Acne, zits, pimples, pustules, blemishes. Whatever we call them, we detest them, and in this age of high stress, pollution, and processed foods, they’re widespread. For some people, acne may be a minor annoyance, but for others, it undermines self-image and lowers self-esteem. “I couldn’t even look people in the eye,” one client told me. Such people are easy prey for the false promises given by makers of “deep-pore cleansers” and “oil-free creams.” I was one of those people.
The problem is that many of us are misinformed. When I had acne, several doctors and estheticians told me that my blemishes had nothing to do with my diet or my general physical and emotional state; however, until these were addressed, I saw no changes in my skin. Many dermatologists and skin care professionals concentrate solely on topical pimple formation as a basis for treating acne. While it may seem logical to identify and eliminate the factors that cause a blemish, this does not provide long-term results. From this perspective, blemishes are simply clogged pores that have become infected and inflamed, sometimes turning them into pustules. This is why many acne solutions focus on reducing sebum, minimizing blackheads (through peeling), and using antibacterial agents. But why do some people develop clogged pores while others do not? Why do some comedones turn into acne, while others simply remain congested pores for years?
The answer lies in the fact that acne is both an internal and an external problem. It is an expression of imbalance that cannot be overcome by looking only at the blemishes and their formation. Acne is complex, with a multitude of causes, and is most often aggravated by many factors at the same time. It is a highly unpredictable condition, with varying levels of severity, making it impossible to give a blanket solution to all acne sufferers, which is often the approach of conventional skin care professionals.
As I have described in other chapters, in my struggle with acne, I actually made my skin worse through my own short-sightedness and naïveté. What began as a small imbalance caused by poor skin care choices paired with hormonal changes turned into a decade-long skin problem. Desperate to clear up my complexion, I dried out my skin (which depleted its defenses), accumulated heat and inflammation from my own stress and frustration, and finally damaged and weakened my internal health by using powerful antibiotics. If I had known then what I know today, I would have simply taken a deep breath and recognized my acne as a signal to examine my overall health. Armed with the information in this chapter, I would have been able to make more informed decisions based not on emotions but on the consciousness and awareness of my own body’s systems.
Internal and External Causes of Acne
To understand the best approach to use when trying to clear up your acne, you must first identify the causative factors. While some blemishes are aggravated by imbalances on the skin surface, others come from internal health issues. It’s important to distinguish between them, because when you treat the real causes of your acne, the improvements to your skin will be both dramatic and long term.
Clogged pores are a precursor of acne, because the encapsulation of a pore is what traps bacteria beneath the skin. Excess oil is the commonly blamed culprit for acne; therefore, it is generally believed that stripping the skin of its oils will prevent and clear up blemishes. But this does not actually cure acne. Instead, it causes dehydration, which is the root cause of overproduction of sebaceous oil, which initiates a vicious cycle. Congested skin is often caused by stripping away oil. The absence of oil makes the body produce more oil to compensate in an effort to create balance. This extra sebum is thicker than normal to try to protect the skin. So the result of using oil-free products or not using a moisturizer creates an even bigger oil problem.
Oily skin is the most beautiful and healthiest type, if properly maintained, and it should never be stripped. It needs gentle care and lots of hydration to maintain clarity so that sebum does not dry and solidify in the pores and create blackheads. Dehydration is actually the most common cause of acne (and also contributes to scarring). While sebum overproduction may set the stage for clogged pores and blemishes, acne does not occur without dehydration. A lack of water in the skin is what dries out facial oil so it sits in the pores instead of flowing across the skin surface to protect and lubricate. Breakouts often occur during the seasonal change from summer to fall or in a move to a less humid environment. Even skin types with little sebaceous activity accumulate blackheads and congestion when they are dehydrated.
The skin must be hydrated from both the inside and the outside. As people who have acne become more hydrated, not only does their skin clear up, but it becomes moister, less sensitive, and less irritated. With many of my acne clients, improved hydration and a decrease in sensitivity also allows me to do more thorough extractions and skin purification without the risk of scarring. Eating lots of fresh vegetables and drinking at least two liters of water a day cleanses your system and hydrates your cells. Avoid dehydrating foods and activities such as caffeine, alcohol, and smoking, which are dehydrating and taxing to the liver. While going to sleep early and avoiding alcohol is ideal, a topical boost of moisture can lessen the effects of bad habits. If you are getting to sleep too late or indulging in a glass of good wine, use a rich moisturizer or face oil before going to bed. This deeply feeds your skin overnight and minimizes the consequences of skin dehydration.
Proper skin care is a necessity when combating dehydration (and therefore clogged pores). Since you cannot control how your body absorbs and disperses the water you ingest, applying moisturizers to your skin is an essential support and the most direct way to fight superficial dehydration. Nourishing, oil-based products also help seal water in, preventing the evaporation of precious hydration.
As we have discussed previously in this book, the concept of fighting acne with oil may be surprising to many acne sufferers. It is often difficult for acne-prone people to take this approach because they are so used to avoiding oil; many of my first-time acne clients have been using a gel moisturizer or none at all. But once they begin to use pure oils on their skin and see an improvement, they become oil enthusiasts. One of my most devoted clients came to me when he began breaking out in his thirties. He was frustrated because he had never had problem skin before, even as a teenager. Although skeptical, he began using a facial oil as his nighttime moisturizer. His skin became so much clearer and less congested that he happily used the oil regularly and switched to an oily textured milk cleanser as well.
It is important to emphasize that I am talking about using only natural vegetable oils, not petrochemical-based moisturizers or mineral oil. Natural skin care is essential for maintaining hydrated, acne-free skin. Harsh chemical cleansing agents dehydrate the skin, and as explained earlier, petroleum-based products sit on the skin, inhibiting moisture absorption and clogging the pores. Sometimes the use of chemical-based skin care products is even the initial cause of breakouts. In such cases, the switch to a natural regimen helps diminish acne on its own.
When making this kind of switch, think beyond your basic skin care routine to include your sunblock and cosmetics. Many acne sufferers depend on cosmetics to hide their blemishes, worsening the problem. Even if you use proper, high-quality natural skin care products, the clogging effect of commercial makeup can prevent the skin from clearing fully. When you ensure that everything you put on your skin is made from pure ingredients, overcome your fear of oil, and increase your body’s and skin’s hydration, you eliminate the occurrence of congested pores, which is fundamental to achieving clear, blemish-free skin.
HEAT AND INFLAMMATION
Pimples and blemishes are forms of inflammation. Therefore, anything that increases inflammation, whether it is topical or internal, also triggers breakouts in acne-prone skin.
Direct, topical heat such as sun exposure can prompt acne breakouts. Abundant sun exposure can cause this in a pitta constitution because this heat pushes out toxins. The sun also stimulates the sebaceous glands while drying out the skin. Excess exposure resulting in sunburn traumatizes the skin and taxes its immunity. This creates a lot of heat in the skin’s layers and damages them, leaving the skin vulnerable to more blemishes.
Another topical heat factor is the use of products that stimulate circulation. While blood flow is excellent for feeding skin cells, too much circulation in acne-prone skin leads to more blemishes. Ingredients like ginseng, rosehip oil, and vitamin C are great for rejuvenation and repair, making them effective for healing scars, but they also aggravate breakouts in acne-prone skin. Use them either as spot treatments for scarring or after your skin has normalized and stopped breaking out.
Although external heat increases inflammation on the skin, internal heat is closer to the root cause of acne. Avoiding topical heat is fairly easy to do, but internal heat is a result of excess pitta, and the body attempts to purge this hot energy. According to ayurveda, the first thing to examine in cases of inflamed acne is the circulatory system. Because pitta governs the blood, and the blood feeds the skin directly, acne is known to be a rakta dhatu (blood) disorder. In this case, the blood is considered “dirty,” loaded with pitta heat and other toxins such as kapha dampness.
Cleansing the blood is key to clarifying the skin. Blood-purifying herbs are also pitta reducers, and a knowledgeable ayurvedic physician or naturopathic doctor can help you choose which ones are best suited to your constitution. If you would like to start with something subtle and simple, incorporating turmeric in your daily meals is an excellent way to pacify pitta and gently clean the blood. This spice is tridoshic, so it is a good choice for all body types.
Turmeric supports good digestion, decreases excess stomach acid, calms inflamed skin, and removes heat from the liver. One of my clients, who broke out in a terrible heat rash with pustules, found that taking turmeric capsules in conjunction with daily meditation and a pitta-pacifying diet was immensely soothing. Her breakout was so severe that I thought it would take two weeks to ease and would leave scars, but with the help of the turmeric, her skin improved dramatically within days and remained unmarked afterward. A common dose of turmeric is two to four capsules with meals, but if you decide to use it this way rather than as a flavoring spice, consult a health practitioner to determine the best amount and consumption method for your constitution and situation.
Eating a pitta-reducing diet is also important for treating inflamed acne. Although many acne sufferers know that food affects their skin on a daily basis, there is the misconception that simply eating less junk and fast food is sufficient. In actuality, you need foods that calm inflammation. According to ayurveda, this means avoiding circulation-stimulating foods and liquids such as coffee and hot spices like cayenne, black pepper, and chili. Eating water-rich foods also fights fire, so cucumbers, melons, and sprouts are good for pacifying pitta. But when incorporating hydrating fruits and vegetables into your diet, you must stay away from those that are acid forming, such as grapefruit, sour cherries, plums, radishes, and tomatoes. One client who followed these recommendations admitted, “I was a bit skeptical. How could tomatoes be bad for me? These restrictions seem so specific, but it makes sense now, and my skin is much clearer.”
Sweet grains such as white basmati rice and barley are also excellent, because they are bland and counteract spicy foods. Dairy and wheat are also pitta balancing for this reason, but avoid these kapha-forming foods if you have wet, pus-filled blemishes.
The liver is another organ to assess when dealing with acne, because it stores heat. Chronic acne (especially adult acne) is an indication of a liver imbalance, and even the best skin care products cannot heal this. The liver is the body’s filtration system; if it is overheated and overworked, it does not absorb or filter properly, and excess waste spills into other areas. Because the skin is the largest organ of detoxification, toxins that cannot be filtered and eliminated will end up here. According to ayurveda, the liver is closely related to the emotion of anger, making someone with a weak liver prone to irritability. This is important because all acne is related to the pitta dosha, and pitta behaviors increase the presence of heat in the liver and skin (and vice versa).
While eating an anti-inflammatory diet is excellent for reducing heat, so is cooling the mind. Pittas often have difficulty calming down, so rest is important. Sleep helps to regenerate and detoxify the liver, and according to natural body rhythms, the liver usually detoxifies from 1 A.M. to 3 A.M. This makes sleep during these hours extremely necessary to the health of the liver and, because of its filtration role, that of the rest of the body. The liver filters many hormones, so when it is not functioning properly, this influences the endocrine system. Instead of being cleansing and eliminating excess hormones from the body, a weak liver can lead to a buildup of them. This gives way to other hormonal issues, because much of hormone production is based on the body’s estimation of how much it has. This can cause an imbalance in the excessive, improperly filtered hormone as well as the regulation of others. As we’ve discussed, all systems in the body are interconnected, and hormones play a huge part in the treatment of acne.
HORMONES
Hormonal imbalances are a common cause of breakouts, evidenced by the fact that many women get flare-ups around the time of menstruation and during pregnancy, and men and women experience skin problems during puberty and times of hormonal change midlife. In the ayurvedic view, hormonal change causes an excess of internal heat, and again, the result is acne. Common hormonal imbalances also create this excess; for example, heightened testosterone both heats and increases sebum, while excess estrogen creates inflammation. Out-of-balance hormones are a sign of out-of-balance doshic energies. It is important to understand this and not assume that you cannot change your hormonal patterns or that hormone supplements or replacement therapy is the only treatment.
Sometimes excess pitta that affects the liver is the root cause, and liver cleansing helps normalize hormones. In other cases, kapha excess causes polycystic ovary syndrome (PCOS), a syndrome in which cysts are found on the ovaries and that is often linked to excess male hormones as well as imbalances in estrogen production. In this case, avoiding kapha foods and taking herbs aimed at reducing cysts (such as neem) can be effective. Even many Western doctors recommend that PCOS patients avoid starches and high-glucose foods, which is an essential part of a kapha-balancing diet.
With the help of a knowledgeable alternative health practitioner or physician, you can heal the real cause of a hormonal imbalance and treat your endocrine system naturally.
CONSTIPATION
As mentioned earlier, the skin is an organ of elimination. This means that when the body is backed up with too much waste, it tries to expel toxins through the complexion. One obvious sign of constipation is an abundance of blackheads along the jawline and lower cheeks. Chronic constipation is a major cause in moderate to severe acne, so regular bowel evacuation is necessary for clearing up the skin.
One client, with whom I’d been working for three years, had such congested skin that she wouldn’t go anywhere without makeup. When I did extractions, it seemed as if almost every pore was clogged. In most facials, I allot fifteen minutes or so for extractions, but hers took me well over an hour. When she returned for follow-up treatments, every pore would again be full of dried sebum. We tried many different approaches, but her skin would clear up for only a few weeks at a time before she suffered yet another severe breakout. I couldn’t understand why we could never stabilize her. She was a holistic nutrition student with an excellent diet; she drank three liters of water a day and exercised regularly. We tried to track her stress levels and did frequent facials with only minimal results. Finally, I asked her how many times a day she eliminated, stating that twice was ideal.
“Really? I’m lucky if I have a bowel movement every two or three days!” she exclaimed.
With such a buildup of toxicity in her body, it was no wonder she was eliminating through her skin. I had assumed she had regular bowel movements because she was so educated about food and the body, and I was shocked to hear how constipated she was.
I recommended that she take a tincture of milk thistle for her liver and drink half a cup of aloe vera juice with water twice a day. Aloe vera cools pitta and works as a mild laxative. I also prescribed a fiber-based laxative. Amazingly, after about a month, her skin looked smooth and clear. I was sure she must have resorted to taking strong antibiotics or birth control pills, but she announced with a smile, “I’ve only done what you told me to do, and I’m not even wearing makeup. You changed my life!”
This illustrates how the body always attempts to balance itself and stay healthy. Remember, if you do not release toxins through the bowels, they will come out in other ways, such as through your skin.
STRESS
Stress taxes the whole body, lowering its immune system, causing it to dehydrate, leaving it defenseless against bacteria and infection, and decreasing its ability to regenerate. Constant anxiety causes the production of adrenaline, which unbalances the endocrine system. Many people experience major breakouts in stressful situations because they create internal inflammation; this is also why some people experience stress-related hives, eczema, and rashes.
Another reason distress leads to acne is because it causes tension in the abdomen. According to ayurveda, relaxation of this area is important for proper elimination and digestion. While you may not notice that you are holding stress in this area, it results in poor digestion (often causing gas and bloating) as well as constipation. This is one reason that stomach breathing during yoga practice is so beneficial. (See chapter 5 for other tips to reduce stress.)
While stress may simply seem to be a catalyst for other acne triggers, it is so common and so important that it needs to be mentioned separately. The first step in treating stress is to identify that you are actually under pressure. Sometimes it is such a regular part of life that you forget your mind and body are under strain. In some ways, the presence of clogged pores and pimples is a good reminder to analyze your behavior and reassess your lifestyle choices.
Conventional Solutions and Why They Don’t Work
As we have discussed, acne is not strictly a topical skin ailment, which is why a superficial approach cannot cure it. It takes sensitivity to your body’s needs, a respect for your health, and a lot of patience. Unfortunately, many people feel patience is a luxury they can’t afford.
Many panicked teenagers seek the advice of dermatologists at the first sight of blemishes. The popular solution is to dry the skin with salicylic acid and benzoyl peroxide or to peel it with harsh retinol creams. This only worsens the problem by unbalancing and depleting the skin, causing more blemishes. Stripping also leaves the skin more susceptible to infection and, therefore, acne. Because acne rarely goes away with these methods alone, the next step is usually a more invasive one: antibiotics, birth control pills, and Accutane. Many people take antibiotics for teenage acne; although their skin clears up, their complexion becomes blotchy, dry, flaky, and sensitive, and they experience side effects such as nausea and a weakened immune system. When they stop taking the medication, since their root health issues have not been addressed, their acne often returns—even worse that it originally was. Many of my clients come to me with their skin in terrible condition after deciding to stop their antibiotics or birth control pills (which were taken as an acne treatment rather than a contraceptive).
Drugs provide only a short-term solution and leave dreadful after-effects. Antibiotics do a lot of damage, because they dehydrate the internal organs and cause photosensitivity (vulnerability to the sun). Hydration is imperative for waste elimination, so the medication ends up intensifying acne in the long run. Like a dried-up river, the system cannot flow and flush itself when it’s dehydrated. Even topical detoxification in the form of extractions becomes difficult, because dried out skin holds on to pore congestion.
Antibiotics also weaken the liver. As we discussed earlier, ayurveda says that adult acne is usually liver-related, so when acne sufferers take antibiotics, they run the risk of further damaging their already dysfunctional liver for temporary results. This increases heat and agitates internal inflammation, which purges fiercely when they discontinue the drugs. As a side effect, the heat also creates skin sensitivity and promotes broken capillaries and reactive skin.
Birth control pills are another quick-fix solution. Artificially altering hormone levels is harmful to both the skin and overall health, and the result of going off the medication is often severe acne. Again, because the root cause of the acne was not addressed, it simply lies dormant and accumulates more internal inflammation. The body has so much excess hormone it attempts to detoxify when usage is stopped that it results in a huge skin breakout. It usually takes about a year to completely rebalance the skin.
Accutane, otherwise known as isotretinoin, has become popular in recent years because it is very effective, and after an initially painful period of severe breakouts, it clears acne up well. Accutane is made up of high-dosage vitamin A and works by drying up all of the oil glands. But this is harmful to the skin long term, causes premature aging, and compromises overall heath. Unfortunately, its clarifying results are also not permanent. This treatment is especially popular among men, possibly because their acne becomes severe so quickly due to their higher testosterone levels and because of their lack of education about skin care.
Accutane is extremely hard on the body, and common side effects include dry skin, constipation, vaginal dryness, inflammation of the liver, possible genetic damage, and dehydration of the internal organs. Accutane has also been linked to more than thirteen hundred psychiatric side effects such as severe depression, and according to the U.S. Food and Drug Administration, it has been cited as the cause of more than sixty-six suicides. Even one round of this medication can be incredibly damaging to internal organs, the immune system, and emotional health and well-being.
Affected Parts of the Face and What They Mean
If acne is product-related, it generally appears all over the face, as that’s where skin care products are applied. But when pimples are isolated in specific areas, they indicate an internal problem. Referring back to the face maps in chapter 2, you can see the relationship between different parts of the face and the internal organs.
According to ayurveda, vata governs the top of the face, pitta controls the middle (undereyes to upper lip), and kapha rules the lower part. When these doshas are out of balance, acne will gather in the corresponding areas. For example, allergy breakouts on the upper cheeks relate to the lungs. People who quit smoking may also break out here, because inhaling cigarette smoke causes the body to create and retain a lot of internal heat, and pitta toxins purge as the body starts to detoxify.
Excess kapha manifests on the chin. This is often is due to an imbalance in the reproductive organs, so women coming off birth control pills may experience breakouts here (often in the form of cystic acne). The jawline is also kapha territory, and boil-like breakouts show up when this dosha’s energy trait of retention builds up. Kapha imbalance, in the form of candida and sluggish bowel elimination, also promotes dampness in the body and translates to acne in the lower face.
The forehead, with its thin vata qualities, breaks out when there is dysfunction with the air dosha. Vata is related to the colon, so ensuring that this organ is hydrated and evacuated helps clear up blemishes in this facial area. Vata also governs movement, so dysfunction and stagnation in the lymphatic system (congested vata) can cause clogged pores on the forehead. Lastly, a hyperactive mind is the result of high vata and leads to dehydration—a major cause of acne—in this area of the face.
The affected sections of the face and the type of acne indicate what is happening inside the body. While unsightly, acne may actually be beneficial, because it indicates that the body is purging toxins rather than holding them where they could lead to more serious damage. Blemishes can be an early warning sign of illness and organ dysfunction.
Types of Acne
The type of blemishes you experience indicates more about their causative factors. Knowing the different categories of acne helps you determine the qualities of your internal imbalance and facilitate proper treatment.
In my practice, clients complain most about milia (whiteheads) and comedones (blackheads), which are also called “noninflammatory acne.” Whiteheads occur when sebum and bacteria are trapped beneath the skin’s surface. They may be virtually invisible or appear as white, hard-to-extract bumps. Blackheads occur when the trapped sebum and bacteria are partially open to the skin’s surface. When the melanin in the skin oxidizes, they become black in color. Blackheads can be precursors to blemishes, or they may simply remain as they are—clogged pores.
Papules and pustules are more severe forms of acne. These pittatype blemishes are categorized as “inflammatory acne.” Papules appear as red bumps; they do not come to a head and are usually smaller than pustules. Pustules are red, inflamed bumps with a white, pus-filled head; what we generally think of as pimples. While the presence of pus indicates a bacterial infection related to pitta, an abundance of fluid is associated with kapha, so pustules have both a pitta and kapha quality to them and indicate imbalances of both of these doshas.
Cystic acne (also known as “blind pimples”) consists of large, tender-to-the-touch pimples. They have no white head and are deeply seated in the dermis layer of the skin. These long-lasting blemishes lie beneath the skin and are sometimes invisible. They embody the kapha qualities of wetness and accumulation. Sometimes, cystic acne does show redness and inflammation, which indicates some pitta imbalance as well.
Cystic acne stays for a long time, so relief often involves having to remove the pimples by pricking them with a sterilized needle and extracting the fluid. Only a professional should do this, because cystic acne scars easily.
Holistic Solutions for Vata, Pitta, and Kapha Acne
The process of overcoming acne should not be like fighting a war, but most people view the condition as an enemy. When they see a pimple on their face, they want to eliminate it, extract it, and dry it out. If it feels like you against your acne, you’re going on the belief that acne is a topical and external problem rather than the expression of an internal imbalance.
After years of thinking and behaving like some sort of pimple warrior in a losing battle, I realized that I needed to be kinder to my skin. When I began to look at my acne as my body making a cry for help, I started making it healthier as opposed to damaging and depleting it. Only then was my skin able to heal itself and my complexion improved. Stopping my use of harsh peels and detergents was only the first step. Using my breakouts—their size, qualities, placement, and timing—to diagnose which of my doshas were out of balance was what truly cleared up my acne. This newfound attitude toward my skin and body made my overall health much better, and not only was my complexion pimple-free, but it took on a radiance I had not seen in years.
VATA ACNE
As explained previously, vata acne consists of noninflammatory blackheads and whiteheads. These blemishes result from vata depletion, dryness, and dehydration, and they often cluster in areas with thinner skin (the forehead and temples). They multiply and worsen when you attempt to clear them up with conventional astringent acne products, creating more whiteheads and dried out, clogged pores. While these blemishes can be bearable, with their small deposits of sebum and dirt, they lead to larger, more inflamed pimples if the imbalance is not treated.
Topically, the first thing to do with vata blemishes is to lubricate the skin. Start with a face oil or rich cream. A neutral oil like jojoba is good because of its medium weight and similarity to the skin’s own sebum. I have never had a client break out from or react to pure jojoba, making it a safe option even if you are wary of introducing oil into your regimen. This usually yields significant results in a matter of weeks. Underneath, use a natural serum whose high water content will increase hydration, quenching thirsty skin and allowing it to heal and regenerate.
Besides reducing vata through moisture, you need to exfoliate this type of acne. If your skin type is also vata, the exfoliation must be done carefully because the skin is so thin. A gentle scrub two to three times per week helps immensely, especially when you steam the skin for five minutes beforehand. If your acne exhibits qualities of doshas besides vata and pustules are present, a peel is better so you do not break open blemishes and spread bacteria.
Sometimes topical measures alone can diminish vata acne, but more often you need to address your internal health as well. You need to nourish the skin through diet and eat hydrating, moistening foods that are heavy, sweet, warm, and wet—such as vegetable soups and moist rice dishes—to pacify vata (see the food chart). Vata blemishes may also be caused by drying toxins within the colon (a vata organ), so always consider constipation. Water-rich, warm foods help soften stools and allow for better elimination. Being liberal with oils, essential fatty acids, and water intake is also important, as is the incorporation of heating spices like ginger and cumin. They help stimulate the digestive system, which is excellent if you have excess vata and are prone to poor, irregular digestion and bowel evacuation.
If you do not find relief in dietary changes alone and feel you need professional assistance with dry, constipated bowels, seek the expertise of an ayurvedic physician or practitioner. One therapy they may employ, which is excellent for reducing vata energy as well as lubricating and cleansing the colon, is an oil enema (basti). Oil, whether applied to your face, ingested through your diet, or inserted into your intestines, is incredible for vata pacification.
Finally, you must address vata acne by managing vata emotions. Anxiety, worry, and stress all tax the kidneys, dehydrate the body, and create tension in the digestive tract. Lack of or interrupted sleep also increases vata and puts you in a state of mind that contributes to nervous feelings. Refer back to the “Calm Down” section in chapter 5 for tips on how to manage both stress and insomnia.
PITTA ACNE
Pitta embodies inflammation, and the blemishes it produces are red, angry, and inflamed. They can occur all over the face or primarily in the cheek area. Some pitta pimples contain pus, while others (papules) simply look like red bumps.
Pitta acne demands some antibacterial measures, but addressing inflammation (both inside and out) is more important to eliminating these breakouts. Skin with pitta acne must be soothed, and all cleansers, toners, and moisturizers must be free of drying, astringent ingredients such as alcohol. Ingredients like coconut oil, chamomile, witch hazel, and melissa (lemon balm) are excellent, because they are naturally antiseptic and calming.
Pitta acne also needs hydration, and the use of serum and oil assists in healing as well as skin purification. Serums containing aloe vera are especially fitting because of this plant’s water content and cooling action. Coconut oil is best for pitta skin types and pitta acne, and its light texture does not aggravate heat like other, more fatty oils do.
Pustules (which have both pitta and kapha properties) can be particularly unsightly, as they have a white cap of pus on top of a reddened blemish. But even though you want to clear them up, do not exfoliate them. Scrubs can make these pimples burst and spread bacteria all over the skin, infecting previously acne-free areas. Nonabrasive peels are an option, but because they can also increase inflammation, use them with caution. The more kapha (wet and full of pus) blemishes are, the more effective nonabrasive exfoliants are. These types of peels are antikapha; they are slightly drying and break up fluid accumulation in the skin. But if you have more papules than pustules, you will want to mitigate pitta and avoid too much peeling. Peels can be applied as spot treatments as necessary or all over your face when you first begin your healing regimen. Nonetheless, you should incorporate nonabrasive exfoliants into your skin care regimen only as advised by an esthetician.
Peels such as sea-salt microdermabrasion can be performed by a professional who is trained to control the depth and vigor of the exfoliation and to avoid areas that are better left untreated. The antibacterial properties of the natural salt used in this procedure help to clarify the skin underneath the surface of dry skin cells.
Extracting pustules when they are “ready” is the fastest way to heal them. But it is difficult for untrained individuals to determine when this is; people get emotional over acne and often try to perform extractions prematurely and too roughly. This can lead to scarring and the recurrence of the pustule. If you cannot see a professional, try applying a drying clay or mud as an overnight spot treatment. This helps dry and draw out the blemish so you don’t need to extract it.
Balancing pitta internally is also important. Eating cooling foods such as raw, watery vegetables and steamed bitter greens helps reduce this impaired dosha. Natural medicines such as amalaki and turmeric also help by balancing heat and can be taken in tea, capsule, or powder form or used fresh in food. Amalaki is a small fruit that is cooling and packed with antioxidants; turmeric root is an antibacterial, antiviral, and anti-inflammatory herb that is also a staple of many Asian cuisines. It is rare to find either of them fresh; they are most often available only as dry powder that can be used as tea. To make tea, add half a teaspoon of herbal powder to hot water, steep for ten minutes, then strain. Both amalaki and turmeric can be found in capsule form from a number of ayurvedic supplement companies (see “Ayurvedic Herbs and Supplements” in the resources section of this book).
Water consumption is also essential to this type of acne, because proper hydration reduces internal heat. Adding various supplements to your drinking water can help with its absorption. I put a few tablespoons of liquid chlorophyll, aloe vera, or kelp extract in my one-liter reusable water bottle to help me fight dehydration and excess fire dosha throughout the day. Liquid chlorophyll is an extract of the green pigment from plants. It is incredibly alkalizing, making it excellent for reducing inflammation and pacifying pitta. If you prefer to use aloe vera, the juice makes the best additive. Some formulas are made from the whole leaf, while others are made from the inner fillet. The latter is preferable because it is more of an anti-inflammatory than the former. Kelp extract is a liquid concentrate. Kelp not only contains a number of nourishing minerals, but it also helps you retain water and hydration, so it’s an ideal additive to your daily water supply. All three of these ingredients are common staples found in health food stores.
Water additives and a cooling diet also help restore a weak liver, which according to ayurveda, stores heat and causes acne by preventing toxins from being filtered out of the body. As mentioned earlier, pitta governs the liver, and when this organ is not working properly, it can lead to hormonal imbalance—and hormonal acne. In this situation, people with pitta constitutions must do a monthly liver cleanse. There are many different types of liver cleanses, but a simple and traditional ayurvedic cleanse consists of taking one to two tablespoons of castor oil once a month. This expels dry stool from the bowels, gets rid of the heat that has built up in the small intestine, and cleans the liver. An ayurvedic physician can determine if this is the best treatment for each individual.
Finally, ridding yourself of this acne type involves keeping pitta emotions in check. Anger, irritability, and self-pressure all cause imbalance and are common emotions experienced by teenagers and menopausal women, along with pitta acne. Breathing exercises can be particularly helpful, and yoga practice offers healing exercises called pranayama (controlled breath). In the next chapter, we will discuss step-by-step breath work that helps control aggravated pitta and therefore is effective for diminishing stress-related blemishes. By alleviating your internal fire, you can stop your skin from being the avenue of heat dispersion and get rid of pitta acne.
KAPHA ACNE
Like the kapha dosha, kapha acne is all about accumulation, heaviness, storage, and dampness. Blemishes triggered by kapha imbalance are large, deep, full of fluid, and clear up very slowly. Classic kapha acne is cystic and hard to treat topically, because it does not occur in the superficial epidermis layer of the skin. These cysts are usually found on the chin or along the jawline, and according to ayurveda, they are most often related to yeast in the body or an imbalance in the reproductive organs.
As noted earlier, acne is a known symptom of polycystic ovary syndrome. The formation of cysts on the ovaries often contributes to cystic blemishes, and one of my clients discovered she had PCOS thanks to her pursuit of clearer skin. From an ayurvedic perspective, PCOS is commonly an expression of too much kapha, though this is not always the cause. It is a complex health disorder, so consulting a natural health practitioner who has a good understanding of the endocrine system is important.
One topical treatment for cystic acne is arnica lotion or tincture. Arnica is readily available in natural health food stores. It helps drain the fluid from a cyst by promoting circulation and breaking up the stagnation of the kapha dosha. If you have this type of acne, you must try to stay hydrated, because dry skin can accumulate dead skin cells and lead to ingrown hairs on the face and body. These can easily become infected, causing boil-like cystic breakouts. Apply both a serum and a lotion morning and night. Products that include algae (usually listed as “algae” or “algae extract”) as one of their ingredients are an excellent choice, because they subtly promote circulation and help the skin hold water.
For kapha acne, you need to eat a kapha-reducing diet, which means avoiding oily foods, dairy, sugar, shellfish, bananas, and heavy starches. Purifying foods such as kale, fennel, burdock root, and mustard greens are excellent for balancing excess kapha. Apples are especially good for this dosha, as they are vata in quality and help dry up kapha wetness. This also helps reduce pustules, which are blemishes that have both pitta and kapha influences.
The herb neem is fantastic for clearing up cystic acne. Neem reduces kapha and pitta, and it has both calming and purifying properties. I have prescribed it to many clients in capsule form, with two capsules taken with lunch and dinner, but neem can also be taken as a powder or tea. Many of my clients saw their cysts disappear completely after they started taking this herb, while others found that it simply helped heal their cysts more quickly. You can apply neem oil topically, and it is good for many skin rashes and even topical parasites. Neem powder can be mixed with water to make a paste, which you can use as a mask treatment for both cystic acne and pitta acne. For a list of retailers that sell neem, refer to the resources section of this book.
Stimulation and lymphatic movement are imperative for balancing kapha excess. Exercise and vigorous massage both help move kapha accumulation and purge mucus. Both are good for preventing the formation of cystic acne, as well as cysts in other areas of the body.
Kapha skin tends toward kapha acne and clogged pores (which are due to dryness and excess vata). This is because oily skin types are so often advised to use skin care products that dry out the skin and remove oil from its surface. If you have this type of skin, you need to use a deep peel (only kapha skin can stand up to this treatment); follow exfoliation with a rich moisturizer or oil. This is the same treatment as for vata acne, only with the addition of the deep peel.
This chapter has given some examples of how acne can become worse when you treat it with methods that actually work against your natural constitution. When you do not embrace the beauty of your doshas, you end up creating problems and actually aggravating your imbalances. Because the skin is a reflection of overall health, working toward groundedness and internal nourishment leads to a smooth, clear, and healthy complexion.