A common theme we always hear in our clinic are clients telling us that absolutely nothing has come back from their previous blood tests to reveal what their acne is caused by and everything is “normal”. We rarely see a blood test with absolutely nothing outside our IDEAL reference range. Reference ranges on blood tests are designed to be able to identify disease, however, we aren’t looking for “disease” we are looking for “dysfunction”. Through tightening the window of the reference ranges and looking for OPTIMAL function, we investigate your blood test results through a different lens to help guide your acne treatment.

Should I get a blood test for my acne?

With all of our Initial Consultations, we will provide you with particular markers of what should be tested for your acne, first starting with general pathology through a General Practitioner (GP) or referral to one of our collaborative Integrated GPs (GP’s that also work with Nutrition!). General pathology refers to the laboratory testing of body fluids such as blood, urine, stool samples, and certain tissue samples to measure levels of direct markers. Your GP can order these for you as these tests are often covered by Medicare so you won’t have to pay out of pocket (most of the time). Otherwise, we can organise this testing for you.

What tests should be done for acne?

As we discussed in our Part 1 blog, which you can read here- acne is such a multifactorial condition, and what your acne is caused by could extend over multiple body systems. Unfortunately, the skin is the last place the body cares about - your body doesn’t care about healing your acne whilst it’s worrying about running away from a tiger (stress) or trying to repair a damaged digestive tract! First, our body will prioritise our digestive system, then our stress response, then our reproductive system, and a few more other things before the skin is then put on the priority list. General Pathology can give us clues of where to begin your acne treatment, areas to address and can then help us make connections to what your acne is caused by.

This can include:

• Nutritional Deficiencies (Iron, B12, Folate, Zinc, Magnesium, Vitamin D) 

• Hormonal Imbalances (PCOS etc.)

• Stress

• Poor liver function and detoxification

• Genetic variances affecting detoxification

• Inflammatory load and acidity

Should I get my hormones tested for acne?

General pathology testing done post ovulation (around day 19-21 of your menstrual cycle) can help us determine whether your acne is caused by deficiencies or hormonal imbalances. So yes, you definitely will get your hormones tested for acne after your first initial consultation.

Hormonal imbalances such as excess estrogen relative to progesterone, or excess androgens such as testosterone can be related to disrupted pH balance in the skin, excess oil and sebum production, reduced liver detoxification, increased histamine levels, and more. 

Once we know which hormones are affected, we can have a more targeted approach to your acne treatment. It is important to wait at least 3 months (or 3 regular menstrual cycles) after discontinuing birth control to accurately identify if your acne is caused by a hormonal imbalance.

The following markers are common hormones that we commonly request tests for:

• FSH/LH Ratio: FSH & LH are hormones secreted from the brain that tell the ovaries what to do. Hormonal imbalances from the brain can give us clues to potential estrogen or testosterone excess, PCOS, or blood sugar imbalances that could be affecting your acne. 

• Oestrogen/Progesterone ratio: Healthy ovulation and detoxification are crucial for the balance of these hormones. Imbalanced oestrogen and progesterone can lead to increased sebum production and acne. Progesterone also suppresses DHT (an androgen involved in acne), so low progesterone can also contribute to acne.

• Testosterone: Excess testosterone is involved in acne formation by stimulating the sebaceous glands to increase sebum production and promoting abnormal keratinisation of skin cells, leading to blockages in the pilosebaceous units and priming the skin for acne formation.

• DHEA: DHEA is primarily produced by the adrenal glands; excess levels convert into androgens such as testosterone and DHT which directly interact with the sebaceous glands in the skin, leading to a disturbed regulation of skin cells proliferation and increased sebum production that underlies acne formation. 

• 2 Hour Glucose Tolerance Test (GTT) with Insulin: This test assesses how your cells respond to sugar, rather than the sugar levels themselves. When your insulin levels do not respond in a normal way to sugar, there may be insulin resistance present. Insulin resistance increases levels of insulin-like growth factors and androgens such as testosterone, thereby leading to acne. 

• Sex Hormone Binding Globulin (SHBG): SHBG ‘binds’ up sex hormones and keeps them in their inactive form so that they are unavailable to be used by body tissues. When SHBG is too low, then the levels of certain sex hormones such as testosterone may become too high and therefore affect the skin, contributing to acne.

Could I be tested for nutritional deficiencies that could guide the course of my acne treatment?

Being able to identify nutritional deficiencies is often an important part of acne treatment, as it allows us to pinpoint any gaps in your nutritional foundations for healthy skin. Many nutrient deficiencies are associated with acne formation, as the skin requires adequate levels of nutrients to function. This is because certain nutrients play essential roles in collagen synthesis, the hydration of skin cells, skin cell turnover (a process called keratinization), liver detoxification, hormonal synthesis, the immune response in the skin, and more.

Deficiencies in nutrients may be caused by birth control, high alcohol intake, a poor diet, poor gut health, an increased need for certain nutrients due to genetics or lifestyle factors, and more. 

Some of the nutrients we commonly request testing for include:

• Vitamin D - Vitamin D plays an essential role in the regulation of vitamin A for immune function. Vitamin D is also involved in the control of skin cell proliferation and differentiation, regulating the growth cycle of the hair follicles (in the pilosebaceous units where acne forms), protection from UV (photoprotection), and wound/acne healing.

• Iron - Adequate iron levels are required for the production of key hormones, healthy red blood cell production so that cells are able to carry oxygen around the body (including to the skin!), collagen synthesis, and the regulation of skin-cell turnover.

• B12 & Folate - B12 and folate play key roles in detoxification, skin cell turnover, and the production of new healthy stem cells (new skin cells), and healthy red blood cell production, just to name a few.

• Zinc - Zinc is one of the best nutrients for skin as it helps stabilize cell membranes, is involved in skin cell proliferation, kills bacteria, and is an antioxidant. Zinc is also required for healthy hormone balance, the nervous system response, and immune function which are all involved in the formation of acne.

What other tests can help me understand what my acne is caused by?

General blood tests can also provide us with information about whether liver function, acidity, and inflammation could be at the root of your acne or contribute in a significant way. This helps us to place all the pieces together to develop your acne treatment

Does general pathology (testing) give us the full picture of what my acne is caused by? 

Although your blood tests can provide us with extensive information in regards to hormonal imbalances, nutritional deficiencies and more, we always need to relate this back to your presenting symptoms and consider all of the information from the consultation. We learn so much about you just through all of the questions we ask and your blood tests are the missing pieces of the puzzle.

If further testing is required and your case may be a little more complex, we then look into further Functional Pathology including DUTCH (to assess your stress response) & stool testing (to investigate the presence of microbiome imbalances). This is all individualised to your personal history.