Healing Acne from the Inside Out: A Dermatologist Explains Why Treating the Skin as a ‘System’ Matters
Your skin is a part of a system shaped by your gut, hormones, genetics, environment, and products
The difference between a good dermatologist and an average one is in how they see your acne. One will treat the bumps on your skin, while the other will help you understand what’s causing them. If you ever consult my dermatologist, Dr. Vandhana Manoharan, the first thing she will tell you is that acne is a symptom of something larger that’s going awry in your body. Until you address the root cause, you can’t really treat your acne.
I couldn’t agree more - addressing the root cause of my acne finally helped me treat it. Read about my journey below:
Through all my conversations with Dr. Vandhana, and all my research on the space, I’ve learnt that skin care needs to be reframed as skin health. We need to look at our skin as a system influenced by various factors, and not the result of quick fixes.
Acne can never be treated in isolation. Yet, most people are misled with half-truths and end up using products that worsen their already damaged skin (been there and done that, btw).
So I got Dr. Vandhana to answer the deepest questions about acne, so you are no longer left guessing.
1. Can you explain why acne is more about skin health than just “spots on the face”?
Acne is a health problem, not a cosmetic one. Most people only focus on the cosmetic aspect of acne, like pimples and scars, but what gets brushed under the carpet is the root cause. In simple words, you have acne because something has gone wrong internally, which could be your gut, hormones, diet, stress, or sleep. For example:
➡️Hyperglycemic foods (foods that spike blood sugar) could cause acne in some people.
➡️Hormonal imbalances could increase oil production on the skin and cause acne.
2. What are the most common internal and external factors that lead to acne in your patients? Are there any causes that get overshadowed?
There are some recurring factors I see in the people who come to me:
Women who have PCOS (or PCOD) are more likely to present with acne because of hormonal imbalances.
Poor hygiene, especially among men or gym goers. This includes sweat or dandruff clogging pores.
High glycemic foods and skimmed dairy milk can cause flare-ups.
Erratic sleep and high stress levels disrupt your hormonal balance.
Overuse of supplements like vitamin B12 can cause acneiform eruptions (which many mistake for acne).
Some people are genetically predisposed to acne (i.e., it runs in the family).
Miscellanous: Steroidal fairness creams, steroidal medication, heavy or oil based skincare or makeup, highly processed whey protein, excessive smoking, and long hours in masks or helmets.
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3. DIY remedies and over-the-counter “miracle creams” are everywhere. What damage can these actually cause?
Trust me, if someone is selling you a ‘miracle cream’ - run in the opposite direction and never look back. These creams will damage your skin beyond repair. I’ve had people come to me with absolutely damaged skin barrier caused by prolonged usage of these ‘miracle creams’. They contain steroidal compounds, which temporarily make your acne go away but make your skin dependent on them.
The minute you stop using them, your acne comes back in full force. They will not only damage your skin barrier but also cause side effects like hirsutism (facial hair growth in women), thinning of blood vessels in the skin.
For example, people use steroidal creams like Betnovate without a prescription or medical guidance and damage their skin.
Some unregulated fairness creams that local parlours sometimes hand out contain mercury or hydroquinone, which disrupt the skin. Honestly, stay away from fairness creams!
When it comes to DIY remedies, some combinations might offer a low-grade soothing or healing effect, but others will harm your skin.
4. What does a holistic acne treatment plan look like?
You can’t treat acne without knowing what’s causing it. It’s one of the most critical (yet most ignored) steps. Your skin doesn’t exist in a vacuum — it reacts to what you eat, how you sleep, your hormones, stress levels, hygiene, the quality of air and even the water you use. A real holistic treatment plan takes into account the multiple factors that affect the skin.
If you have acne and are still wondering what actually might be causing it - we’ve designed a comprehensive root cause analysis test and blueprint to heal acne (inside-out).
5. What would you tell someone who feels “I’ve tried everything and nothing works”?
Most people try the incorrect combination of treatments, thanks to misinformation and low patience. They want quick results! This makes them think nothing is working for them, but they never really address the root cause.
People tend to have an expectation mismatch - they are unaware of the severity of the acne, which accounts for more treatment time. This stress of trying to ‘fix’ their acne quickly instead triggers more breakouts. For those with PCOS (or PCOD), not managing hormone levels or skipping gynae consults might worsen acne flare-ups.
Many people who think they’ve tried everything are usually missing the root cause or trying the wrong combination of treatments. My advice to them would be: don’t lose faith, get the triggers diagnosed and be consistent with your treatment – consistency is key. Additionally, avoid drinking or smoking, as these can worsen flare-ups.
Like I said before, acne is a health issue, and we need to treat it holistically. There is no magic pill or cream that can cure your acne - only small, consistent steps towards better skin health — inside and out.