Ask the Esthetician: Clearing Acne


When it comes to blemish-free skin, our philosophy is to go deep and address the root of the issue. Which is why we asked revered esthetician and acne expert, Cali Strauhs, to share her inside-out and outside-in approach to clear and healthy skin. Cali's own journey with acne led to years of research and study in order to heal her condition and in the process she created a thriving practice that focuses on clearing acne, through the use of topicals, ingestibles and education. The acne expert is in.



What are the general root causes of acne?

Root causes for acne vary from person to person, but imbalanced insulin and blood sugar levels, gut dysbiosis and poor digestion tend to exacerbate symptoms. More often than not, multiple imbalances are actually going on simultaneously, further complicating the problem. Also inefficient liver detoxification and disregulated hormones, especially estrogen and progesterone imbalances and high levels of androgens, contribute to acne. And don't forget stress is a major culprit!


How does one deal with hormonal acne?

Firstly, I would take a look at the birth control you are taking (if any). Birth control pills, IUDs, implants and shots are widely used today and prescribed as a means to control acne. Most forms of birth control can have the potential to cause acne and weight gain in those susceptible. Typically birth control is divided up as estrogen or progestin dominant and results in varying degrees of androgenic (testosterone like) effects.

As a general rule of thumb, people prone to acne should avoid anything that might cause higher levels of androgens because they promote breakouts. As an acne sufferer, it is important to speak with your doctor about selecting a form of birth control that is higher in estrogen and lower in androgen potency. 


What supplements are good for hormonal acne?

I love DIM to support hormonal acne and metabolize excess estrogen in the body. But please speak with your doctor prior to starting any new supplements as DIM should not be combined with birth control. The typical dosage of DIM is 200mg per day with food and the brands I recommend are: Indole-3-Carbinol by Thorne (I3C converts to DIM), Skin Accumax, and DIM + CDG by Jarrow Formulas.


How do I choose a good fish oil for skin / acne?

Fish oil is a great anti-inflammatory and helps to alter sebum production BUT only if it is molecularly distilled or pharmaceutical grade. Unfortunately, many fish oil supplements are oxidized which actually creates inflammation. So, only take it if you are sure about your source. 

The vital ingredients in fish oil supplements are Omega-3 fatty acids, or EPA and DHA. These two fatty acids are the only ones that matter in reducing inflammation and chronic breakouts. The amount of each should be shown separately and should total between 100-1700 mg per serving. There should be a higher ratio of EPA to DHA, 2:1 or thereabouts. Many labels only mention the total count of Omega-3 fatty acids, but it's important to know the ratios. In choosing a supplement be sure you will be able to take all of the capsules necessary to get your daily dosage of 1000-1700 mg.

Ideally, look for molecularly distilled or pharmaceutical grade fish oil. This is the highest grade fish oil because it avoids any oxidation and is also the only process that successfully removes impurities and contaminants (mercury, dioxins, pcbs, etc). And it produces a more concentrated form of fish oil with higher potencies of EPA and DHA, so less capsules to swallow! I recommend 1000-1700 mg of purified omega-3 oils daily.


Can probiotics help with acne?

Yes! We know probiotics help colonize good bacteria both in the digestive tract and on the skin. They especially help people who've been on long-term antibiotics (both oral and topical) to recolonize good bacteria and outcompete pathogenic bacteria, reducing the occurrences of future breakouts.


What can help with cystic acne?

Zinc picolinate, the most bioavailable form of zinc, acts directly as an anti-inflammatory. We see that many people with acne have low levels of zinc in their body and supplementing with zinc has been shown to reduce the severity of cysts and inflamed lesions. Zinc has also been proven beneficial for many of the dermatological symptoms associated with PCOS (Polycystic-Ovary Syndrome).


How do you know if your acne is digestive or gut related?

Acne that is gut related tends to show up on the forehead, temples and eyebrows — basically the top half of the face. Sluggish bowel movements, how well our elimination organs get rid of waste, and gut dysbiosis (gut infections and an absence of proper beneficial gut bacterial) can contribute to acne.

Digestive issues can sometimes be remedied by adequate blood levels of vitamins A, B-complex and magnesium. A slight deficiency in these nutrients can mimic different digestive disorders. It’s not what you eat, it's what you absorb and if you have digestive issues, these nutrient deficiencies should be on your radar immediately.


What specific protocol would you recommend for hormonal acne?

First, icing your breakouts 2x daily for about 10 minutes. I like to think about a cystic breakout like a swollen ankle, we want to reduce inflammation and promote healing. Also, applying a Manuka honey mask which has powerful antibacterial, anti-inflammatory, and regenerative properties that beautify, protect and balance your skin. Manuka honey also helps mitigate acne, dryness and scarring. You can use it as a mask, spot treat and even a cleanser!


What would you recommend for inflamed sensitive skin?

I like to soak oats in purified water for 30 minutes and then use the remaining oat water to cleanse the skin or better yet turn that oat water into ice cubes for a soothing ice facial. Plain greek yogurt masks also are fantastic for calming inflammation.


What protocol would you recommend for scalp psoriasis? 

To combat itchiness, apply a solution of five parts water to one part apple cider vinegar to scalp to reduce symptoms and then rise thoroughly to prevent any irritation. You can use this treatment a few times per week and likely see results in several weeks. However, if experiencing any cracked or bleeding skin, do not use. Tea tree oil is also works great added to shampoo as an anti-bacterial booster.


What supplements can be aggravating for acne?

Fish oils 

Fish oils can aggravate acne for many people. Often acne patients need liver support because they are not efficient detoxifiers and it is more difficult for their livers to break down concentrated PUFAs (polyunsaturated fatty acids). In this case, I recommend increasing Omega 3 Fatty Acids and decreasing Omega 6 Fatty Acids through diet changes.


B Vitamins (B1, B2, B3, B5, B6, B12, Folate, Biotin)

B vitamins tend to be stimulating for the adrenal glands, which can then produce androgens called DHEAs in many acne sufferers. High levels of DHEAs can trigger acne.


Vitamin C

Like B vitamins, vitamin C can be too stimulating for the adrenal glands. Often this can produce the androgen DHEAs in acne sufferers, which can trigger acne break-outs.



Maca is a very popular adrenal supplement, and it can be too stimulating for the adrenal glands and like B vitamins and vitamin C, it can produce excess DHEAs in acne sufferers.


Adrenal Adaptogens (includes ginseng, rhodiola, ashwaganda, withania, etc.)

Most adrenal adaptogens will over-stimulate the adrenal glands and may produce increased levels of the androgenic DHEAs in acne sufferers. This could lead to increased levels of acne.



Zinc can be very helpful for many skin conditions, but it also has the ability to block an enzyme called aromatase, which converts testosterone to estrogen. This is very helpful if you are trying to reduce excess estrogen levels, but it can also lead to increased testosterone levels, which can contribute to acne.



Vitex, or Chaste Tree, can only be used for acne when blood tests show that Lutenizing Hormon (LH) levels are not elevated in relation to Follicle Stimulating Hormone (FSH) levels. Vitex works by increasing LH levels, and if LH levels are already high then acne can be exacerbated. Most women with PCOS have elevated LH levels, which makes vitex the wrong herb to take for acne if you have PCOS!


Green tea

Green tea can be very stimulating for the adrenal glands, and many acne patients tend to produce an androgen called DHEAs when their adrenal glands are stimulated. However, green tea is a great topical treatment for acne.





Depending on the type of acne someone presented with, how would your product recommendations change, i.e. deep cystic hormonal acne versus overall congestion? 

Acne, or retention hyperkeratosis, is an inherited condition in which pores shed dead skin cells quicker than the body can expel them. While typical pores shed one layer of dead skin cells a day, acne-prone pores shed up to five layers a day. Acne-prone skin benefits from more frequent exfoliation with chemical exfoliants such as alpha hydroxy acids, and should be iced when there are inflamed lesions or cysts present to bring down the inflammation. For acne-prone clients, I always look for products that are both anti-bacterial and anti-fungal. Congested skin can really benefit from oil cleansing with non-comedogenic oil blends such as the Monastery's Rose Cleansing Oil or the Marie Veronique Cleansing Oil. Products with salicylic acid also help to decongest the pore, and Glycolic Acid can help clear little pebbly comedones (bumps beneath the skin), and tea tree for breaking up congestion.


Do you recommend exfoliation for someone with acne? Chemical or abrasive and how often? 

For active acne, stick to chemical exfoliation and avoid any physical exfoliants as it can aggravate acne. Physical exfoliants can be helpful for non-inflamed acne, which manifests as little non-inflamed bumps or comedones under the skin. Pretend your skin is like a balloon, and barely use any pressure when using a scrub. Think of it like brushing your teeth - when you use too much pressure, you can damage the gums.


Are there any masks, peels or treatments that we can do at home and how often? 

Manuka Honey 850 is one product that everyone should have in their cupboard. It's a wound healing, anti-bacterial ingredient that you can not overdue. It's even great to cleanse with if you have a compromised skin barrier. 


What ingredients should someone with acne avoid in their skincare? 

Coconut oil. It's comedogenic and has a larger molecular size, so it sits on the surface layer of the skin and can tend to clog pores to those who are prone to congestion or acne.


What specific brands or products do you love and recommend for people with acne? 

Monastery! I love how the founder Athena, is holistic yet result driven. She came from a medical esthetician background and found value in more minimal formulas with high quality ingredients. She's also amazing at extractions and can lancet milia like a pro. Overall, the quality of the Monastery products are divine. I have been acne-prone my whole life so I'm the toughest critic!


What are the most common mistakes you see people make when trying to treat acne topically at home? 

Disrupt their moisture barrier and do their own extractions. Acne can only heal in a hydrated, healthy place. It's important to understand dehydration vs dry skin, because it's very common that oilier skin types with acne are severely dehydrated and lack water. You can feel this when the skin is surface dry (and can feel a lot of texture). I love water based serums with beta-glucan that can be sandwiched underneath moisturizer. Serums are generally more concentrated and a smaller molecular size than other products, so they penetrate deeper into the skin. Beta glucan is 20% more hydrating than hyaluronic acid, it is wound healing and anti-inflammatory. For pure hydration I like the Marie Veronique Soothing B3 Serum. For cell renewal and plump, bouncy skin, I love the Monastary Rei Gentle Retinol Cream — both of these products contain beta glucan!


Are there any acne treatment myths or wives tales you'd like to bust? 

Spot treating with toothpaste — it will only cause more inflammation! Use Marie Veronique Treatment Serum or Manuka Honey 850 instead.


Let's say we wake up with an inflamed pimple, what's your protocol to speedy and scarless healing? 

ICE ICE, BABY! When we ice inflamed lesions, it's like bringing down a swollen ankle. We are accelerating the healing process. I like to ice anything cystic for 10 minutes 2x daily, and mask or spot treat with Activist Manuka Honey. The more important thing to learn about are the root causes of our break-outs, instead of obsessing over quick fixes. Working with an acne specialist can help clients understand acne triggers on a deeper level. It's important to learn about supplements that are triggering, as well as Birth Control and topical ingredients.


Can we do extractions at home or should we leave it to the professionals? 

You are most likely causing trauma to the skin when trying to extract at home. In a professional setting, we do so much prep work before the actual extraction. During a facial there are professional products such as a desincrustation solution (which helps soften tissues and open pores), and steam, to help melt the sebaceous oils to prepare for extractions. Scarring from picking and popping pimples is MUCH more difficult (and costly) to heal over the actual acne. Not picking at your acne is an act of self-love, and we can nourish our skin and understand root causes of our break outs, instead of causing damage to it. Once the skin is picked, texture can tend to look uneven and we are left with post-inflammatory hyperpigmentation (dark marks) or post-inflammatory erythma (pinker marks on more Fair skin types).



This information is NOT intended as medical advice, nor is it intended to replace the care of a qualified healthcare professional. This content is not intended to diagnose or treat any diseases. Always consult with your primary care physician or licensed healthcare provider for all diagnosis and treatment of any diseases or conditions, for medications or medical advice as well as before changing your health care regimen.

Leave a comment

Please note, comments must be approved before they are published