hormones. It is when androgens are out of balance that they can cause symptoms including breakouts. Usually there will be a connection with these hormones and breakouts occurring in women over the age of 20, and in other populations as well.
Androgens I test with blood work include free and total testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone sulphate (DHEA-S). I will often include sex hormone binding globulin (SHBG) if any of the previous tests come back elevated.
Elevated androgens can be treated. Often, medical doctors will treat this condition with the birth control pill or a medication called spironolactone. In naturopathic medicine, we treat with diet + lifestyle modifications and the appropriate supplements + herbs.
Note: these tests can be affected by pharmaceuticals and may not be worth doing if you are on certain medications.
In addition to androgens and insulin, I typically look at other hormones including but not limited to: estradiol (on day 3 of a woman’s cycle), progesterone (on approximately day 21 of a woman’s cycle), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, cortisol, and thyroid hormones. Often these are not typical causes of acne, but can be related and worth assessing with the above.
Although not usually the cause of acne, certain nutrients are worth assessing and can provide greater insight into the overall acne picture. The top three nutrients I generally run include ferritin (iron), vitamin B12, and vitamin D. I may add to the list depending on a patient’s presentation, past and familial medical history, and dietary habits.
Other tests I generally run are a complete blood count (CBC), cholesterol panel, liver and kidney function, electrolytes, inflammatory markers like C-reactive protein and erythrocyte sedimentation rate. If digestion is a concern, I will also test for celiac disease (note: in order for this test to be accurate, the patient must be eating gluten very regularly).
This is not an exhaustive list and only refers to blood testing. Other tests including stool and breath tests may be useful in the case of acne. As always, seek the individualized care of a medical or naturopathic doctor who can order the tests appropriate to you and prescribe a treatment plan accordingly.